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11152022 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 11]. AGENDA TEMECULA CITY COUNCIL REGULAR ADJOURNED MEETING COUNCIL CHAMBERS 41000 MAIN STREET TEMECULA, CALIFORNIA NOVEMBER 15, 2022 - 6:00 PM CLOSED SESSION - 5:30 PM CONFERENCE WITH LEGAL COUNSEL — POTENTIAL LITIGATION. The City Council will meet in closed session with the City Attorney pursuant to Government Code Section 54956.9(d)(4) with respect to three matters of potential litigation. A point has been reached where, in the opinion of the City Attorney, based on existing facts and circumstances, there is a significant exposure to litigation involving the City. Based on existing facts and circumstances, the City Council will decide whether to initiate litigation. CALL TO ORDER: Mayor Matt Rahn INVOCATION: Apostle Terrence Hundley of The Place City of Miracles Cathedral FLAG SALUTE: Mayor Matt Rahn ROLL CALL: Alexander, Edwards, Rahn, Schwank, Stewart PRESENTATIONS Proclamation for Native American Heritage Month Proclamation for Pu'6ska Mountain Day BOARD / COMMISSION REPORTS Planning Commission and Public/Traffic Safety Commission PUBLIC SAFETY REPORT California Department of Forestry and Fire Protection PUBLIC COMMENTS - NON -AGENDA ITEMS A total of 30 minutes is provided for members of the public to address the City Council on matters not listed on the agenda. Each speaker is limited to 3 minutes. Public comments may be made in person at Page 1 City Council Agenda November 15, 2022 the meeting by submitting a speaker card to the City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. 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 minutes will be devoted to these reports. CONSENT CALENDAR 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. A total of 30 minutes is provided for members of the public to address the City Council on items that appear on the Consent Calendar. Each speaker is limited to 3 minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. 1. Waive Reading of Standard Ordinances and Resolutions Recommendation: That the City Council waive the reading of the text of all standard ordinances and resolutions included in the agenda except as specifically required by the Government Code. Attachments: Agenda Report 2. Approve Action Minutes of October 25, 2022 Recommendation That the City Council approve the action minutes of October 25, 2022. Attachments: Action Minutes 3. Approve List of Demands Recommendation: That the City Council adopt a resolution entitled: RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A Page 2 City Council Agenda November 15, 2022 4. 5. 6. 7. Attachments: Agenda Report Resolution List of Demands AUUrove Citv Treasurer's Report as of Julv 31. 2022 and AuLyust 31. 2022 Recommendation: That the City Council approve and file the City Treasurer's Report as of July 31, 2022 and August 31, 2022. Attachments: Agenda Report July Treasurer's Report August Treasurer's Report Adopt the 2022 Conflict of Interest Code Recommendation: That the City Council adopt a resolution entitled: RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ADOPTING THE CITY' S 2022 CONFLICT OF INTEREST CODE Attachments: Agenda Report Biennial Notice Resolution Exhibit A Notice of Intent Aaarove Amendment to the Citv of Temecula Section 125 Cafeteria Plan Recommendation: That the City Council adopt a resolution entitled: RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA AMENDING THE CITY OF TEMECULA SECTION 125 CAFETERIA PLAN Attachments: Agenda Report Resolution Cafeteria Plan Amendment Adopt Resolution Declaring City Owned Parcels Located at 28725 and 28731 Pujol Street to be Exempt from the Surplus Land Act Recommendation: That the City Council adopt a resolution entitled: Page 3 City Council Agenda November 15, 2022 8. 9. 10. RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA DECLARING A CITY -OWNED PARCEL LOCATED AT 28725 AND 28731 PUJOL STREET IN THE CITY OF TEMECULA TO BE EXEMPT SURPLUS LAND PURSUANT TO GOVERNMENT CODE SECTIONS 54221(b)(1) AND 54221(f)(1)(A), FINDING THE DECLARATION EXEMPT FROM THE CALIFORNIA ENVIRONMENTAL QUALITY ACT, AND TAKING RELATED ACTIONS Attachments: Agenda Report Resolution Exhibit A HCD Approval of Surplus Land Act Approve First Amendment to the Minor Maintenance Agreement with Craftsmen Plumbing Heating & Cooling Inc. Recommendation: That the City Council approve the first amendment to the minor maintenance agreement with Craftsmen Plumbing Heating & Cooling, Inc., to amend the scope of services to include additional general contracting services, and to amend the payment terms for a total agreement value for the term of the agreement. Attachments: Agenda Report Amendment Approve First Amendment for General Plan Update City -Wide Traffic Analysis Services Recommendation: That the City Council approve the first amendment to the agreement with Fehr and Peers for General Plan Update City -Wide Traffic Analysis Services and increase the agreement amount by $7,500, for a total contract amount of $137,500. Attachments: Agenda Report Amendment Approve Increase to Contingency Authorization for Fiber Optic Communication System Upgrade Project, PW 18-05 Recommendation That the City Council: 1. Approve an increase to the contingency for the Fiber Optic Communication System Upgrade Project, PW 18-05 by $40,000; and 2. Increase the City Manager Authority to approve change orders to the contract by $40,000. Page 4 City Council Agenda November 15, 2022 Attachments: Agenda Report CIP Budget Sheet RECESS CITY COUNCIL MEETING TO SCHEDULED MEETINGS OF THE TEMECULA COMMUNITY SERVICES DISTRICT, THE SUCCESSOR AGENCY TO THE TEMECULA REDEVELOPMENT AGENCY, THE TEMECULA HOUSING AUTHORITY, AND/OR THE TEMECULA PUBLIC FINANCING AUTHORITY Page 5 City Council Agenda November 15, 2022 TEMECULA COMMUNITY SERVICES DISTRICT MEETING CALL TO ORDER: President James Stewart ROLL CALL: Alexander, Edwards, Rahn, Schwank, Stewart CSD PUBLIC COMMENTS - NON -AGENDA ITEMS A total of 30 minutes is provided for members of the public to address the Board of Directors on matters not listed on the agenda. Each speaker is limited to 3 minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. CSD CONSENT CALENDAR 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 Community Services District request specific items be removed from the Consent Calendar for separate action. A total of 30 minutes is provided for members of the public to address the Board of Directors on items that appear on the Consent Calendar. Each speaker is limited to 3 minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. 11. Approve Action Minutes of October 25, 2022 Recommendation: That the Board of Directors approve the action minutes of October 25, 2022. Attachments: Action Minutes CSD DIRECTOR OF COMMUNITY SERVICES REPORT CSD GENERAL MANAGER REPORT CSD BOARD OF DIRECTOR REPORTS Page 6 City Council Agenda November 15, 2022 CSD ADJOURNMENT The next regular meeting of the Temecula Community Services District will be held on Tuesday, November 29, 2022, at 4:30 p.m., for a Closed Session, with regular session commencing at 6:00 p.m., at the Council Chambers located at 41000 Main Street, Temecula, California. Page 7 City Council Agenda November 15, 2022 SUCCESSOR AGENCY TO THE REDEVELOPMENT AGENCY - NO MEETING TEMECULA HOUSING AUTHORITY - NO MEETING TEMECULA PUBLIC FINANCING AUTHORITY - NO MEETING RECONVENE TEMECULA CITY COUNCIL PUBLIC HEARING Any person may submit written comments to the City Council before a public hearing or may appear and be heard in support of or in opposition to the approval of a project at the time of the hearing. If you challenge a project in court, you may be limited to raising only those issues you or someone else raised at the public hearing or in written correspondence delivered to the City Clerk at or prior to the public hearing. For public hearings each speaker is limited to 5 minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Email comments on all matters, including those not on the agenda, must be received prior to the time the item is called for public comments. At public hearings involving land use matters, the property owner and/or applicant has the burden of proof and, therefore, shall be allowed 15 minutes for an initial presentation, and an additional 10 minutes for rebuttal by its development team following other comments on the matter. An appellant, other than the property owner and/or applicant, and the spokesperson for an organized group of residents residing within the noticed area of the property, which is the subject of the public hearing, shall be allowed 15 minutes to present the appellant's position to the Council. The Mayor may allow more time if required to provide due process for the property owner, applicant or appellant. All other members of the public may speak during the public hearing for a maximum period of 5 minutes each. Deferral of one speaker's time to another is not permitted. In the event of a large number of speakers, the Mayor may reduce the maximum time limit for members of the public to speak. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. 12. Approve Community Development Block Grant (CDBG) Substantial Amendment to the 2022-23 CDBG Annual Action Plan for the Reallocation of CDBG Funds to the Mary Phillips Senior Center Recommendation That the City Council adopt the resolution entitled: RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING THE SUBSTANTIAL AMENDMENT TO THE 2022-23 COMMUNITY DEVELOPMENT BLOCK GRANT ANNUAL ACTION PLAN AND FINDING THE ACTIONS TO BE EXEMPT FROM FURTHER ENVIRONMENTAL REVIEW UNDER THE CALIFORNIA ENVIRONMENTAL QUALITY ACT (CEQA) AND NATIONAL ENVIRONMENTAL PROTECTION ACT (NEPA) Page 8 City Council Agenda November 15, 2022 Attachments: RITSINESS Agenda Report Resolution Exhibit A - Substantial Amendment Notice of Public Hearing Any member of the public may address the City Council on items that appear on the Business portion of the agenda. Each speaker is limited to 5 minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. 13. Approve Recommendation for Community Service Funding - Reinvestment in Temecula Grant Program for Fiscal Year 2022-23 (At the Request of Subcommittee Members Mayor Pro Tern Schwank and Council Member Stewart) Recommendation: Attachments: That the City Council: 1. Approve the Community Service Funding Ad Hoc Subcommittee's recommendation to allocate a total of $1,090,500 to fund grant applications received from nonprofit organizations for the Community Service Funding - Reinvestment in Temecula Grant Program Fiscal Year 2022-23; and 2. Approve a budget transfer of $1,000,000 from Fund 110 - Community Reinvestment Program Fund to Fund 001 - General Fund to program towards the Community Services Funding Program. Agenda Report Application Summary Applications 1-20 Applications 21-40 Applications 41-66 14. Receive and File the Recommended Updated Allocations from Community Reinvestment Program Funding (At the Request of Subcommittee Members Mayor Rahn and Council Member Edwards Recommendation: That the City Council receive and file the recommended updated allocations from Community Reinvestment Program (CRP) Funding and provide general direction regarding the same. Attachments: Agenda Report Summary Page 9 City Council Agenda November 15, 2022 15. Approve Quality of Life Master Plan (At the Request of Subcommittee Members Mayor Rahn and Council Member Edwards) Recommendation That the City Council approve, in substantial form, the Quality of Life Master Plan 2040. Attachments: Agenda Report Quality of Life Master Plan 2040 Citizens' 20-year Priorities Timeline Exhibit A - 07/14/2020 City Council Agenda Report Exhibit B - Commissions Meetings SummarX ITEMS FOR FUTURE CITY COUNCIL AGENDAS Any Council Member, including the Mayor, may request an item be placed on a future agenda. Any such request will be discussed under this section. In making the request, a Council Member may briefly describe the topic of the proposed agenda item and any timing associated with the placement of the item on the agenda. This description shall not exceed 3 minutes unless extended by a majority vote of the City Council. No substantive discussion on the subject of the motion may occur. General discussion amongst the City Council on items listed under this section of the agenda shall be limited to 15 minutes. Items may only be placed on the agenda by Council Members pursuant to policy or by the City Manager based on administrative or operational needs of the City. Public comments on the placement of these agenda items shall be limited to a maximum of 30 minutes. Individual comments shall not exceed 3 minutes. All public participation is governed by the Council Policy regarding Public Participation at Meetings and Agenda Placements by Council Members adopted by Resolution No. 2021-54. CITY MANAGER REPORT CITY ATTORNEY REPORT ADJOURNMENT The next regular adjourned meeting of the City Council will be held on Tuesday, November 29, 2022, at 4:30 p.m., for a Closed Session, with regular session commencing at 6:00 p.m., at the Council Chambers located at 41000 Main Street, Temecula, California. NOTICE TO THE PUBLIC The full agenda packet (including staff reports, public closed session information, and any supplemental material available after the original posting of the agenda), distributed to a majority of the City Council regarding any item on the agenda, will be available for public viewing in the main reception area of the Temecula Civic Center during normal business hours at least 72 hours prior to the meeting. The material will also be available on the City's website at TemeculaCa.gov. and available for review at the respective meeting. If you have questions regarding any item on the agenda, please contact the City Clerk's Department at (951) 694-6444. Page 10 Item No. 1 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Randi Johl, Director of Legislative Affairs/City Clerk DATE: November 15, 2022 SUBJECT: Waive Reading of Standard Ordinances and Resolutions PREPARED BY: Randi Johl, Director of Legislative Affairs/City Clerk RECOMMENDATION: That the City Council waive the reading of the text of all standard ordinances and resolutions included in the agenda except as specifically required by the Government Code. BACKGROUND: The City of Temecula is a general law city formed under the laws of the State of California. With respect to adoption of ordinances and resolutions, the City adheres to the requirements set forth in the Government Code. Unless otherwise required, the full reading of the text of standard ordinances and resolutions is waived. FISCAL IMPACT: None ATTACHMENTS: None Item No. 2 ACTION MINUTES TEMECULA CITY COUNCIL REGULAR MEETING COUNCIL CHAMBERS 41000 MAIN STREET TEMECULA, CALIFORNIA OCTOBER 25, 2022 - 6:00 PM CLOSED SESSION - 5:00 PM CONFERENCE WITH LEGAL COUNSEL — POTENTIAL LITIGATION. The City Council convened in closed session with the City Attorney pursuant to Government Code Section 54956.9(d)(4) with respect to three matters of potential litigation. A point has been reached where, in the opinion of the City Attorney, based on existing facts and circumstances, there is a significant exposure to litigation involving the City. Based on existing facts and circumstances, the City Council will decide whether to initiate litigation. CONFERENCE WITH LEGAL COUNSEL — POTENTIAL LITIGATION. The City Council convened in closed session with the City Attorney pursuant to Government Code Section 54956.9(d)(2) with respect to one matter of potential litigation. A point has been reached where, in the opinion of the City Attorney, based on existing facts and circumstances, there is a significant exposure to litigation involving the City from MCM Construction, Inc., with respect to bids for the project known as I-15/French Valley Parkway Improvements —Phase II (Project No. PW16-01). The October 14, 2022 letter from Attorney D. Michael Schoenfeld of Murphy Austin on behalf of MCM Construction, Inc., objecting to the bid process and threatening litigation is on file in the office of the City Clerk and is attached to the agenda packet with Item #9 on the Consent Calendar. CALL TO ORDER: Mayor Matt Rahn INVOCATION: Dr. Brenda Harper of AACTS International Ministries FLAG SALUTE: Council Member Maryann Edwards ROLL CALL: Alexander, Edwards, Rahn, Schwank, Stewart (Left Meeting at 7:40 PM) PRESENTATIONS Proclamation for Domestic Violence Awareness Month Presentation Regarding Girl Scout Recognition for Scout's Closet Presentation by National Association of Hispanic Real Estate Professionals for Dia De Los Muertos BOARD / COMMISSION REPORTS Planning Commission and Race, Equity, Diversity and Inclusion Commission PUBLIC SAFETY REPORT Riverside County Sheriffs Department PUBLIC COMMENTS - NON -AGENDA ITEMS The following individual(s) addressed the City Council: • Bob Kowell • Pam Barrett • Carol Brown • Dan Brown • Mick Sobczak • Greg Langworthy PUBLIC COMMENTS - AGENDA ITEMS • Simon Cooper • Payam Daneshvar • James & Janice Richardson • Steven G. Sidlovsky • Bernard Budney • Bryant Rumbaugh The following individual(s) addressed the City Council: • Michael Roe (Item #9) • Sean Ashburn (Item #9) • Tyler Cesar (Item #9) • Bob Kowell (Item #14) • Mario Martinez (Item #9) PUBLIC COMMENTS — FUTURE AGENDA ITEMS The following individual(s) addressed the City Council: • Porsche Pold • Amber Doesburg • Theresa Brennan • Laurel Lamont • Gabriel Renfro Christine Massa • Shalini Renfro Allison Donahoe -Beggs • Allison Aranda Jennifer Krumm • Jennifer Reeves PUBLIC COMMENTS — RECEIVED ELECTRONICALLY Electronically submitted comments have been made part of the record. CITY COUNCIL REPORTS CONSENT CALENDAR Unless otherwise indicated below, the following pertains to all items on the Consent Calendar. Approved the Staff Recommendation (5-0): Motion by Edwards, Second by Schwank. The vote reflected unanimous approval. 1. Waive Reading of Standard Ordinances and Resolutions Recommendation: That the City Council waive the reading of the text of all standard ordinances and resolutions included in the agenda except as specifically required by the Government Code. 2. Approve Action Minutes of October 11, 2022 Recommendation: That the City Council approve the action minutes of October 11, 2022. 2 3. Approve List of Demands Recommendation: That the City Council adopt a resolution entitled: RESOLUTION NO. 2022-80 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A 4. Approve City Council Meeting Schedule for November and December 2022 Recommendation: That the City Council 1. Approve the cancellation of the regular meetings in November 2022; and 2. Conduct adjourned regular meetings on November 15, 2022 and November 29, 2022; and 3. Approve the cancellation of the December 27, 2022 meeting. 5. Approve Site Access for Research Agreement with Center for Natural Lands Management, Riverside Conservation Authority and Riverside County Transportation Commission on City -Owned Properties within Roripaugh Ranch Recommendation: That the City Council approve the site access for research agreement with the Center for Natural Lands Management, Riverside Conservation Authority, Riverside County Transportation Commission, Riverside County Habitat Conservation Agency and City of Temecula on city -owned properties within Roripaugh Ranch. 6. Approve License Agreement with Eastern Municipal Water District for Facilities Removal on Pujol Street Recommendation: That the City Council approve the license agreement with Eastern Municipal Water District for removal of facilities on Pujol Street. 7. Approve First Amendment to Non -Exclusive Commodity Agreement with SWARCO McCain, Inc. Recommendation: That the City Council approve the first amendment to the agreement with SWARCO McCain, Inc., in the amount of $500,000, and extend the terms of the agreement to June 30, 2025, for the purchase of traffic signal equipment maintenance supplies for operations and maintenance, and to support the City's Capital Improvement Program Project, Traffic Signal Equipment Enhancement Program -Citywide. 8. Accept Improvements and File Notice of Completion for Pedestrian Signalquipment Upgrade -Citywide, PW19-10 Recommendation: That the City Council: 1. Accept the improvements for the Pedestrian Signal Equipment Upgrade -Citywide, PW19-10, as complete; and 2. Direct the City Clerk to file and record the Notice of Completion, release the Performance Bond; and 3. Release the Labor and Materials Bond seven months after filing the Notice of Completion if no liens have been filed. 9. Reject All Construction Bids Received for the I-15 / French Valley Parkway Improvements - Phase 11, PW 16-01 and Authorize Construction Contract to be Rebid Recommendation: That the City Council: Reject all construction bids received for the I-15 / French Valley Parkway Improvements - Phase II, PW 16-01; and 2. Authorize the Department of Public Works to re -advertise construction contract for the I-15 / French Valley Parkway Improvements - Phase II, PW16-01. Approved the Staff Recommendation (4-0, Alexander abstained): Motion by Edwards, Second by Schwank. The vote reflected unanimous approval with Alexander abstaining. 10. Receive and File Temporary Street Closures for 2022 Winterfest Events Recommendation: That the City Council receive and file the temporary closure of certain streets for the following 2022 Winterfest Events: HOLIDAY DECORATION INSTALLATION PU'ESKA MOUNTAIN DAY EMERGENCY PREPAREDNESS FAIR SANTA' S ELECTRIC LIGHT PARADE TEMECULA ON ICE NEW YEAR'S EVE GRAPE DROP RECONVENE TEMECULA CITY COUNCIL PUBLIC HEARING 12. Conduct Public Hearing, Adopt Resolution Making Certain Findings, and Adopt Ordinance No. 2022-12 Adopting the 2022 California Fire Code (Second Reading) Recommendation: That the City Council conduct a public hearing and adopt a resolution and ordinance entitled: RESOLUTION NO. 2022-81 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA MAKING EXPRESS FINDINGS AND DETERMINATIONS THAT MODIFICATIONS TO THE CALIFORNIA FIRE CODE, 2022 EDITION, ARE REASONABLY NECESSARY BECAUSE OF LOCAL CLIMATIC, GEOLOGICAL AND/OR TOPOGRAPHICAL CONDITIONS ORDINANCE NO. 2022-12 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TEMECULA ADOPTING BY REFERENCE THE 2022 EDITION OF THE CALIFORNIA FIRE CODE BASED ON THE 2021 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 OCCUPANCY 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 Approved the Staff Recommendation (5-0): Motion by Edwards, Second by Schwank. The vote reflected unanimous approval. 13. Conduct Public Hearin-, Adopt Resolution Making Certain Findings, and Adopt Ordinance No. 2022-13 Adopting the 2022 California Building Codes (Second Reading] Recommendation: That the City Council conduct a public hearing and adopt a resolution and ordinance entitled: RESOLUTION NO. 2022-82 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA MAKING EXPRESS FINDINGS AND DETERMINATIONS THAT MODIFICATIONS TO THE 2022 CALIFORNIA BUILDING CODE; CALIFORNIA MECHANICAL CODE; CALIFORNIA PLUMBING CODE; CALIFORNIA ELECTRICAL CODE; AND CALIFORNIA RESIDENTIAL CODE, AS ADOPTED BY THE CITY OF TEMECULA, ARE REASONABLY NECESSARY BECAUSE OF LOCAL CLIMATIC, GEOLOGICAL AND/OR TOPOGRAPHICAL CONDITIONS 5 ORDINANCE 2022-13 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TEMECULA ADOPTING BY REFERENCE THE 2022 EDITIONS OF THE CALIFORNIA BUILDING CODE; CALIFORNIA MECHANICAL CODE; CALIFORNIA PLUMBING CODE; CALIFORNIA ELECTRICAL CODE; CALIFORNIA ADMINISTRATIVE CODE; CALIFORNIA ENERGY CODE; CALIFORNIA GREEN BUILDING STANDARDS CODE; CALIFORNIA HISTORICAL BUILDING CODE; CALIFORNIA EXISTING BUILDING CODE; CALIFORNIA RESIDENTIAL CODE; AND CALIFORNIA REFERENCED STANDARDS CODE; TOGETHER WITH CERTAIN AMENDMENTS AND DELETIONS, AND AMENDING TITLE 15 OF THE TEMECULA MUNICIPAL CODE Approved the Staff Recommendation (5-0): Motion by Edwards, Second by Schwank. The vote reflected unanimous approval. BUSINESS 14. Receive and File Update Regarding County of Riverside Winchester Community Plan and Recent Development Applications in the Interstate (I-215) Policy Area Related to the 2003 Settlement Agreement and 2005 Cooperative Agreement Between the City of Temecula and County of Riverside Recommendation: That the City Council receive and file the update on the County of Riverside's proposed Winchester Community Plan and recent development applications in the I-215 Policy Area related to an increase of residential density by 33,000 units, traffic impacts, road and freeway mitigation measures, public service infrastructure, compliance with California Environmental Quality Act, and the 2003 Settlement Agreement and the 2005 Cooperative Agreement between the City of Temecula and the County of Riverside, and provide direction to staff. Receive and file only. DEPARTMENTAL REPORTS (RECEIVE AND FILE) 15. City Council Travel/Conference Report 16. Community Development Department Monthly Report 17. Fire Department Monthly Report 18. Public Works Department Monthly Report ITEMS FOR FUTURE CITY COUNCIL AGENDAS A. Resolution Opposing Proposition 1 (At the Request of Council Member Jessica Alexander) Motion by Alexander to place on the City Council agenda, motion failed for lack of a second. CITY MANAGER REPORT CITY ATTORNEY REPORT The City Attorney stated there was no reportable actions from closed session. ADJOURNMENT At 9:01 PM, the City Council meeting was formally adjourned to Tuesday, November 15, 2022, at 4:30 PM for Closed Session, with regular session commencing at 6:00 PM, City Council Chambers, 41000 Main Street, Temecula, California. Matt Rahn, Mayor ATTEST: Randi Johl, City Clerk [SEAL] Item No. 3 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Jennifer Hennessy, Director of Finance DATE: November 15, 2022 SUBJECT: Approve List of Demands PREPARED BY: Pam Espinoza, Accounting Technician II RECOMMENDATION: That the City Council adopt a resolution entitled: RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A 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: 1. Resolution 2. List of Demands RESOLUTION NO.2022- 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 $ 21,162,986.47. 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 15th day of November, 2022. Matt Rahn, Mayor ATTEST: Randi Johl, City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Randi Johl, City Clerk of the City of Temecula, do hereby certify that the foregoing Resolution No. 2022- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 15th day of November, 2022, by the following vote: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: Randi Johl, City Clerk CITY OF TEMECULA LIST OF DEMANDS 10/11/2022 TOTAL CHECK RUN: 10/13/2022 TOTAL CHECK RUN: 10/18/2022 TOTAL CHECK RUN: 10/19/2022 TOTAL CHECK RUN: 10/20/2022 TOTAL CHECK RUN: 10/21/2022 TOTAL CHECK RUN: 10/25/2022 TOTAL CHECK RUN: 10/27/2022 TOTAL CHECK RUN: 10/27/2022 TOTAL PAYROLL RUN: 92,827.39 7,919,177.38 190,534.69 7,356.70 10,882,536.89 57,016.27 218,167.35 1,158,352.52 637,017.28 TOTAL LIST OF DEMANDS FOR 11/15/2022 COUNCIL MEETING: $ 21,162,986.47 DISBURSEMENTS BY FUND: CHECKS: 001 GENERAL FUND 14,185,169.04 110 RANCHO CALIF ROAD REIMB DIST 296.66 125 PEG PUBLIC EDUCATION & GOVERNMENT 1,356.27 140 COMMUNITY DEV BLOCK GRANT 2,385.14 165 RDA AFFORDABLE HOUSING 20% SET ASIDE 7,286.03 190 TEMECULA COMMUNITY SERVICES DISTRICT 420,758.37 192 TCSD SERVICE LEVEL B STREET LIGHTS 23,414.00 194 TCSD SERVICE LEVEL D REFUSE RECYCLING 2,986.33 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 14,300.67 197 TEMECULA LIBRARY FUND 12,026.46 210 CAPITAL IMPROVEMENT PROJECTS FUND 703,189.07 300 INSURANCE FUND 168,550.46 305 WORKER'S COMPENSATION 28,925.33 320 INFORMATION SYSTEMS 157,707.84 330 CENTRAL SERVICES 11,568.61 340 FACILITIES 29,315.75 380 SARDA DEBT SERVICE FUND 4,137,968.37 395 2011 FINANCING LEASE 2001 & 2008 COPS 400,688.65 396 2018 FINANCING LEASE MRC 138,951.55 472 CFD 01-2 HARVESTON A&B DEBT SERVICE 2,715.00 473 CFD 03-1 CROWNE HILL DEBT SERVICE FUND 3,830.00 475 CFD 03-3 WOLF CREEK DEBT SERVICE FUND 3,500.68 477 CFD 03-02 RORIPAUGH DEBT SERVICE FUND 2,585.00 478 CFD 16-01 RORIPAUGH PHASE II 2,980.50 501 SERVICE LEVEL"C"ZONE 1 SADDLEWOOD 1,378.95 502 SERVICE LEVEL"C"ZONE 2 WINCHESTER CREEK 750.58 503 SERVICE LEVEL"C"ZONE 3 RANCHO HIGHLANDS 1,046.32 504 SERVICE LEVEL"C"ZONE 4 THE VINEYARDS 215.31 505 SERVICE LEVEL"C"ZONE 5 SIGNET SERIES 1,400.03 506 SERVICE LEVEL"C"ZONE 6 WOODCREST COUNTRY 754.34 507 SERVICE LEVEL"C"ZONE 7 RIDGEVIEW 486.78 508 SERVICE LEVEL"C"ZONE 8 VILLAGE GROVE 5,391.20 509 SERVICE LEVEL"C"ZONE 9 RANCHO SOLANA 121.81 510 SERVICE LEVEL"C"ZONE 10 MARTINIQUE 275.49 511 SERVICE LEVEL"C"ZONE 11 MEADOWVIEW 121.95 512 SERVICE LEVEL"C"ZONE 12 VINTAGE HILLS 2,121.03 513 SERVICE LEVEL"C"ZONE 13 PRESLEY DEVELOP 1,082.02 514 SERVICE LEVEL"C"ZONE 14 MORRISON HOMES 671.72 515 SERVICE LEVEL"C"ZONE 15 BARCLAY ESTATE 18.54 516 SERVICE LEVEL"C"ZONE 16 TRADEWINDS 325.30 517 SERVICE LEVEL"C"ZONE 17 MONTE VISTA 69.35 518 SERVICE LEVEL"C"ZONE 18 TEMEKU HILLS 1,171.53 519 SERVICE LEVEL"C"ZONE 19 CHANTEMAR 1,153.01 520 SERVICE LEVEL"C"ZONE 20 CROWNE HILL 6,402.37 521 SERVICE LEVEL"C"ZONE 21 VAIL RANCH 4,426.03 522 SERVICE LEVEL"C"ZONE 22 SUTTON PLACE 242.95 523 SERVICE LEVEL"C"ZONE 23 PHEASENT RUN 145.65 524 SERVICE LEVEL"C"ZONE 24 HARVESTON 13,870.14 525 SERVICE LEVEL"C"ZONE 25 SERENA HILLS 844.24 526 SERVICE LEVEL"C"ZONE 26 GALLERYTRADITION 84.09 527 SERVICE LEVEL"C"ZONE 27 AVONDALE 649.48 528 SERVICE LEVEL"C"ZONE 28 WOLF CREEK 5,840.08 529 SERVICE LEVEL"C"ZONE 29 GALLERY PORTRAIT 86.12 700 CERBT CALIFORNIA EE RETIREE-GASB45 12,367.00 $ 20,525,969.19 001 GENERAL FUND 110 RANCHO CALIF ROAD REIMB DIST 140 COMMUNITY DEV BLOCK GRANT 165 AFFORDABLE HOUSING 190 TEMECULA COMMUNITY SERVICES DISTRICT 194 TCSD SERVICE LEVEL D REFUSE RECYCLING 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 197 TEMECULA LIBRARY FUND 300 INSURANCE FUND 305 WORKERS' COMPENSATION 320 INFORMATION TECHNOLOGY 330 SUPPORT SERVICES 340 FACILITIES TOTAL BY FUND: 368,318.02 642.67 643.24 4,162.76 191,837.02 1,505.09 201.93 4,441.32 3,100.10 3,100.12 45,328.24 4,536.02 9,200.75 $ 637,017.28 21,162,986.47 apChkLst Final Check List Page: 1 10/11/2022 12:31:33PM CITY OF TEMECULA Bank: eunion EFT UNION BANK Check # Date Vendor Description 503247 10/13/2022 009374 ALLEGRO MUSICAL VENTURES PIANO TUNING/MAINT. THEATER DBA, ALLEGRO PIANO SERVICE 503248 10/13/2022 000936 AMERICAN RED CROSS, STAFF/LIFEGUARDS CERTS: HEALTH AND SAFETY SVCS AQUATICS 503249 10/13/2022 022651 BRAND ASSASSINS QRTRLY STORAGE/CLEANING/INVENTORY FEES 503250 10/13/2022 021588 BRAUN PETER, DBA OCT PLANTSCAPE SVC: CIVIC CTR TEMECULA PLANTSCAPE OCT PLANTSCAPE SVC: LIBRARY 503251 10/13/2022 022670 BROWN, JAMAL DEON, DBA TCSD INSTRUCTOR EARNINGS JDB TRAINING 503252 10/13/2022 021502 BUCHER, BRET PHILLIP TCSD INSTRUCTOR EARNINGS 503253 10/13/2022 022790 CLEARSTAR INC PRE -EMPLOYMENT SCREENINGS: HR PRE -EMPLOYMENT SCREENINGS: HR 503254 10/13/2022 020648 DG INVESTMENT HOLDINGS 2 CITYWIDE SURVEILLANCE: INFO TECH INC, CONVERGINT TECHNOLOGIES CITYWIDE SURVEILLANCE: INFO TECH MAINT & REPAIR OF SECURITY SYSTEM 503255 10/13/2022 003945 DIAMOND ENVIRONMENTAL PORTABLE RESTROOM SVCS: TEM SRVCS SHERIFF 503256 10/13/2022 004192 DOWNS ENERGY FUEL FUEL FOR CITY VEHICLES: PARKS: PW FUEL FOR CITY VEHICLES: STREET MAI FUEL FOR CITY VEHICLES: TRAFFIC: PVC FUEL FOR CITY VEHICLES: TCSD FUEL FOR CITY VEHICLES: CIP: PW FUEL FOR CITY VEHICLES: LAND DEV: P FUEL FOR CITY VEHICLES: POLICE FUEL FOR CITY VEHICLES: LAND DEV: P 503257 10/13/2022 018098 ELITE CLAIMS MANAGEMENT SEP'22 3RD PARTY CLAIMADMIN: WC INC 503258 10/13/2022 022726 FORENSIC NURSING OF SART EXAM: TEM SHERIFF SOCAL INC 503259 10/13/2022 014865 FREIZE UHLER KIMBERLY DBA, PROMOTIONAL ITEMS: HEALTH FAIR: CLEAR BLUE PROMOTIONS HR Amount Paid Check Total 480.00 480.00 513.00 513.00 1,909.05 1,909.05 500.00 200.00 700.00 2,541.53 2,541.53 1,050.00 1,050.00 106.69 76.69 183.38 6,680.88 838.00 550.00 8,068.88 133.21 133.21 2,509.31 1,484.02 634.62 529.84 246.69 154.45 151.29 83.24 5,793.46 1,250.00 1,250.00 1,200.00 1,200.00 751.58 751.58 Page-1 apChkLst Final Check List Page: 2 10/11/2022 12:31:33PM CITY OF TEMECULA Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description 503260 10/13/2022 021365 GEORGE HILLS COMPANY INC SEP CLAIMS ADMINISTRATION: HR ANNUAL MEDICARE/CMS REPORT FEE: 503261 10/13/2022 020628 HASA INC POOL SANITIZING CHEMICALS: VARI POOLS 503262 10/13/2022 001135 HEALTHPOINTE MEDICAL Medical Screenings GROUP INC, DBA: FIRST CARE INDUSTRIA 503263 10/13/2022 006914 INNOVATIVE DOCUMENT JUL COPIER MAINT/REPAIR/USAGE: SOLUTIONS CITYWIDE DESKTOP PRINTER:TCSD SOMMERS BE JUL COPIER MAINT/REPAIR/USAGE: LIBF 503264 10/13/2022 012285 JOHNSTONE SUPPLY MAINT SUPPLIES: MPSC 503265 10/13/2022 020907 MICHELLE MEDINA, DBA TCSD INSTRUCTOR EARNINGS MICHELLE O MEDINA 503266 10/13/2022 012264 MIRANDA, JULIO C TCSD INSTRUCTOR EARNINGS 503267 10/13/2022 004043 MISSION ELECTRIC SUPPLY ELECTRICAL SUPPLIES: STA 95 INC 503268 10/13/2022 004040 MORAMARCO ANTHONY J, TCSD INSTRUCTOR EARNINGS DBA BIGFOOT GRAPHICS 503269 10/13/2022 019019 MUSIC CONNECTION LLC SPEAKEASY @ THE MERC 10/8 503270 10/13/2022 021998 OLD TOWN TIRE AND SERVICE VEHICLE REPAIRS: FACILITIES INC 503271 10/13/2022 005075 PRUDENTIAL OVERALL FLOOR MATS/TOWEL RENTALS: CIVIC SUPPLY CTR UNIFORM SVCS: STREET MAINT: PW FLOOR MATS/TOWEL RENTALS: CRC FLOOR MATS/TOWEL RENTALS: TCC FLOOR MATS/TOWEL RENTALS: MUSEUI FLOOR MATS/TOWEL RENTALS: FOC FLOOR MATS/TOWEL RENTALS: THEATE FLOOR MATS/TOWEL RENTALS: JRC Amount Paid Check Total 3,013.40 500.00 3,513.40 263.39 263.39 190.00 190.00 4,130.38 1,160.32 520.41 5,811.11 225.59 225.59 1,925.00 1,925.00 1,915.20 1,915.20 2,650.98 2,650.98 1,688.40 1,688.40 565.60 565.60 444.73 444.73 95.70 45.51 29.51 12.96 11.37 9.70 9.10 8.28 222.13 Paget apChkLst 10/11/2022 12:31:33PM Final Check List CITY OF TEMECULA Page: 3 Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 503272 10/13/2022 022537 REFRIGERATION SUPPLIES, MISC HVAC SUPPLIES: SENIOR CTR 397.96 DISTRIBUTOR MAINT SUPPLIES: AQUATICS 376.86 MISC HVAC SUPPLIES: CIVIC CTR 374.53 MISC HVAC SUPPLIES: CRC 78.57 MISC HVAC SUPPLIES: PARKING GARAC 38.02 MISC HVAC SUPPLIES: THEATER 20.85 1,286.79 503273 10/13/2022 004274 SAFE AND SECURE LOCKSMITH SVCS: CIVIC CTR 451.83 LOCKSMITH SRVC LOCKSMITH SVCS: CIVIC CTR 60.60 512.43 503274 10/13/2022 009213 SHERRY BERRY MUSIC JAZZ @ THE MERC 10/06 800.00 JAZZ @ THE MERC 9/29 550.00 1,350.00 503275 10/13/2022 022051 SINGH GROUP INC HOMELESS ENCAMPMENT CLEAN-UP 7,277.00 HOMELESS ENCAMPMENT CLEAN-UP 7,227.00 HOMELESS ENCAMPMENT CLEAN-UP 7,202.00 HOMELESS ENCAMPMENT CLEAN-UP 7,202.00 28,908.00 503276 10/13/2022 000645 SMARTAND FINAL INC MISC SUPPLIES: SPECIAL EVENTS: 214.13 TCSD MISC SUPPLIES: WORKFORCE PRGM: T 21.08 235.21 503277 10/13/2022 014783 SOFTRESOURCES, LLC CONSULTING: FINANCIAL SYS 462.48 462.48 UPGRADE MUNIS 503278 10/13/2022 009452 EMPLOYEE #00427 REIMB: SUPPLIES FOR COMMUNITY 228.36 228.36 THEATER 503279 10/13/2022 016311 TIERCE, NICHOLAS GRAPHIC DESIGN SVCS: THEATER 2,640.00 2,640.00 503280 10/13/2022 000668 TIMMY D PRODUCTIONS INC DJ SVCS: ART OF THE WALLS: TCSD 800.00 800.00 503281 10/13/2022 021580 TOWNSEND PUBLIC AFFAIRS OCT CONSULTING SVCS: CITY CLERK 6,000.00 6,000.00 INC 503282 10/13/2022 009101 VISION ONE INC, DBA SEP SHOWARE TICKETING SVCS: 2,914.50 2,914.50 ACCESSO THEATER 503283 10/13/2022 021442 WHOOSTER INC Cell phone web data access: Tern Sheriff 3,500.00 3,500.00 Grand total for EFT UNION BANK: 92,827.39 Page:3 apChkLst Final Check List Page: 4 10/11/2022 12:31:33PM CITY OF TEMECULA 37 checks in this report. Grand Total All Checks: 92,827.39 Page:4 apChkLst Final Check List Page: 1 10/13/2022 4:38:18PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor Description 14244 9/19/2022 000537 SO CALIF EDISON AUGUST 600001004059 41320 BUTTERFIELD 14250 9/21/2022 000537 SO CALIF EDISON AUGUST 700030933344 26706 YNEZ RD 14251 9/21/2022 000537 SO CALIF EDISON AUGUST 700145715868 30499 RANCHO 14252 9/21/2022 000537 SO CALIF EDISON AUGUST 700246548782 26953 YNEZ RD 14253 9/21/2022 000537 SO CALIF EDISON AUGUST 700246573943 26953 YNEZ RD 14254 9/21/2022 000537 SO CALIF EDISON AUGUST 700475634086 26036 YNEZ 14255 9/21/2022 000537 SO CALIF EDISON AUGUST 70003696937040820 WINCHESTER RD 14256 9/21/2022 000537 SO CALIF EDISON AUGUST 700408183926 40233 VILLAGE RD 14257 9/30/2022 000262 RANCHO CALIF WATER VAR AUG WATER 3031158 NACKE DR DISTRICT 14261 9/21/2022 018098 ELITE CLAIMS MANAGEMENT FUNDS FOR WORKERS COMP CLAIMS INC 14272 9/23/2022 001212 SO CALIF GAS COMPANY AUG 091-085-1632-0: 41951 MORAGA RD 14273 9/23/2022 010276 TIME WARNER CABLE SEPTEMBER INTERNET SVCS: 30600 PAUBA RD 14274 9/26/2022 002390 EASTERN MUNICIPAL WATER AUGUST WATER SVCS MURRIETA HOT DIST SPRINGS 14275 9/26/2022 002390 EASTERN MUNICIPAL WATER AUGUST WATER SVCS MURRIETA HOT DIST SPRINGS 14276 9/26/2022 002390 EASTERN MUNICIPAL WATER AUGUST WATER SVCS 39569 DIST SERAPHINA RD 14277 9/26/2022 000537 SO CALIF EDISON SEPTEMBER 700252118808 29721 RYECREST Amount Paid Check Total 5,997.40 5,997.40 80.46 80.46 98.59 98.59 109.76 109.76 173.11 173.11 397.23 397.23 1,425.83 1,425.83 4,635.14 4,635.14 33,829.97 33,829.97 20,000.00 20,000.00 231.84 231.84 625.16 625.16 89.57 89.57 532.16 532.16 630.72 630.72 20.32 20.32 Page:1 apChkLst Final Check List Page: 2 10/13/2022 4:38:18PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 14278 9/26/2022 010276 TIME WARNER CABLE 14279 9/26/2022 010276 TIME WARNER CABLE 14280 9/27/2022 000537 SO CALIF EDISON 14281 9/28/2022 000537 SO CALIF EDISON 14282 9/28/2022 010276 TIME WARNER CABLE 14283 9/29/2022 018858 FRONTIER CALIFORNIA INC 14284 9/29/2022 018858 FRONTIER CALIFORNIA INC 14285 9/30/2022 018858 FRONTIER CALIFORNIA INC 14286 9/30/2022 018858 FRONTIER CALIFORNIA INC 14287 9/30/2022 018858 FRONTIER CALIFORNIA INC 14288 9/30/2022 018858 FRONTIER CALIFORNIA INC 14289 9/30/2022 018858 FRONTIER CALIFORNIA INC 14290 9/30/2022 018858 FRONTIER CALIFORNIA INC 14291 9/30/2022 018858 FRONTIER CALIFORNIA INC 14293 9/1/2022 014685 COMPASS BANK 14294 9/1/2022 014685 COMPASS BANK 14295 9/26/2022 005460 U S BANK (Continued) Description Amount Paid Check Total SEPTEMBER INTERNET SVCS 32380 600.91 600.91 DEER SEPTEMBER INTERNET SVCS:42569 857.09 857.09 MARGARITA AUGUST 700606072010 46679 672.51 672.51 PRIMROSE AVE SEPTEMBER 700066386743 32805 99.38 99.38 PAUBA RD SEPTEMBER INTERNET SVCS 28922 600.91 600.91 PUJOL ST SEPT INTERNET SVCS: SKATE PARK & 191.01 191.01 SR SEPT INTERNET SVCS: CITY HALL 295.98 295.98 SEPT INTERNET SVCS: CITY HALL 82.29 82.29 SEPT INTERNET SVCS: CITY HALL 86.26 86.26 SEPT INTERNET SVCS: COMMUNITY 130.99 130.99 CENTER SEPT INTERNET SVCS: SENIOR 150.98 150.98 CENTER SEPT INTERNET SVCS: CITY HALL 1,955.20 1,955.20 OCT INTERNET SVCS: CITY HALL 5,066.49 5,066.49 SEPT INTERNET SVCS: CITY HALL 280.21 280.21 2018 MRC DEBT SVC 138,951.55 138,951.55 '11 REFUNDING 01/08 CERT PART 400,688.65 400,688.65 DEBT SVC 17 TAX ALLOCATION BONDS DEBT 4,137,968.37 4,137,968.37 SRVC Paget apChkLst 10/13/2022 4:38:18PM Final Check List CITY OF TEMECULA Page: 3 Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 14296 9/22/2022 013286 INTRADO LIFE & SAFETY INC JULY ENTERPRISES 911 SVC: IT 300.00 300.00 14297 8/8/2022 010276 TIME WARNER CABLE AUGUST INTERNET SVCS 32211 WOLF 194.54 194.54 VALLEY 210315 10/7/2022 000161 TYLER TECHNOLOGIES, INC MUNIS MIGRATION SVCS: FINANCE 14,817.95 14,817.95 210316 10/13/2022 004594 2 HOT UNIFORMS INC UNIFORMS: TCC: FIRE DEPT 312.58 UNIFORMS: TCC: FIRE DEPT 312.58 UNIFORMS: TCC: FIRE DEPT 312.58 UNIFORMS: TCC: FIRE DEPT 329.98 UNIFORMS: TCC: FIRE DEPT 312.58 1,580.30 210317 10/13/2022 001517 AETNA BEHAVIORAL HEALTH OCT EMPLOYEE ASSISTANCE PRGM: 1,289.20 1,289.20 LLC, DBAAETNA RESOURCES HR 210318 10/13/2022 003552 AFLAC PREMIUM HOLDING, AFLAC ACCIDENT INDEMNITY 3,153.28 3,153.28 C/O BNB BANK LOCKBOX PAYMENT 210319 10/13/2022 007282 AMAZON CAPITAL SERVICES REC SUPPLIES: HUMAN SVCS: TCSD 208.24 INC MISC OFC SUPPLIES: EOC 84.60 REC SUPPLIES: CRC 136.74 MISC SUPPLIES: FIRE STA 12 17.10 MISC OFC SUPPLIES: EOC 21.72 REC SUPPLIES: HUMAN SVCS: TCSD 337.43 MISC BOOKS: RHRTPL: TCSD 31.80 SUPPLIES: RECREATION: CRC 122.82 SUPPLIES: SKATE PARK PRGM: TCSD 308.79 MISC SUPPLIES: HUMAN SVCS: TCSD 93.40 MISC BOOKS: RHRTPL: TCSD 549.18 MISC SUPPLIES: TVM: TCSD 18.87 MISC SUPPLIES: FIRE STA 12 71.03 MISC SUPPLIES: SPECIAL EVENTS: TCS 223.63 MISC OFC SUPPLIES: CMO 89.94 MISC SUPPLIES: 2ND SAT: TVM: TCSD 284.61 MISC SUPPLIES: AQUATICS: TCSD 168.90 MISC SUPPLIES: TVM: TCSD 44.53 MISC SUPPLIES: SPECIAL EVENTS: TCS 39.30 MISC BOOKS: RHRTPL: TCSD 115.73 2,968.36 210320 10/13/2022 020691 ANN M HOWELL, DBAANN MILITARY BANNER PROGRAM: TCSD 637.50 637.50 HOWELL DESIGN 210321 10/13/2022 022025 ARTHUR J GALLAGHER, RISK BROKERAGE FEE: RISK MGMT 15,425.00 15,425.00 MANAGMENT SRVCS INC Page:3 apChkLst Final Check List Page: 4 10/13/2022 4:38:18PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 210322 10/13/2022 017149 B G P RECREATION INC 210323 10/13/2022 013105 BACKHAUSDANCE 210324 10/13/2022 013105 BACKHAUSDANCE 210325 10/13/2022 006254 BALLET FOLKLORICO, AKA LORENA HANCOCK (Continued) Description TCSD INSTRUCTOR EARNINGS ADV PMT PERFORMANCE: 11/19/22 THEATER PERF: DANCE SCHOLAR TCSD INSTRUCTOR EARNINGS 210326 10/13/2022 015592 BAMM PROMOTIONAL STAFF UNIFORMS: STREET MAINT: PW PRODUCTS INC STAFF UNIFORMS: SPECIAL EVENTS: TC INSPECTOR UNIFORMS: B&S 210327 10/13/2022 023049 BETTS, KENNETH TCSD INSTRUCTOR EARNINGS 210328 10/13/2022 023035 BIKE TEMECULA VALLEY CORP CC DISCRETIONARY FUNDS: JS 210329 10/13/2022 022568 BIO CLEAN ENVIRONMENTAL, INLET FILTER & INSTALLATION: SERVICES INC NPDES: PW 210330 10/13/2022 001323 BLUETRITON BRANDS INC, 8/23-9/22 WTR DLVRY SVCS: DBA READYREFRESH HARVESTON PK 210331 10/13/2022 022948 BRYANT, ROBERT TCSD INSTRUCTOR EARNINGS 210332 10/13/2022 013098 CADENCE ARTS NETWORK INC THEATER PERFORMANCE: 11/19/2022 210333 10/13/2022 021054 CANTRELL, TINA J TCSD INSTRUCTOR EARNINGS 210334 10/13/2022 005417 CINTAS PROTECTION NO2, FIRST AID KIT MAINT: RISK MGMT CINTAS FIRE 636525 FIRST AID KIT MAINT: RISK MGMT FIRST AID KIT MAINT: RISK MGMT FIRST AID KIT MAINT: RISK MGMT FIRST AID KIT MAINT: RISK MGMT FIRST AID KIT MAINT: RISK MGMT FIRST AID KIT MAINT: RISK MGMT 210335 10/13/2022 022992 CLEMENTSMITH, KATINKA UTILITY BOX ARTIST: TVM: TCSD 210336 10/13/2022 017429 COBRAADVANTAGE INC, DBA SEP COBRA ADMINISTRATION FEES: THE ADVANTAGE GROUP HR Amount Paid Check Total 4,704.00 7,500.00 1,200.00 504.00 136.11 415.01 98.96 3,662.75 1,000.00 366,439.92 34.85 315.00 7,500.00 280.00 ivz'WAi 125.56 131.78 128.26 46.60 208.89 233.70 400.00 631.70 4,704.00 7,500.00 1,200.00 504.00 650.08 3,662.75 1,000.00 366,439.92 34.85 315.00 7,500.00 280.00 999.00 400.00 631.70 Page:4 apChkLst Final Check List Page: 5 10/13/2022 4:38:18PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 210337 10/13/2022 022962 COLLIN, BARBARA 210338 10/13/2022 013379 COSSOU, CELINE 210339 10/13/2022 014521 COSTAR REALTY INFORMATION INC 210340 10/13/2022 004329 COSTCO TEMECULA 491 210341 10/13/2022 004329 COSTCO TEMECULA 491 210342 10/13/2022 022830 VOID 210343 10/13/2022 021191 DOUGLAS CO INC 210344 10/13/2022 008532 DREAM SHAPERS 210345 10/13/2022 017432 EYEMED VISION CARE 210346 10/13/2022 000165 FEDERAL EXPRESS INC 210347 10/13/2022 002982 FRANCHISE TAX BOARD 210348 10/13/2022 022024 GERARD, TAMRAA., DBA GERARD DESIGN 210349 10/13/2022 023082 GUERRERO, ROBERT 210350 10/13/2022 023090 HUBBARD, BROOKS 210351 10/13/2022 018352 JAMES ELLIOTT ENTERTAINMENT 210352 10/13/2022 021896 JP HANDMADE CORP, DBA MINUTEMAN PRESS 210353 10/13/2022 023100 LAW OFFICES OF S.SEAN BRAL, & ASSOC. (Continued) Description Amount Paid Check Total Theater Performance: JAN 14, 2023 1,750.00 1,750.00 TCSD INSTRUCTOR EARNINGS 1,808.10 1,808.10 OCT'22 WEB SUBSCRIPTION: ECO 1,296.00 1,296.00 DEV SUPPLIES: MPSC/HUMAN SVCS: TCSD 325.32 325.32 MEMBERSHIP RENEWAL: TCSD 180.00 180.00 MEMBERSHIP APPLICATION: EOC 0.00 0.00 MERCHANDISE: TVM GIFT SHOP 618.24 618.24 COMM PRGRM: ECUADORIAN DANCE: 500.00 500.00 TCSD VISION PLAN PAYMENT 1,788.99 1,788.99 EXPRESS MAIL SVCS: THEATER: TCSD 11.77 11.77 SUPPORT PAYMENT 50.00 50.00 UTILITY BOX ARTISIT: TVM: TCSD 400.00 400.00 REFUND: WEST SIDE STORY 52.00 52.00 CANCELLED CLAIMS SETTLEMENT: RISK MGMT 946.60 946.60 STTLMNT: THE LONG RUN: 09/29 5,717.12 5,717.12 BUSINESS CARDS: B&S 76.44 76.44 RELEASE CLAIMS SETTLEMENT: RISK 25,000.00 25,000.00 MGMT Page:5 apChkLst 10/13/2022 4:38:18PM Final Check List CITY OF TEMECULA Page: 6 Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 210354 10/13/2022 003782 MAIN STREET SIGNS, DBA SIGN EQUIP: PW TRAFFIC MAINT 1,184.71 1,184.71 ATHACO INC 210355 10/13/2022 017427 MATCHETT, VIVIAN TCSD INSTRUCTOR EARNINGS 291.20 291.20 210356 10/13/2022 003076 MET LIFE INSURANCE DENTAL PAYMENT 13,682.61 13,682.61 COMPANY 210357 10/13/2022 023060 MINNOY, TERRANCE AIRMAN SPEAKER ENGAGEMENT: RISK MGMT 6,000.00 6,000.00 210358 10/13/2022 018099 NATIONAL SAFETY DOT TESTING: HR 54.00 54.00 COMPLIANCE INC 210359 10/13/2022 022982 PASSINI, COLLETTE UTILITY BOX ARTISIT: TVM: TCSD 400.00 400.00 210360 10/13/2022 022981 RICH, JENNIFER ROXANNE UTILITY BOX ARTISIT: TVM: TCSD 400.00 400.00 210361 10/13/2022 017391 RISE INTERPRETING INC AUG SIGN LANGUAGE INTERPRETING: 750.00 CLASSES SEP SIGN LANGUAGE INTERPRETING: C 1,120.00 JUL SIGN LANGUAGE INTERPRETING: C 1,050.00 2,920.00 210362 10/13/2022 000406 RIVERSIDE CO SHERIFFS 07/28-08/24 LAW ENFORCEMENT 2,578,596.23 DEPT 07/01-09/30 TOWING SVCS: POLICE 3,227.45 2,581,823.68 210363 10/13/2022 023095 ROSA, ASHLEY BROOK REFUND: SMARTPAY: TPL 12.99 12.99 210364 10/13/2022 023099 EMPLOYEE #614 REIMB: SMALL/TOOLS EQUIPMENT 99.00 99.00 210365 10/13/2022 009980 SANBORN GWYNETH A, CO COUNTRY LIVE! @ THE MERC 10/01 795.00 795.00 TEMECULA MUSIC ACADEMY 210366 10/13/2022 017699 SARNOWSKI SHAWNA M PHOTOGRAPHY SVCS: SANTA 200.00 PRESTON GERTRUDIS:TCSD PHOTOGRAPHY SVCS: MERC: TCSD 225.00 PHOTOGRAPHY SVCS: HEALTH FAIR: TC 400.00 PHOTOGRAPHY SVCS: COLOR RUN: TSi 100.00 PHOTOGRAPHY SVCS: SEP THEATER: T 650.00 1,575.00 210367 10/13/2022 015457 SHAW HR CONSULTING, INC. CONSULTING SVCS: HR 1,675.00 1,675.00 210368 10/13/2022 023092 SILVA, LEAH THEATER PERF: REVERB TAP CO 7,000.00 7,000.00 01 /07/23 Page6 apChkLst Final Check List Page: 7 10/13/2022 4:38:18PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 210369 10/13/2022 000293 STADIUM PIZZA INC RFRSHMNTS: TEEN ZONE ACTIVITIES: TCSD 210370 10/13/2022 007762 STANDARD INSURANCE BASIC LIFE INSURANCE PAYMENT COMPANY 210371 10/13/2022 012723 STANDARD INSURANCE VOLUNTARY SUPP LIFE INSURANCE COMPANY PAYMENT 210372 10/13/2022 008337 STAPLES BUSINESS CREDIT MISC OFC SUPPLIES: TCSD MISC OFC SUPPLIES: MALL STOREFROP MISC SUPPLIES: RHRTPL:TCSD MISC OFC SUPPLIES: HUMAN SVCS: TC; MISC OFC SUPPLIES: MALL STOREFROf 210373 10/13/2022 009061 STURDIVANT, ANGELA P TCSD INSTRUCTOR EARNINGS 210374 10/13/2022 012937 TARGETSOLUTIONS LEARNING TARGET SOLUTIONS MEMBERSHIP LLC, DBA VECTOR SOLUTIONS FEE: HR 210375 10/13/2022 005970 TEMECULAVALLEY STTLMNT: WEST SIDE STORY PLAYHOUSE, DBATEMECULA 9/15-9/18/22 VLY PLAYERS 210376 10/13/2022 021242 TWOS COMPANY INC WHOLESALE GIFT PRODUCTS: GIFT SHOP:TVM WHOLESALE GIFT PRODUCTS: GIFT SHi 210377 10/13/2022 005460 U S BANK TRUSTEE ADMIN FEES: CFD 03-02 RORIPAUGH TRUSTEE ADMIN FEES: CFD 16-01 RORI TRUSTEE ADMIN FEES: CFD 01-2 HARVE TRUSTEE ADMIN FEES: CFD 03-1 CROW TRUSTEE ADMIN FEES: CFD 03-03 W CR 210378 10/13/2022 019793 URBANE CAFE, TGH RFRSHMNTS: ACE EVENT 10/7/22 ENTERPRISES LLC 210379 10/13/2022 002702 USPS - POC, CITYWIDE VOTING LOCATIONS: CITY ACCOUNT#8089685 CLERK 210380 10/13/2022 023097 VICKERS, DIERDRE REIMB: WOMEN LEADERS IN LAW ENF 210381 10/13/2022 007987 WALMART MISC SUPPLIES: MPSC: TCSD MISC SUPPLIES: CRC: TCSD MISC SUPPLIES: CRC: TCSD 210382 10/13/2022 023002 WELTY, EVELYN UTILITY BOXARTISIT: TVM: TCSD Amount Paid Check Total 81.57 81.57 10,649.13 10,649.13 1,215.38 1,215.38 84.72 -40.57 54.98 326.91 40.57 466.61 945.00 945.00 5,991.84 5,991.84 20,670.45 20,670.45 158.63 203.86 362.49 2,585.00 2,715.00 2,715.00 3,830.00 3,500.68 15,345.68 129.19 129.19 7,333.33 7,333.33 215.40 215.40 351.39 157.73 102.12 611.24 400.00 400.00 Page:? apChkLst Final Check List Page: 8 10/13/2022 4:38:18PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 210383 10/13/2022 021148 WEX BANK (Continued) Description Amount Paid Check Total 09/07-10/06 FUEL USAGE: POLICE 2,582.83 2,582.83 Grand total for UNION BANK: 7,919,202.38 Void Check # 210342 25.00 Revised Total 7,919,177.38 Page:8 apChkLst Final Check List Page: 9 10/13/2022 4:38:18PM CITY OF TEMECULA 104 checks in this report. Grand Total All Checks: 7,919,202.38 Page9 apChkLst Final Check List Page: 1 10/18/2022 3:22:15PM CITY OF TEMECULA Bank: eunion EFT UNION BANK Check # Date Vendor Description 503284 10/20/2022 016450 AIR EXCHANGE INC PLYMOVENT REPAIR: STA 92: FIRE 503285 10/20/2022 009374 ALLEGRO MUSICAL VENTURES PIANO TUNING/MAINT: LIBRARY: TCSD DBA, ALLEGRO PIANO SERVICE 503286 10/20/2022 021843 ALLISON CONTRERAS, FLEET TRUCK REPAIRS: STREET MAINT: PW TRUCK & AUTO SHOP 503287 10/20/2022 004240 AMERICAN FORENSIC NURSES DRUG/ALCOHOL ANALYSIS: TEM AFN SHERIFF DRUG/ALCOHOL ANALYSIS: TEM SHERIF DRUG/ALCOHOL ANALYSIS: TEM SHERIF DRUG/ALCOHOL ANALYSIS: TEM SHERIF 503288 10/20/2022 012951 APPLIED DEVELOPMENT QUALITY OF LIFE MASTER PLAN: ECONOMICS PLANNING 503289 10/20/2022 013950 AQUA CHILL OF SAN DIEGO OCT DRINKING WTR SYS MAINT: STOREFRONT OCT DRINKING WTR SYS MAINT: FOC OCT DRINKING WTR SYS MAINT: MPSC OCT DRINKING WTR SYS MAINT: LIBRAF OCT DRINKING WTR SYS MAINT: PW OCT DRINKING WTR SYS MAINT: TCC OCT DRINKING WTR SYST MAINT: THEA OCT DRINKING WTR SYS MAINT: STORE 503290 10/20/2022 021400 AYERS ELECTRIC INC LABOR SVC: THEATER FOUNTAIN: PW 503291 10/20/2022 012859 BARRETT ENGINEERED PUMP PARTS: OLD TOWN FOUNTAIN PUMPS PUMP PARTS: OLD TOWN FOUNTAIN 503292 10/20/2022 018408 BOB CALLAHAN'S POOL OCT POOL MAINT: OLD TOWN SERVICE FOUNTAIN OCT POOL MAINT: CRC & TES 503293 10/20/2022 004248 CALIF DEPT OF AUG FINGERPRINTING SVC: JUSTICE-ACCTING CONTRACT/VOLUNTE JUL FINGERPRINTING SVC: CONTRACT/ AUG FINGERPRINTING SVC: POLICE JUL FINGERPRINTING SVC: POLICE JUL FINGERPRINTING SVC: HR AUG FINGERPRINTING SVC: HR Amount Paid Check Total 562.49 562.49 280.00 280.00 6,067.49 6,067.49 62.01 310.05 120.40 124.02 616.48 7,243.42 7,243.42 61.96 28.28 35.89 28.28 29.09 28.28 28.55 62.53 302.86 700.00 700.00 3,900.97 1,560.08 5,461.05 950.00 1,100.00 2,050.00 588.00 816.00 3,646.00 3,470.00 49.00 392.00 8,961.00 Page:1 apChkLst 10/18/2022 3:22:15PM Final Check List CITY OF TEMECULA Page: 2 Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 503294 10/20/2022 010650 CRAFTSMEN PLUMBING & PLUMBING SVCS: MPSC 285.00 HVAC INC PLUMBING SVCS: MPSC 285.00 PLUMBING SVCS: TVE2: PW 999.83 PLUMBING REPAIR: STA 92: FIRE 401.85 PLUMBING REPAIR: STA 84: FIRE 469.98 LABOR: EPDXY FLOORING: FOC 8,850.00 PLUMBING SERVICES: PARKS 1,520.00 PLUMBING REPAIR: STA 95: FIRE 285.00 PLUMBING REPAIR: STA 92: FIRE 977.13 PLUMBING SVCS: MPSC 420.17 14,493.96 503295 10/20/2022 003945 DIAMOND ENVIRONMENTAL TEMP RESTROOM SVCS: TES POOL 325.76 SRVCS RENOVATION TEMPORARY FENCING: JRC 95.00 420.76 503296 10/20/2022 019720 DIVERSIFIED WATERSCAPES AIR COMPRESSOR REPAIR: 2,700.00 2,700.00 INC HARVESTON LAKE 503297 10/20/2022 004192 DOWNS ENERGY FUEL FUEL FOR CITY VEHICLES: LAND DEV: 262.94 PW FUEL FOR CITY VEHICLES: TRAFFIC: PN 515.15 FUEL FOR CITY VEHICLES: TCSD 404.55 FUEL FOR CITY VEHICLES: EOC 135.46 FUEL FOR CITY VEHICLES: STREET MAI 1,008.69 FUEL FOR CITY VEHICLES: CIP: PW 73.71 FUEL FOR CITY VEHICLES: FIRE DEPT 196.97 FUEL FOR CITY VEHICLES: PARKS: PW 1,760.89 FUEL FOR CITY VEHICLES: POLICE 133.03 FUEL FOR CITY VEHICLES: FIRE DEPT 329.83 FUEL FOR CITY VEHICLES: BLDG INSPE 548.64 FUEL FOR CITY VEHICLES: CODE ENFOI 211.67 5,581.53 503298 10/20/2022 012217 DUDEK AUG URBAN FOREST MGMT PLAN & 1,113.07 1,113.07 INVENTORY 503299 10/20/2022 012747 EMERGENCY LIGHTING BATTERY LIGHTING SYS: THEATER 1,250.00 1,250.00 EQUIPMENT, SERVICE COMPANY INC DBA: 503300 10/20/2022 020921 EMPLOYEE #00539 REIMB: NEOGOV CONF 10/4-10/7/22 98.73 98.73 503301 10/20/2022 013211 EMPLOYEE #00307 REIMB: RFRSHMNTS: DEPT MEETING: 93.87 93.87 FINANCE 503302 10/20/2022 022526 EMPLOYEE #00594 REIMB: NEOGOV CONF 10/4-10/7/22 171.21 171.21 503303 10/20/2022 022726 FORENSIC NURSING OF SART EXAM: TEM SHERIFF 800.00 800.00 SOCAL INC Paget apChkLst Final Check List Page: 3 10/18/2022 3:22:15PM CITY OF TEMECULA Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description 503304 10/20/2022 000177 GLENNIES OFFICE PRODUCTS MISC OFC SUPPLIES: PLANNING INC MISC OFC SUPPLIES: PLANNING MISC OFC SUPPLIES: PLANNING 503305 10/20/2022 020628 HASA INC POOL SANITIZING CHEMICALS: VARI POOLS 503306 10/20/2022 012883 JACOB'S HOUSE INC EMPLOYEE CHARITY DONATIONS PAYMENT 503307 10/20/2022 011841 JOE RHODES MAINTENANCE, FUEL PUMP MAINT: STA 84 SERVICE INC 503308 10/20/2022 022716 KOEPFLI, TRISTAN H. HELMET PAINT SVCS: TEM SHERIFF 503309 10/20/2022 022664 MARIPOSATREE TREE SVCS: S-27 SERAPHINA: PARKS MANAGEMENT INC TREE SVCS: P-06 RIVERTONE: PARKS ANNUAL TREE TRIMMING: ROW: PARKS TREE SVCS: P-06 RIVERTON: PARKS TREE SVCS: S-24 HARVESTON SLOPE: F TREE SVCS: S-08 VILLAGES SLOPE: PAF TREE SVCS: SP-01 RRSP: PARKS TREE SVCS: P-29 WOLF CREEK TRAIL: F 503310 10/20/2022 004043 MISSION ELECTRIC SUPPLY ELECTRICAL SUPPLIES: PARKS INC ELECTRICAL SUPPLIES: CIVIC CTR ELECTRICAL SUPPLIES: PARKS: PW 503311 10/20/2022 004586 MOORE FENCE COMPANY INC FENCE REPAIR: VETERANS PARK 503312 10/20/2022 002925 NAPAAUTO PARTS AUTO PARTS: STREET MAINT: PW AUTO PARTS: STREET MAINT: PW 503313 10/20/2022 021998 OLD TOWN TIRE AND SERVICE VEHICLE REPAIRS: PARKS: PW INC VEHICLE REPAIRS: PARKS: PW VEHICLE MAINT: STREET MAINT: PW VEHICLE MAINT: PARKS: PW VEHICLE MAINT: BLDG & SAFETY VEHICLE REPAIRS: FACILITIES VEHICLE REPAIRS: PARKS: PW VEHICLE REPAIRS: PARKS: PW VEHICLE SERVICE: MPSC BUS: TCSD VEHICLE REPAIRS: CIP: PW VEHICLE MAINT: PARKS: PW VEHICLE MAINT: PARKS: PW Amount Paid Check Total 53.44 52.36 228.21 334.01 395.09 395.09 40.00 40.00 1,340.20 1,340.20 350.00 350.00 10,199.84 755.84 6,189.54 404.00 10,100.00 2,015.36 2,264.20 16,463.00 48,391.78 1,480.36 -512.67 39.88 1,007.57 5,581.36 5,581.36 91.45 28.95 120.40 52.46 78.54 76.99 1,866.99 261.91 248.54 214.84 65.83 178.50 182.55 1,575.68 150.43 4,953.26 Page:3 apChkLst 10/18/2022 3:22:15PM Final Check List CITY OF TEMECULA Page: 4 Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 503314 10/20/2022 020544 PARKHOUSE TIRE SERVICE TIRE SVC: STREET MAINT: PW 1,449.88 1,449.88 INC 503315 10/20/2022 012904 PRO ACTIVE FIRE DESIGN SEP PLAN REVIEW SVCS: FIRE PREV 9,407.00 9,407.00 AND, CONSULTING 503316 10/20/2022 005075 PRUDENTIAL OVERALL FLOOR MATS/TOWEL RENTALS: FOC 9.70 SUPPLY UNIFORM SVCS: STREET MAINT: PW 46.61 FLOOR MATS/TOWEL RENTALS: TVM 11.37 FLOOR MATS/TOWEL RENTALS: JRC 8.28 FLOOR MATS/TOWEL RENTALS: TCC 12.96 FLOOR MATS/TOWEL RENTALS: MPSC 23.15 FLOOR MATS/TOWEL RENTALS: THEATE 9.10 FLOOR MATS/TOWEL RENTALS: IWTCM 21.37 UNIFORM SVCS: PARKS MAINT: PW 61.38 203.92 503317 10/20/2022 022537 REFRIGERATION SUPPLIES, MISC HVAC SUPPLIES: FIRE 48.22 DISTRIBUTOR MISC HVAC SUPPLIES: CIVIC CTR 69.36 MISC HVAC SUPPLIES: STA 95 38.81 156.39 503318 10/20/2022 021981 EMPLOYEE #606 REIMB: NEOGOV CONF 10/4-10/7/22 100.24 100.24 503319 10/20/2022 004274 SAFE AND SECURE LOCKSMITH SVCS: CIVIC CTR 64.73 LOCKSMITH SRVC LOCKSMITH SVCS: CIVIC CTR 228.76 LOCKSMITH SVCS: CIVIC CTR 70.80 LOCKSMITH SVCS: PARKS: PW 409.00 773.29 503320 10/20/2022 009746 SIGNS BY TOMORROW SIGN POSTING SVCS: PA22-0996: 213.75 PLNG SIGN POSTING SVCS: PA22-0593: PLNG 213.75 SIGN POSTING SVCS: PLANNING 427.50 SIGN POSTING SVCS: PA22-0595: PLNG 213.75 SIGN POSTING SVCS: PA22-0594: PLNG 213.75 SIGN POSTING SVCS: LR21-0279: PLNG 855.00 2,137.50 503321 10/20/2022 013482 SILVERMAN ENTERPRISES 9/26-10/16 OVERNIGH SECURITY: 3,507.00 3,507.00 INC, DBA BAS SECURITY TCSD 503322 10/20/2022 022051 SINGH GROUP INC HOMELESS ENCAMPMENT CLEAN-UP 12,641.00 HOMELESS ENCAMPMENT CLEAN-UP 1,813.00 14,454.00 503323 10/20/2022 000645 SMART AND FINAL INC SUPPLIES: COLOR RUN: TCSD 565.04 RFRSHMNTS: COLOR RUN: TCSD 364.08 RFRSHMNTS: HIGH HOPES EVENT: MPS 197.07 RFRSHMNTS: VITICULTURE COOKING C 130.34 RFRSHMNTS: COLOR RUN: TCSD 143.43 1,399.96 Page:4 apChkLst Final Check List Page: 5 10/18/2022 3:22:15PM CITY OF TEMECULA Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 503324 10/20/2022 000944 SWARCO MCCAIN INC TRAFFIC CABINET REPLACEMENT: PW 20,982.33 503325 10/20/2022 003849 TERRYBERRY COMPANY EMPLOYEE SVC RECOGNITION: HR 346.10 503326 10/20/2022 021603 TITAN RENTALS GROUP INC, RENTALS: SPECIAL EVENTS: TCSD 14,066.24 TITAN TENT & EVENT RENTAL 503327 10/20/2022 021549 EMPLOYEE #00534 SUPPLIES: TEAM PACE 69.25 Grand total for EFT UNION BANK: 20,982.33 346.10 14,066.24 69.25 190,534.69 Page:5 apChkLst Final Check List Page: 6 10/18/2022 3:22:15PM CITY OF TEMECULA 44 checks in this report. Grand Total All Checks: 190,534.69 Page6 apChkLst 10/ 19/2022 11:46:35AM Final Check List CITY OF TEMECULA Bank: eunion EFT UNION BANK Check # Date Vendor Description 503328 10/20/2022 009374 ALLEGRO MUSICAL VENTURES PIANO TUNING/MAINT: THEATER DBA, ALLEGRO PIANO SERVICE 503329 10/20/2022 021502 BUCHER, BRET PHILLIP TCSD INSTRUCTOR EARNINGS 503330 10/20/2022 017542 COX, KRISTI LYN TCSD INSTRUCTOR EARNINGS 503331 10/20/2022 004192 DOWNS ENERGY FUEL FUEL FOR CITY VEHICLES: INFO TECH 503332 10/20/2022 020907 MICHELLE MEDINA, DBA TCSD INSTRUCTOR EARNINGS MICHELLE Q MEDINA 503333 10/20/2022 001868 MIYAMOTO JURKOSKY SUSAN, TCSD INSTRUCTOR EARNINGS DBA MIYAMOTO MUSIC STUDIO 503334 10/20/2022 004040 MORAMARCO ANTHONY J, TCSD INSTRUCTOR EARNINGS DBA BIGFOOT GRAPHICS Amount Paid 315.00 2,226.00 200.00 119.60 2,148.30 1.036.00 126.00 503335 10/20/2022 018147 WADDLETON, JEFFREY L. TCSD INSTRUCTOR EARNINGS 660.80 DJ/MC SOUND SVC: RRSP RIBBON CUT- 525.00 Grand total for EFT UNION BANK: Page: 1 Check Total 315.00 2,226.00 200.00 119.60 2,148.30 1,036.00 126.00 1,185.80 7.356.70 Page:1 apChkLst Final Check List Page: 2 10/19/2022 11:46:35AM CITY OF TEMECULA 6 checks in this report. Grand Total All Checks: 7,356.70 Paget apChkLst Final Check List Page: 1 10/20/2022 3:55:13PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor Description 14271 9/29/2022 000246 PERS (EMPLOYEES' PERS RETIREMENT PAYMENT RETIREMENT) 14298 10/7/2022 001212 SO CALIF GAS COMPANY SEPT 125-244-2108-3: 30600 PAUBA RD 14299 10/7/2022 001212 SO CALIF GAS COMPANY AUG 095-167-7907-2: 30650 PAUBA RD 14302 10/5/2022 018858 FRONTIER CALIFORNIA INC OCT INTERNET SVCS: STA 73 14306 10/3/2022 000537 SO CALIF EDISON SEPTEMBER 700187069897 44173 14311 10/3/2022 000537 SO CALIF EDISON SEPTEMBER 700295838526 44747 REDHAWK 14312 10/3/2022 000537 SO CALIF EDISON SEPTEMBER 700376130476 29429 TEMECULA 14314 10/3/2022 000537 SO CALIF EDISON SEPTEMBER 600000000717 31885 MONIQUE CIR 14315 10/3/2022 000537 SO CALIF EDISON SEPTEMBER 700316536912 32131 S LOOP RD 14319 9/27/2022 001212 SO CALIF GAS COMPANY AUG 055-475-6169-5: 32380 DEER HOLLOW 14320 9/27/2022 001212 SO CALIF GAS COMPANY AUG 015-575-0195-2: 32211 WOLF VALLEY RD 14323 10/13/2022 010349 CALIF DEPT OF CHILD SUPPORT PAYMENT SUPPORT 14324 10/13/2022 017429 COBRAADVANTAGE INC, DBA FSA REIMBURSEMENT PAYMENT THE ADVANTAGE GROUP 14325 10/13/2022 021301 I C M A RETIREMENT -PLAN ICMA- 401(A) RETIREMENT PLAN 106474 PAYMENT 14326 10/13/2022 000194 I C M A RETIREMENT -PLAN ICMA-RC RETIREMENT TRUST 457 303355 PAYMENT 14327 10/13/2022 000444 INSTATAX (EDD) STATE TAX PAYMENT Amount Paid Check Total 137, 854.03 137, 854.03 30.84 30.84 149.14 149.14 171.84 171.84 18.58 18.58 37.66 37.66 98.94 98.94 1,749.54 1,749.54 4,273.93 4,273.93 15.78 15.78 153.53 153.53 138.92 138.92 24,134.18 24,134.18 384.62 384.62 17,628.44 17,628.44 42,485.32 42,485.32 Page:1 apChkLst Final Check List Page: 2 10/20/2022 3:55:13PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 14328 10/13/2022 000283 INSTATAX (IRS) FEDERAL TAX PAYMENT 14332 10/13/2022 000245 PERS - HEALTH INSUR PERS HEALTH PAYMENT PREMIUM PERS HEALTH PAYMENT 14334 10/11/2022 006887 UNION BANK OF CALIFORNIA 020829 MURRIETA CHAMBER OF REGISTRATION: MURRIETA STATE OF COMMERCE THE CITY 14335 10/11/2022 006887 UNION BANK OF CALIFORNIA 020829 MURRIETA CHAMBER OF REGISTRATION: MURRIETA STATE OF COMMERCE THE CITY 015626 EVENTBRITE.COM REGIST: EVENING WITH SHERIFF BIANCO 14336 10/11/2022 006887 UNION BANK OF CALIFORNIA 020829 MURRIETA CHAMBER OF REGISTRATION: MURRIETA STATE OF COMMERCE THE CITY 004380 BOY SCOUTS OF AMERICA, REGISTRATION: CITIZEN OF THE YEAR CAL.INLAND EMPIRE COUNCIL 015626 EVENTBRITE.COM REGIST: EVENING WITH SHERIFF BIANCO 14337 10/11/2022 006887 UNION BANK OF CALIFORNIA 010514 CAMPINI'S ITALIAN DELI RFRSHMNTS: HOMELESS OUTREACH: TCSD 020489 GREYHOUND LINES HOMELESS OUTREACH: BUS PASS: TCSD 003198 HOME DEPOT MISC SUPPLIES: HELP CTR: TCSD 007987 WALMART MISC SUPPLIES: HELP CTR: TCSD 020489 GREYHOUND LINES HOMELESS OUTREACH: BUS PASS: TCSD 14338 10/11/2022 006887 UNION BANK OF CALIFORNIA 008669 VONS RFRSHMNTS: COUNCIL CANDIDATES: CLERK 005531 FRONT STREET BAR & GRILL RFRSHMNTS: CITY COUNCIL MTG DBA, BAILY WINE COUNTRY 8/23/22 CAFE 000254 PRESS ENTERPRISE ONLINE SUBSCRIPTION: CITY CLERK COMPANY INC 14339 10/11/2022 006887 UNION BANK OF CALIFORNIA 021262 CALIF POLICE CHIEFS ASSOC REGIST: WOMEN LEADERS IN LAW ENF Amount Paid Check Total 126, 030.48 126, 030.48 154,647.58 0.00 154,647.58 35.00 35.00 35.00 107.72 142.72 35.00 150.00 107.72 292.72 97.79 39.99 76.08 112.05 18.99 344.90 59.69 271.88 14.00 345.57 450.00 450.00 Paget apChkLst Final Check List Page: 3 10/20/2022 3:55:13PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 14340 10/11/2022 006887 UNION BANK OF CALIFORNIA 001264 COSTCO TEMECULA 491 SYMPATHY FLOWERS: FIRE DEPT -59.80 BOSCPROPERTIES - CREDIT RECEIVED 10.30 023088 BORN PRIMITIVE UNIFORM SAMPLES: FIRE DEPT 241.88 010046 TV CONVENTION &VISITORS REGIST: STATE OF THE DISTRICT: 100.00 BUREAU, DBA VISIT TEMECULA FIRE VALLEY 013338 APPLE STORE ADD'L PHONE STORAGE: FIRE DEPT 0.99 021342 RING.COM SUBSCRIPTION: OVERLAND TRAIL: 100.00 FIRE 001264 COSTCO TEMECULA 491 SYMPATHY FLOWERS: FIRE DEPT 59.80 453.17 14341 10/11/2022 006887 UNION BANK OF CALIFORNIA 003198 HOME DEPOT MISC SUPPLIES: FAIRVIEW FIRE 537.07 003198 HOME DEPOT MISC SUPPLIES: FAIRVIEW FIRE -525.07 001060 HYATT LODGING: LEAGUE OF CA CITIES 592.44 604.44 CONF 14343 10/11/2022 006887 UNION BANK OF CALIFORNIA 020829 MURRIETA CHAMBER OF REGISTRATION: MURRIETA STATE OF 140.00 COMMERCE THE CITY 006952 PAYPAL REGISTRATION: SPVSR WA STATE OF 500.00 DISTRICT 001264 COSTCO TEMECULA 491 RFRSHMNTS: COUNCIL MEETINGS 18.97 020074 LA COCINA BAR AND GRILL RFRSHMNTS: CITY OF MURRIETA 48.29 MEETING 001060 HYATT RFRSHMNTS: LEAGUE OF CA CITIES 20.87 CONF 001060 HYATT LODGING: LEAGUE OF CA CITIES 277.72 1,005.85 CONF Page:3 apChkLst Final Check List Page: 4 10/20/2022 3:55:13PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 14344 10/11/2022 006887 UNION BANK OF CALIFORNIA 007594 EXPEDIA.COM 007287 UNITED AIRLINES 000398 CALIF MUNI TREASURERS ASSN 000175 GOVERNMENT FINANCE OFFICERS, ASSOCIATION, GFOA 023086 BOSWELL SAFE & VAULT INC 006952 PAYPAL 000924 CALIF ASSOC PUBLIC PROCUREMENT, OFFICIALS (CAPPO) 019159 CALPERS EDUCATION FORUM 2016 007837 ALASKAAIRLINES 14345 10/11/2022 006887 UNION BANK OF CALIFORNIA 023048 TAP'S TACO CATERING INC 001060 HYATT 023071 PACIFIC CAFE 001060 HYATT 001060 HYATT 013338 APPLE STORE 013338 APPLE STORE 000515 TEMECULA VALLEY CHAMBER OF, COMMERCE 017736 FEAST CALIFORNIA CAFE LLC, DBA CORNER BAKERY CAFE (Continued) Description Amount Paid Check Total AIRFARE: CAPPO CONF: FINANCE 2.13 AIRFARE: CAPPO CONF: FINANCE 168.60 INVESTMENT POLICY APP FEE: 175.00 FINANCE ELECTRONIC GAAFR 2022 EDITION 129.00 DELIVERY OF SAFE: FINANCE 250.00 VERISIGN PAYFLOW PRO 25.00 TRANSACTION REGISTRATION: CONFERENCE: 495.00 FINANCE REGISTRATION: EDUCATION FORUM: 499.00 FINANCE AIRFARE: CAPPO CONF: FINANCE 99.00 1,842.73 RFRSHMNTS: PIO MEETING: ECON 859.12 DEV RFRSHMNTS: LEAGUE OF CA CITIES 38.62 CONF RFRSHMNTS: LEAGUE OF CA CITIES 71.53 CONF RFRSHMNTS: LEAGUE OF CA CITIES 25.91 CONF LODGING: LEAGUE OF CA CITIES 629.44 CONF ADD'L PHONE STORAGE: SOCIAL 2.99 MEDIA APP CHARGES: SOCIAL MEDIA: ECON 2.99 DEV REGISTRATION: ECO FORECAST 60.00 EVENT RFRSHMNTS: WAYFINDING WALK: 172.31 1,862.91 ECO DEV Page:4 apChkLst Final Check List Page: 5 10/20/2022 3:55:13PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 14347 10/11/2022 006887 UNION BANK OF CALIFORNIA 023075 RIVERSIDE POLICE FOUNDATION 010307 CHICK FILA INC 012550 MARRIOTT, COURTYARD BY MARRIOTT 023076 TEMECULA RECYCLING &, SURPLUS CORNER STORE 010366 SAN DIEGO COUNTY MOTOR, OFFICERS ASSOCIATION 14348 10/11/2022 006887 UNION BANK OF CALIFORNIA 019967 MISAC 023063 A2Z RECOGNITION PRODUCTS 023064 MASTERAIRSCREW 023065 TIMELAPSECAMERAS.COM 022789 SCHNEIDER ELECTRIC, IT CORPORATION (Continued) Description Amount Paid Check Total REGISTRATION: EXPLORER 800.00 COMPETITION RFRSHMNTS: VOLUNTEERS: DUI 71.32 CKPOINT LODGING: WOMEN IN LAW 657.27 ENFORCEMENT SUPPLIES: METAL SHELVING UNITS: 652.50 PD REGISTRATION: TERRY BENNETT 640.00 2,821.09 MEMORIAL AWARD APP FEE: INFO TECH 100.00 SUPPLIES: AV MOBILE CART: INFO 450.00 TECH REPLACEMENT ROTORS DRONES: 108.27 INFO TECH TIME LAPSE CAMERAS: INFO TECH 798.00 REPLACEMENT PARTS: DATA CTR: 1,460.25 2,916.52 INFO TECH Page:5 apChkLst Final Check List Page: 6 10/20/2022 3:55:13PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 14349 10/11/2022 006887 UNION BANK OF CALIFORNIA 012085 ISTOCK INT'L INC. SUBSCRIPTION: PROMO IMAGES: TCSD 020249 LAUND3R.COM LLC LAUNDRY XVCS: ACE/TVM: TCSD 020792 CANVA.COM MONTHLY SUBSCRIPTION: TCSD 001365 RIVERSIDE, COUNTY OF, HEALTH PERMIT: NAT'L ENVIRONMENTAL HEALTH PREPAREDNESS FAIR: DEPT 001365 RIVERSIDE, COUNTY OF, HEALTH PERMIT: NAT'L ENVIRONMENTAL HEALTH PREPAREDNESS FAIR: DEPT 000254 PRESS ENTERPRISE ONLINE SUBSCRIPTION: TCSD COMPANY INC 020886 NETFLIX.COM MONTHLY SVC CHARGE: TEEN ZONE: CRC 006952 PAYPAL VERISIGN PAYFLOW PRO TRANSACTION: TCSD 023072 SIGNUPGENIUS.COM SUBSCRIPTION: VOLUNTEER MGMT: TCSD 009612 BJS RESTAURANTS INC RFRSHMNTS: INSTRUCTOR TRAINING: TCSD 021095 NORA'S EMPANADA FACTORY RFRSHMNTS: 2ND SATURDAY 9/10/22: TCSD 000293 STADIUM PIZZA INC RFRSHMNTS: FIRE VICTIMS: PD PERSONNEL 020792 CANVA.COM MONTHLY SUBSCRIPTION: TCSD 017736 FEAST CALIFORNIA CAFE LLC, RFRSHMNTS: POLICE PERSONNEL: DBA CORNER BAKERY CAFE TCSD 14355 10/11/2022 001212 SO CALIF GAS COMPANY SEPT 196-025-0344-3: 42081 MAIN ST 14356 10/11/2022 001212 SO CALIF GAS COMPANY SEPT 101-525-0950-0: 28816 PUJOL ST 14357 10/11/2022 001212 SO CALIF GAS COMPANY SEPT 060-293-3315-7: 28922 PUJOL ST 14358 10/11/2022 001212 SO CALIF GAS COMPANY SEPT 026-671-2909-8: 42051 MAIN ST 14359 10/11/2022 001212 SO CALIF GAS COMPANY SEPT 181-383-8881-6: 28314 MERCEES ST 14360 10/11/2022 001212 SO CALIF GAS COMPANY SEPT 028-025-1468-3: 41375 MCCABE CT 14361 10/11/2022 001212 SO CALIF GAS COMPANY SEPT 133-040-7373-0: 43210 BUSINESS Amount Paid Check Total 120.00 260.50 12.99 207.00 4.91 18.00 9.99 361.40 97.10 200.75 150.85 838.37 12.99 2,288.37 4,583.22 2.15 2.15 15.78 15.78 15.78 15.78 17.93 17.93 22.24 22.24 24.38 24.38 24.38 24.38 Page.-6 apChkLst Final Check List Page: 7 10/20/2022 3:55:13PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 14362 10/11/2022 001212 SO CALIF GAS COMPANY 14363 10/11/2022 001212 SO CALIF GAS COMPANY 14364 10/11/2022 001212 SO CALIF GAS COMPANY 14365 10/11/2022 001212 SO CALIF GAS COMPANY 14366 10/11/2022 001212 SO CALIF GAS COMPANY 14367 10/11/2022 001212 SO CALIF GAS COMPANY 14369 10/5/2022 005460 U S BANK 210384 10/20/2022 021668 A LAU LANGUAGE LLC 210385 10/20/2022 007282 AMAZON CAPITAL SERVICES INC 210386 10/20/2022 011954 BAKER AND TAYLOR INC 210387 10/20/2022 021278 BEAR DESIGNZ 210388 10/20/2022 023094 BLAIR, CHRIS 210389 10/20/2022 023102 EMPLOYEE #00615 210390 10/20/2022 022948 BRYANT, ROBERT 210391 10/20/2022 003138 CAL MAT, DBA VULCAN MATERIALS CO 210392 10/20/2022 001054 CALIF BUILDING OFFICIALS, (CALBO) (Continued) Description SEPT 129-582-9784-3: 43230 BUSINESS SEPT 021-725-0775-4: 41845 6TH ST SEP 117-188-6393-6: 32131 S LOOP RD SEP 101-525-1560-6: 27415 ENTERPRISE SEPT 091-024-9300-5: 30875 RANCHO VISTA SEPT 129-535-4236-7: 41000 MAIN ST INVESTMENT PURCHASE: FINANCE INTERPRETING SVCS: CITY CLERK DBL CREDIT TAKEN: FIRE DEPT SPORTS EQUIPMENT: TCSD SPORTS EQUIPMENT: TCSD MISC SUPPLIES: 2ND SAT: TVM: TCSD MISC OFC SUPPLIES: STREETS: PW BOOK COLLECTIONS: RHRTPL: TCSD BOOK COLLECTIONS: RHRTPL: TCSD SPECIAL EVENT ITEMS: BATTALION 15: FIRE ENG REFUNDABLE DEP: LD20-3942 REIMB: POOL OPERATOR COURSE: PW TCSD INSTRUCTOR EARNINGS TCSD INSTRUCTOR EARNINGS ASPHALT SUPPLIES: STREET MAINT: PW ASPHALT SUPPLIES: STREET MAINT: PV1 ASPHALT SUPPLIES: STREET MAINT: PV1 ED WEEK REGISTRATION: ONTARIO: BLDG Amount Paid Check Total 45.90 97.52 118.01 143.82 981.08 1,858.28 10,000,000.00 400.00 0XI-1i 684.51 1,239.66 35.79 58.81 1,812.32 2,275.36 1,088.86 3,000.00 247.73 1,193.50 210.00 200.64 247.13 534.64 130.00 45.90 97.52 118.01 143.82 981.08 1,858.28 10,000,000.00 400.00 2,051.38 4,087.68 1,088.86 3,000.00 247.73 1,403.50 982.41 130.00 Page:? apChkLst Final Check List Page: 8 10/20/2022 3:55:13PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 210393 10/20/2022 021851 CALIF NEWSPAPERS LGL PUBS REF 9173/9896/0205/0774: PARTNERSHIP, DBA SO CALIF CLERK NEWS GROUP 210394 10/20/2022 021011 EMPLOYEE #00526 REIMB: NEOGOV CONF 10/4-10/7/22 210395 10/20/2022 017867 CAPITOL ENQUIRY 2023 POCKET DIRECTORY CA LEGISLATURE 210396 10/20/2022 018828 CASC ENGINEERING AND, NPDES COMPLIANCE SVCS: PW20-11 CONSULTING INC 210397 10/20/2022 004462 CDW LLC, DBA CDW MISC SMALL TOOLS & EQUIP: INFO GOVERNMENT LLC TECH MICROSOFT SURFACE: CODE ENFORCE MISC SMALL TOOLS & EQUIP: INFO TEC 210398 10/20/2022 010307 CHICK FILA INC RFRSHMNTS: HIGH HOPES & SKIP: TCSD 210399 10/20/2022 016446 CHRISTIAN STITCHERY INC, COLOR RUN EVENT: CRC: TCSD DBA SO CAL IMPRESSIONS 210400 10/20/2022 010792 CLARK EQUIPMENT COMPANY, BOBCAT SKID -STEER LOADER: DBA BOBCAT COMPANY STREETS: PW 210401 10/20/2022 011922 CORELOGIC INC, DBA AUG SOFTWARE SUBSCRIPTION: CORELOGIC SOLUTIONS CODE ENF SEP SOFTWARE SUBSCRIPTION: CODE 210402 10/20/2022 013379 COSSOU, CELINE TCSD INSTRUCTOR EARNINGS 210403 10/20/2022 001264 COSTCO TEMECULA 491 SUPPLIES: PREVENTION: FIRE DEPT MISC SUPPLIES: CERT: FIRE DEPT 210404 10/20/2022 004329 COSTCO TEMECULA491 MISC SUPPLIES: TVM: TCSD MISC SUPPLIES: CLASSES: TCSD 210405 10/20/2022 021077 EMPLOYEE #00542 REIMB: RFRSHMNTS: RIBBON CUTTING EVENT 210406 10/20/2022 022731 CRISP ENTERPRISES INC, DBA REPROGRAPHIC SVCS: FVP PH II: CRISP IMAGING PW16-01 210407 10/20/2022 001233 DANS FEED AND SEED INC MISC SUPPLIES: STREET MAINT: PW 210408 10/20/2022 002990 DAVID TURCH AND SEP FEDERAL LOBBYING SVCS: CITY ASSOCIATES MGR Amount Paid Check Total 1,067.97 1,067.97 253.87 253.87 24.70 24.70 1,624.25 1,624.25 81.13 2,024.23 74.21 2,179.57 1,433.32 1,433.32 3,773.57 3,773.57 67,234.32 67,234.32 383.50 279.00 662.50 218.40 218.40 555.66 793.59 1,349.25 835.97 407.50 1,243.47 163.13 163.13 280.17 280.17 33.16 33.16 5,500.00 5,500.00 Pages apChkLst Final Check List Page: 9 10/20/2022 3:55:13PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 210409 10/20/2022 023106 DONINE, MICHAEL REFUND: BALADJ FOR DISMISSAL 210410 10/20/2022 000164 ESGIL LLC JUL PLAN CK SVCS: COMDEV 210411 10/20/2022 000165 FEDERAL EXPRESS INC EXP MAIL SVCS: ECO DEV 210412 10/20/2022 013937 FIRST AMERICAN TITLE TITLE REPORTS: VINE CREEK INSURANCE PROJECT 210413 10/20/2022 022934 GILLMORE, LAUREN BROOKE TCSD INSTRUCTOR EARNINGS 210414 10/20/2022 021953 GLOBAL MUSIC RIGHTS LLC MUSIC LICENSE: TCSD 210415 10/20/2022 019901 GREAT OAK PRESS BOOKS: TVM GIFTSHOP: TCSD 210416 10/20/2022 000186 HANKS HARDWARE INC MISC MAINT SUPPLIES: STREETS: PW SMALL TOOLS AND EQUIP: TRAFFIC: PV\ 210417 10/20/2022 003198 HOME DEPOT MISC SUPPLIES: TCSD 210418 10/20/2022 014062 ID CARD GROUP PROXIMITY CARD SUPPLIES: INFO TECH 210419 10/20/2022 014435 INLAND EROSION CONTROL EROSION CONTROL SUPPLIES: SRVCS STREETS:PW 210420 10/20/2022 003296 INTL CODE COUNCIL 2022 CODE BOOKS: PREVENTION: FIRE 210421 10/20/2022 020893 JEFF KATZ ARCHITECTURAL DSGN SVCS: CRC SPLASH PADS: CORP PW21-07 210422 10/20/2022 017118 KRACH BREE B, DBA INNOVATION FAST PITCH AWARDS: TEMECULA TROPHY & DES ECON DEV RIC TAGS: STATIONS: FIRE 210423 10/20/2022 013982 M C I COMM SERVICE AUGUST 7DK90589 XXX-0346 GEN USAGE AUGUST 7DK89878 XXX-0714 GEN USAC Amount Paid Check Total 10.00 10.00 76,200.92 76,200.92 13.35 13.35 1,900.00 1,900.00 497.00 497.00 2,000.00 2,000.00 268.65 268.65 834.86 147.61 982.47 218.37 218.37 1,071.27 1,071.27 770.00 770.00 287.10 287.10 13,674.00 13,674.00 141.38 324.08 465.46 37.63 39.35 76.98 Page9 apChkLst 10/20/2022 3:55:13PM Final Check List CITY OF TEMECULA Page: 10 Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 210424 10/20/2022 003782 MAIN STREET SIGNS, DBA VARI SIGNS & SUPPLIES: STREETS: 1,635.81 ATHACO INC PW VARI SIGNS & SUPPLIES: STREETS: PW 6,216.15 VARI SIGNS & SUPPLIES: STREETS: PW 1,453.82 VARI SIGNS & SUPPLIES: STREETS: PW 1,131.38 VARI SIGNS & SUPPLIES: STREETS: PW 177.79 VARI SIGNS & SUPPLIES: STREETS: PW 2,828.44 VARI SIGNS & SUPPLIES: STREETS: PW 107.64 13,551.03 210425 10/20/2022 009812 EMPLOYEE #00425 REIMB: POOL OPERATOR COURSE: 252.42 252.42 PW 210426 10/20/2022 023107 MCCOOL, DAVID REFUND: BALADJ FOR OVERPMT 305.00 305.00 210427 10/20/2022 018925 MEMORABLE BITES LLC, DBA RFRSHMNTS: CERT CLASS TRAINING: 899.77 899.77 FIREHOUSE SUBS FIRE 210428 10/20/2022 000209 NUTRIEN AG SOLUTIONS INC EQUIPMENT REPAIR: STREET MAINT: 239.77 239.77 PW 210429 10/20/2022 016585 PACIFIC PLAY SYSTEMS INC PLAYGROUND PARTS: MIKE NAGGAR: 1,250.00 1,250.00 PARKS 210430 10/20/2022 021152 EMPLOYEE #00596 REIMB: AOAP CONFERENCE 519.00 519.00 REGISTRATION 210431 10/20/2022 021026 QUESTICA LTD QUESTICA SOFTWARE 40,070.27 40,070.27 SUBSCRIPTION: IT 210432 10/20/2022 023101 EMPLOYEE #00585 REIMB: POOL OPERATOR COURSE: 328.03 328.03 PW 210433 10/20/2022 000411 RIVERSIDE CO FLOOD ADDITIONAL DEP REQ: MURRRIETA 1,000.00 1,000.00 CONTROLAND, WATER CREEK: CIP CONSERVATION DIST 210434 10/20/2022 009980 SANBORN GWYNETH A, CO COUNTRY LIVE! @ THE MERC 10/15 877.50 877.50 TEMECULA MUSIC ACADEMY 210435 10/20/2022 017699 SARNOWSKI SHAWNA M PHOTOGRPAHY SVCS: SAFE PROJ: 300.00 300.00 PRESTON ECO DEV 210436 10/20/2022 023105 SHELDON, TRISH REFUND: BEGINNING PICKLEBALL 55.00 55.00 210437 10/20/2022 013695 SHRED -IT US JV LLC, DBA: 8/8-8/11 DOC SHRED SVCS: CITY FACS 254.00 SHRED -IT USA LLC 9/6-9/8 DOC SHRED SVCS: CITY FACS 248.96 502.96 Page:10 apChkLst 10/20/2022 3:55:13PM Final Check List CITY OF TEMECULA Page: 11 Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 210438 10/20/2022 000537 SO CALIF EDISON SEP 700116137841 VARIOUS 33,068.40 33,068.40 LOCATIONS 210439 10/20/2022 002503 SOUTH COAST AIR QUALITY, FY22/23 FLAT EMISSIONS FEE: STA 84 151.85 MANAGEMENT DISTRICT LIQUID FUEL DISPENSING SYSTEM: STA 138.56 290.41 210440 10/20/2022 007341 SOUTH COAST WINERY, INC. RFRSHMNTS: PROMOTIONAL ITEM: 2,592.00 2,592.00 ECO DEV 210441 10/20/2022 000519 SOUTH COUNTY PEST PEST CONTROL SVCS: WEST WING 40.00 CONTROL INC PEST CONTROL SVCS: TVE2 56.00 PEST CONTOL SVCS: PARKING GARAGE 90.00 PEST CONTROL SVCS: HARVESTON PK 95.00 PEST CONTROL SVCS: CIVIC CENTER 120.00 PEST CONTROL SVCS: TES 59.00 PEST CONTROL SVCS: MUSEUM 42.00 PEST CONTROL SVCS: OATC 48.00 PEST CONTROL SVCS: STA 95 80.00 PEST CONTROL SVCS: CHILDRENS MU: 36.00 PEST CONTOL SVCS: THEATER 90.00 PEST CONTROL SVCS: STA 12 74.00 PEST CONTROL SVCS: DUCK POND 49.00 PEST CONTROL SVCS: WEDDING CHAR 32.00 911.00 210442 10/20/2022 012789 STUART, JENNIFER SARAH TCSD INSTRUCTOR EARNINGS 12,480.00 12,480.00 210443 10/20/2022 023108 SUN, LIE FU REFUND: BALANCE ADJ FOR 1,000.00 1,000.00 OVERPAYMENT 210444 10/20/2022 003599 TY LIN INTERNATIONAL 8/16-9/30 CONSULT: FV PKWY/1-15: PH 11 12,779.00 12,779.00 210445 10/20/2022 020301 EMPLOYEE #00515 REIMB: POOL OPERATOR COURSE: 270.03 270.03 PW 210446 10/20/2022 001547 TEAMSTERS LOCAL 911 UNION MEMBERSHIP DUES PAYMENT 4,769.96 4,769.96 210447 10/20/2022 022895 THE STRING QUEENS LLC ADV PMT THEATER PERF: FEB 25, 5,580.00 5,580.00 2023 210448 10/20/2022 022939 TRANSPORTATION CHARTER TRANSPORTATION: SUMMER PRGM: 5,333.79 SRVS TCSD TRANSPORTATION: SUMMER PRGM: TC 4,689.36 TRANSPORTATION: SUMMER PRGM: TC 4,524.51 TRANSPORTATION: SUMMER PRGM: TC 964.08 15,511.74 Page-11 apChkLst Final Check List Page: 12 10/20/2022 3:55:13PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 210449 10/20/2022 000161 TYLER TECHNOLOGIES, INC 210450 10/20/2022 007987 WALMART 210451 10/20/2022 019773 EMPLOYEE #06719 (Continued) Description Amount Paid Check Total MUNIS MIGRATION SVCS: FINANCE 2,381.97 2,381.97 MISC SUPPLIES: MPSC: TCSD 75.81 MISC OFC SUPPLIES: CLASSES: TCSD 54.77 130.58 REIMB: APA CONFERENCE 680.83 680.83 Grand total for UNION BANK: 10,882,536.89 Page:12 apChkLst Final Check List Page: 13 10/20/2022 3:55:13PM CITY OF TEMECULA 114 checks in this report. Grand Total All Checks: 10,882,536.89 Page:13 apChkLst 10/21/2022 12:14:14PM Final Check List CITY OF TEMECULA Page: 1 Bank: union UNION BANK Check # Date Vendor Description Amount Paid Check Total 14146 9/9/2022 001212 SO CALIF GAS COMPANY AUG 026-671-2909-8: 42051 MAIN ST 16.38 16.38 14278 9/26/2022 010276 TIME WARNER CABLE SEP INTERNET SVCS: 28300 600.91 600.91 MERCEDES ST 14300 10/3/2022 010276 TIME WARNER CABLE SEPTEMBER INTERNET SVCS 29119 1,200.00 1,200.00 MARGARITA 14303 10/5/2022 018858 FRONTIER CALIFORNIA INC OCT INTERNET SVCS: LIBRARY 249.99 249.99 14304 10/4/2022 010276 TIME WARNER CABLE SEPTEMBER INTERNET SVCS 32364 119.99 119.99 OVERLAND 14305 10/4/2022 010276 TIME WARNER CABLE SEPTEMBER INTERNET SVCS 40820 600.91 600.91 WINCHESTER 14316 9/27/2022 010276 TIME WARNER CABLE SEPTEMBER INTERNET SVCS: 41000 49.93 49.93 MAIN ST 14317 9/22/2022 018858 FRONTIER CALIFORNIA INC SEPT INTERNET SVCS: DMV LINE 100.98 100.98 14318 9/22/2022 018858 FRONTIER CALIFORNIA INC SEPT INTERNET SVCS: CHILDREN'S 130.98 130.98 MUSEUM 14321 9/29/2022 010276 TIME WARNER CABLE SEPTEMBER INTERNET SVCS 41845 600.91 600.91 6TH ST 14329 10/13/2022 001065 NATIONWIDE RETIREMENT NATIONWIDE RETIREMENT PAYMENT 14,137.21 14,137.21 SOLUTION 14330 10/13/2022 019088 NATIONWIDE RETIREMENT NATIONWIDE LOAN REPAYMENT 427.79 427.79 SOLUTION PAYMENT 14331 10/13/2022 000389 NATIONWIDE RETIREMENT OBRA- PROJECT RETIREMENT 4,589.56 4,589.56 SOLUTION PAYMENT Page:1 apChkLst Final Check List Page: 2 10/21/2022 12:14:14PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 14350 10/11/2022 006887 UNION BANK OF CALIFORNIA 022853 IMOVR OFFICE EQUIPMENT: RISK 001264 COSTCO TEMECULA 491 EMPLOYEE RECOGNITION: HR 000871 HILTON LODGING: NSC CONFERENCE: RISK 009623 PUBLIC AGENCY RISK MGMT REGISTRATION: CONFERENCE: RISK ASSN, (PARMA) 009623 PUBLIC AGENCY RISK MGMT REGISTRATION: CONFERENCE: RISK ASSN, (PARMA) 005363 GRAPELINE, THE EMPLOYEE RECOGNITION: HR 001264 COSTCO TEMECULA 491 RFRSHMNTS: LHMP MTG: RISK 023089 IROBOT EMPLOYEE RECOGNITION: HR 000871 HILTON LODGING: NSC CONFERENCE: RISK 017038 CPS HR CONSULTING REGISTRATION: CYBER TRAINING: HR 000175 GOVERNMENT FINANCE RECRUITMENT ADVERTISING: FIN OFC OFFICERS, ASSOCIATION, MGR GFOA 007282 AMAZON CAPITAL SERVICES EMPLOYEE RECOGNITION: HR INC 005244 SOCIETY FOR HUMAN MEMBERSHIP RENEWAL: HR RESOURCE MGM, THE S H R M STORE 008668 WES FLOWERS SUNSHINE FUND 008668 WES FLOWERS SUNSHINE FUND 011090 TEMECULAVALLEY TRANSP: HR EVENT TRANSPORTATION, DBA STRYDER TRANSPORT. 14351 10/11/2022 010276 TIME WARNER CABLE OCT INTERNET SVCS: 32211 WOLF 14352 10/11/2022 010276 TIME WARNER CABLE 14353 10/11/2022 010276 TIME WARNER CABLE 14354 10/11/2022 010276 TIME WARNER CABLE 14368 10/7/2022 014486 VERIZON WIRELESS 14370 10/6/2022 000166 FIRST AMERICAN TITLE COMPANY VALLEY RD OCT INTERNET SVCS: 41973 6TH ST OCT INTERNET SVCS: 30755 AULD RD OCT INTERNET SVCS: 41000 MAIN ST O8/16-09/15 CELLULAR/BROADBAN D:CITYW I DE LAND ACQUISITION: 26201 YNEZ RD Amount Paid Check Total 1,957.50 455.29 363.45 350.00 320.00 273.48 242.99 217.49 181.73 150.00 150.00 100.00 100.00 91.11 91.11 -237.50 194.54 758.75 758.75 3,163.19 11,323.86 1,553.00 4,806.65 194.54 758.75 758.75 3,163.19 11,323.86 1,553.00 Paget apChkLst Final Check List 10/21/2022 12:14:14PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 14372 10/18/2022 010276 TIME WARNER CABLE 14373 10/18/2022 018858 FRONTIER CALIFORNIA INC 14374 10/17/2022 010276 TIME WARNER CABLE 14375 10/17/2022 010276 TIME WARNER CABLE 14376 10/17/2022 018858 FRONTIER CALIFORNIA INC 14378 10/19/2022 010276 TIME WARNER CABLE 210452 10/21/2022 022830 VOID 210453 10/21/2022 000186 HANKS HARDWARE INC 210454 10/21/2022 022963 EMPLOYEE #00595 Page: 3 (Continued) Description Amount Paid Check Total OCT INTERNET SVCS: 28816 PUJOL ST 600.91 OCT INTERNET SVCS: CIVIC CENTER 102.89 OCT INTERNET SVCS: 40820 5.34 WINCHESTER OCT INTERNET SVCS: 41000 MAIN ST 1,079.33 OCT INTERNET SVCS: EOC 168.16 OCT INTERNET SVCS: 32131 S LOOP 282.73 RD MEMBERSHIP APPLICATION: EOC 0.00 MISC MAINT SUPPLIES: CIVIC CTR 4,676.99 MISC MAINT SUPPLIES: PARKS: PW 2,055.06 MISC MAINT SUPPLIES: AQUATICS 1,467.39 MISC SMALL TOOLS & EQUIP: CIP: PW 253.28 MISC MAINT SUPPLIES: CRC 120.76 MISC MAINT SUPPLIES: OLD TOWN 101.47 MISC MAINT SUPPLIES: MPSC 75.97 MISC MAINT SUPPLIES: TPL 64.72 MISC MAINT SUPPLIS: MAINT FAC: PW 55.36 MISC MAINT SUPPLIES: THEATER 54.35 MISC SMALL TOOLS & EQUIP: NPDES: P' 50.00 MISC MAINT SUPPLIES: HARVESTON LA 38.01 MISC MAINT SUPPLIES: TVM 23.91 MISC MAINT SUPPLIES: IWTCM 10.53 REIMB: TEAM PACE 344.83 Grand total for UNION BANK 600.91 102.89 5.34 1,079.33 168.16 282.73 0.00 9,047.80 344.83 57,041.27 Page:3 apChkLst Final Check List Page: 4 10/21/2022 12:14:14PM CITY OF TEMECULA 29 checks in this report. Grand Total All Checks: 57,041.27 Void Ck# 210452 25.00 Revised Total: 57,016.27 Page:4 apChkLst Final Check List Page: 1 10/25/2022 2:39:17PM CITY OF TEMECULA Bank: eunion EFT UNION BANK Check # Date Vendor Description Amount Paid Check Total 503336 10/27/2022 004240 AMERICAN FORENSIC NURSES DRUG/ALCOHOL ANALYSIS: TEM 682.11 AFN SHERIFF DRUG/ALCOHOL ANALYSIS: TEM SF 62.01 744.12 503337 10/27/2022 000936 AMERICAN RED CROSS, STAFF/LIFEGUARDS CERTS: 648.35 648.35 HEALTH AND SAFETY SVCS AQUATICS 503338 10/27/2022 013950 AQUA CHILL OF SAN DIEGO OCT DRINKING WTR SYS MAINT: IT 28.28 28.28 503339 10/27/2022 014293 BIBLIOTHECA LLC ANNUAL SUPPORT/MAINT OF EQUIP: 21,348.63 21,348.63 TPL 503340 10/27/2022 004248 CALIF DEPT OF JUL FINGERPRINTING SVC: 343.00 JUSTICE-ACCTING CUSTODIAL JUN FINGERPRINTING SVC: CONTR 98.00 AUG FINGERPRINT SVC: CUSTODIA 49.00 490.00 503341 10/27/2022 000442 COMPUTER ALERT SYSTEMS JUL-SEPT ALARM SYS MONITORING: 211.42 211.42 CONVIS 503342 10/27/2022 010650 CRAFTSMEN PLUMBING & GYM WALL FLOORING: STA 92 3,300.00 3,300.00 HVAC INC 503343 10/27/2022 004192 DOWNS ENERGY FUEL FUEL FOR CITY VEHICLES: BLDG 326.61 INSPECTORS FUEL FOR CITY VEHICLES: CODE E 66.34 FUEL FOR CITY VEHICLES: CITY MC 54.11 447.06 503344 10/27/2022 012217 DUDEK CONSULTANT SVCS: PW19-16 29,818.75 29,818.75 503345 10/27/2022 022726 FORENSIC NURSING OF SART EXAMS: TEM SHERIFF 800.00 800.00 SOCAL INC 503346 10/27/2022 014865 FREIZE UHLER KIMBERLY DBA, MISC PROMOTIONAL ITEMS: TVE2 681.55 CLEAR BLUE PROMOTIONS PROMOTIONAL ITEMS: ECO DEV 663.06 1,344.61 503347 10/27/2022 021365 GEORGE HILLS COMPANY INC SUBROGATION RECOVERY FEE: RISK 6,871.63 6,871.63 MGMT 503348 10/27/2022 021308 GILLIS + PANICHAPAN ARCHITECTURAL SVCS: CRC: PW19-07 960.00 ARCHITECTS, INC ARCHITECTURAL SVCS: CRC: PW1f 150.00 1,110.00 503349 10/27/2022 000177 GLENNIES OFFICE PRODUCTS MISC OFC SUPPLIES: MEDIC: FIRE 252.60 252.60 INC 503350 10/27/2022 020628 HASA INC POOL SANITIZING CHEMICALS: VARI 458.99 458.99 POOLS Page:1 apChkLst Final Check List Page: 2 10/25/2022 2:39:17PM CITY OF TEMECULA Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 503351 10/27/2022 000520 HDL COREN AND CONE ACFR STATISCAL PACKAGE 695.00 695.00 503352 10/27/2022 003726 LIFE ASSIST INC TEACHING SUPPLIES: MEDIC: FIRE 1,177.87 MEDICAL SUPPLIES: MEDIC: FIRE 387.30 1,565.17 503353 10/27/2022 010204 M T G L INC MATERIALS TESTING: PW22-02 4,026.75 MATERIALS TESTING: PW22-02 3,690.00 7,716.75 503354 10/27/2022 004043 MISSION ELECTRIC SUPPLY ELECTRICAL SUPPLIES: MUSEUM 128.87 INC ELECTRICAL SUPPLIES: CIVIC CEN- 119.38 248.25 503355 10/27/2022 010334 EMPLOYEE #00354 REIMB: NEOGOV CONF 10/4-10/7/22 151.25 151.25 503356 10/27/2022 005075 PRUDENTIAL OVERALL FLOOR MATS/TOWEL RENTALS: JRC 8.28 8.28 SUPPLY 503357 10/27/2022 022537 REFRIGERATION SUPPLIES, MISC HVAC SUPPLIES: STA 92 321.71 DISTRIBUTOR MISC HVAC SUPPLIES: STA92 38.81 MISC HVAC SUPPLIES: STA 73 32.86 393.38 503358 10/27/2022 002412 RICHARDS WATSON AND SEP 2022 LEGAL SERVICES 53,253.21 GERSHON SEP 2022 LEGAL SERVICES 38,631.74 SEP 2022 LEGAL SERVICES 6,278.00 SEP 2022 LEGAL SERVICES 6,165.50 SEP 2022 LEGAL SERVICES 5,093.59 SEP 2022 LEGAL SERVICES 4,374.00 SEP 2022 LEGAL SERVICES 4,032.00 SEP 2022 LEGAL SERVICES 2,960.00 SEP 2022 LEGAL SERVICES 1,923.00 SEP 2022 LEGAL SERVICES 1,472.00 SEP 2022 LEGAL SERVICES 1,215.00 SEP 2022 LEGAL SERVICES 324.00 SEP 2022 LEGAL SERVICES 265.50 SEP 2022 LEGAL SERVICES 132.50 SEP 2022 LEGAL SERVICES 121.50 SEP 2022 LEGAL SERVICES 79.50 SEP 2022 LEGAL SERVICES 29.50 126,350.54 503359 10/27/2022 020922 EMPLOYEE #00529 REIMB: ROUNDTABLE MTG 10/6 93.44 93.44 503360 10/27/2022 009213 SHERRY BERRY MUSIC JAZZ @ THE MERC 10/13 525.00 525.00 503361 10/27/2022 007766 UNDERGROUND SERVICE SEP DIG SAFE BRD BILLABLE TIX: PW 262.00 ALERT, OF SOUTHERN CALIFORNIA SEP UNDERGRND UTILITY LOCATOI 70.85 332.85 Paget apChkLst Final Check List Page: 3 10/25/2022 2:39:17PM CITY OF TEMECULA Bank: eunion EFT UNION BANK Check # Date Vendor 503362 10/27/2022 020275 WALLACE & ASSOC CONSULTING LLC, ANSER ADVISORY MNGMT LLC (Continued) Description Amount Paid Check Total CONSTRUCTION INSP SVCS: PW 22-02 12,213.00 12,213.00 Grand total for EFT UNION BANK: 218,167.35 Page:3 apChkLst Final Check List Page: 4 10/25/2022 2:39:17PM CITY OF TEMECULA 27 checks in this report. Grand Total All Checks: 218,167.35 Page:4 apChkLst Final Check List Page: 1 10/27/2022 3:45:08PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor Description 14292 10/14/2022 000262 RANCHO CALIF WATER VAR SEP WATER 3015553 DEER DISTRICT HOLLOW WAY 14342 10/11/2022 006887 UNION BANK OF CALIFORNIA 023112 THE TINT SHOP INC WORK TRUCKS TINTING: EOC 022546 AIRWAVE COMMUNICATIONS, UPDATE COMMUNICATIONS VEHICLE: ENTERPRISES EOC 017118 KRACH BREE B, DBA RECOGNITION PROGRAM: TCC TEMECULA TROPHY& DES 14371 10/21/2022 000262 RANCHO CALIF WATER VAR SEP WATER 3003793 28250 YNEZ DISTRICT RD LAKE 14379 9/13/2022 001212 SO CALIF GAS COMPANY AUG 117-188-6393-6: 32131 S LOOP RD 14380 10/20/2022 010276 TIME WARNER CABLE OCT INTERNET SVCS: 41000 MAIN ST 14381 10/20/2022 018858 FRONTIER CALIFORNIA INC OCT INTERNET SVCS: LIBRARY 14382 10/20/2022 018858 FRONTIER CALIFORNIA INC OCT INTERNET SVCS: LIBRARY 14384 10/24/2022 010276 TIME WARNER CABLE OCT INTERNET SVCS: 30600 PAUBA RD 14388 10/27/2022 000444 INSTATAX (EDD) STATE TAX PAYMENT 14389 10/27/2022 000283 INSTATAX (IRS) FEDERAL TAX PAYMENT 102133 10/21/2022 023113 CHINO VALLEY ACOUSTICS REFUND: PD INCORRECT INVOICE 210455 10/27/2022 013387 ADAME LANDSCAPE INC, DBA OCT SWEEPING SVCS: PARKING SWEEPING UNLIMITED GARAGE Amount Paid Check Total 58,528.55 58,528.55 319.00 543.27 118.54 980.81 20,998.76 20,998.76 113.45 113.45 298.38 298.38 5.31 5.31 5.31 5.31 623.62 623.62 40,122.74 40,122.74 118, 613.72 118, 613.72 86.00 86.00 540.00 540.00 Page:1 apChkLst Final Check List Page: 2 10/27/2022 3:45:08PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 210456 10/27/2022 007282 AMAZON CAPITAL SERVICES INC 210457 10/27/2022 002187 ANIMAL FRIENDS OF THE VALLEYS 210458 10/27/2022 020691 ANN M HOWELL, DBAANN HOWELL DESIGN 210459 10/27/2022 000101 APPLE ONE INC (Continued) Description MISC OFC SUPPLIES: ECON DEV REC SUPPLIES: CRC: TCSD MISC OFC SUPPLIES: MALL STOREFROP MISC SMALL TOOLS/EQUIP: TEM SHERIF MISC OFC SUPPLIES: ECON DEV MISC OFC SUPPLIES: MALL STOREFROr MISC SUPPLIES: RISK MGMT MISC SMALL TOOLS & EQUIP: RISK MISC OFC SUPPLIES: RISK MISC OFC SUPPLIES: CITY CLERK MISC SUPPLIES: 2ND SAT: TVM: TCSD MISC SUPPLIES: RISK MGMT MISC SMALL TOOLS & EQUIP: TEM SHEF MISC SUPPLIES: HR AUG ANIMAL CONTROL SVCS: TEMECULA SEP ANIMAL CONTROL SVCS: TEMECUL MISC GRAPHIC DSGN SVCS: ECO DEV GRAPHIC DSGN SVCS: CITY MGR JUL TEMP HELP: PW 210460 10/27/2022 022888 ARAMARK SERVICES INC, DBA RFRSHMNT SVCS: FOC: PW ARAMARK REFRESHMENT RFRSHMNT SVCS: CITY HALL: PW RFRSHMNT SVCS: FOC: PW RFRSHMNT SVCS: CITY HALL: PW RFRSHMNT SVCS: CITY HALL: PW 210461 10/27/2022 017149 B G P RECREATION INC TCSD INSTRUCTOR EARNINGS TCSD INSTRUCTOR EARNINGS 210462 10/27/2022 001323 BLUETRITON BRANDS INC, 9/7-10/6 WTR DLVRY SVC: TVE2 DBA READYREFRESH 8/23-9/22 WTR DLVRY SVC: TES POOL 8/11-9/10 WATER DELIVERY SVCS: FOC 9/11-10/10 WATER DELIVERY SVCS: FOC 210463 10/27/2022 023115 CACATIAN, OSWALD REFUND: RESERVATION: TCC 210464 10/27/2022 021851 CALIF NEWSPAPERS BID ADVRTSMT: REF:0979: PW21-04 PARTNERSHIP, DBA SO CALIF NEWS GROUP 210465 10/27/2022 000152 CALIF PARKS AND MEMBERSHIP RENEWAL: PARKS: PW RECREATION SOC, C P R S Amount Paid Check Total 119.16 177.24 90.75 754.10 149.29 -26.96 493.33 154.60 64.15 227.32 149.79 1,337.64 813.30 -69.20 10,500.00 10,500.00 233.75 361.25 2,830.33 69.97 60.00 18.14 787.88 63.39 3,250.80 4,939.20 85.46 28.69 139.79 192.24 700.00 1,238.76 700.00 4,434.51 21,000.00 595.00 2,830.33 999.38 8,190.00 446.18 700.00 1,238.76 700.00 Paget apChkLst Final Check List Page: 3 10/27/2022 3:45:08PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 210466 10/27/2022 022930 CCS SAN DIEGO JANITORIAL NOV JANITORIAL SVCS: OTSF POLICE INC, DBA CCS FACILITY SERVICES 210467 10/27/2022 002945 CONSOLIDATED ELECTRICAL ELECTRICAL SUPPLIES: CIVIC CTR DIST 210468 10/27/2022 022830 COUNTY OF RIVERSIDE, MEMBERSHIP APPLICATION: EOC EMERGENCY SVCS DIVISION 210469 10/27/2022 022731 CRISP ENTERPRISES INC, DBA REPROGRAPHIC SVCS: MPSC: CIP CRISP IMAGING REPROGRAPHIC SVCS: FIRE STA 84: CIF 210470 10/27/2022 012600 DAVID EVANS AND ENG DSGN SVCS: HOCKEY RINK: ASSOCIATES INC RRSP SEP DSGN SVCS: DIAZ RD PROJ: PW17- 210471 10/27/2022 022798 DS SERVICES OF AMERICA WATER DELIVERY: CMO INC, SPARKLETTS 210472 10/27/2022 019681 EJK CORPORATION, DBA BEST PET WASTE BAGS FOR PARKS - PW BAG COMPANY 210473 10/27/2022 015330 FAIR HOUSING COUNCIL, OF SEP SUB -RECIPIENT: FAIR HOUSING RIVERSIDE COUNTY INC SVCS 210474 10/27/2022 019469 FALCON ENGINEERING CONSTRUCTION MGMT SVCS: SERVICES PW08-04 210475 10/27/2022 000165 FEDERAL EXPRESS INC EXPRESS MAIL SVCS: CIP EXP MAIL SVCS: CIP: PW 210476 10/27/2022 002982 FRANCHISE TAX BOARD SUPPORT PAYMENT 210477 10/27/2022 008469 EMPLOYEE #06203 REIMB: APA CONF: PLAN COMMISSION 210478 10/27/2022 003198 HOME DEPOT MISC SUPPLIES: CITY HALL MISC SUPPLIES: CIVIC CENTER MISC SUPPLIES: CIVIC CENTER HARDWARE SUPPLIES: PARKS: PW HARDWARE SUPPLIES: TCC 210479 10/27/2022 010607 INTL SOCIETY OF ISA MEMEBERSHIP RENEWAL: PARKS ARBORICULTURE 210480 10/27/2022 001091 KEYSER MARSTON ON CALL CONSULTANT SVCS: ASSOCIATES INC PLANNING Amount Paid Check Total 616.04 616.04 146.81 146.81 25.00 25.00 309.83 402.60 712.43 3,327.00 13,997.10 17,324.10 48.21 48.21 5,356.95 5,356.95 1,624.22 1,624.22 25,666.90 25,666.90 15.08 6.29 21.37 50.00 50.00 340.19 340.19 311.94 -433.91 433.91 129.41 98.93 540.28 280.00 280.00 6,118.75 6,118.75 Page:3 apChkLst 10/27/2022 3:45:08PM Final Check List CITY OF TEMECULA Page: 4 Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 210481 10/27/2022 019884 LEONIDA BUILDERS INC SANTA GERTRUDIS CRK PEDESTRIAN 492,555.94 492,555.94 EXT 210482 10/27/2022 021434 MATRIX TELECOM LLC DBA AUGUST 800 SERVICES: CIVIC 70.80 70.80 LINGO CENTER 210483 10/27/2022 020300 NCBOA, INC Adult Basketball Officiating:TCSD: 1,143.00 1,143.00 210484 10/27/2022 003964 OFFICE DEPOT BUSINESS SVS MISC OFC SUPPLIES: EOC 19.07 DIV MISC OFC SUPPLIES: EOC 105.31 MISC OFC SUPPLIES: EOC 61.95 MISC OFFICE SUPPLIES: TRAFFIC: PW 36.96 223.29 210485 10/27/2022 010338 POOL AND ELECTRICAL, POOL SUPPLIES: AQUATICS 632.71 PRODUCTS INC VARIOUS SUPPLIES: SPLASH PAD: PW 1,428.28 POOL SUPPLIES: AQUATICS 50.69 POOL SUPPLIES: AQUATICS 600.00 POOL SUPPLIES: AQUATICS -40.00 2,671.68 210486 10/27/2022 005820 PRE -PAID LEGAL SERVICES PREPAID LEGAL SERVICES PAYMENT 213.65 213.65 INC, DBA LEGALSHIELD 210487 10/27/2022 021853 PROPAC INC SHSP GRANT: AIRLIGHT ITEMS: EOC 3,738.05 3,738.05 210488 10/27/2022 014494 RAND R CONTROLS, INC HVAC PARTS: VARIOUS LOCATIONS 4,846.06 4,846.06 210489 10/27/2022 023116 RESIDENCE MUTUAL RELASE & SETTLMENT OF CLAIM: 5,000.00 5,000.00 INSURANCE CO RISK 210490 10/27/2022 004822 RIVERSIDE TRANSIT AGENCY SEP TROLLEY SVCS: CITY MGR 2,198.60 2,198.60 210491 10/27/2022 021964 RUSSELL SIGLER INC, DBA HVAC SUPPLIES: THEATER 109.03 109.03 SIGLER WHOLESALE DIST 210492 10/27/2022 017699 SARNOWSKI SHAWNA M PHOTOGRAPHY SVCS: CITY MGR 75.00 PRESTON PHOTOGRAPHY SVCS: SKIP: TCSD 200.00 PHOTOGRAPHY SVCS: TVM: TCSD 225.00 PHOTOGRAPHY SVCS: SPEC EVENTS: l 200.00 PHOTOGRAPHY SVCS: MPSC: TCSD 200.00 PHOTOGRAPHY SVCS: UTILITY BOX ARl 600.00 PHOTOGRAPHY SVCS: VITICULTURE: T( 175.00 PHOTOGRAPHY SVCS: MERC: TCSD 225.00 PHOTOGRAPHY SVCS: CITY COUNCIL 225.00 2,125.00 Page:4 apChkLst Final Check List Page: 5 10/27/2022 3:45:08PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 210493 10/27/2022 021309 SB&O INC DSGN, ENVIRO & SURVEY SVS: RRSP TRAILS 210494 10/27/2022 017113 SCHOLASTIC INC EDUCATION MISC BOOKS: RHRTPL: TCSD 210495 10/27/2022 013695 SHRED -IT US JV LLC, DBA: 9/14-9/27 DOC SHRED SVCS: POLICE SHRED -IT USA LLC 10/11-11/8 DOC SHRED SVCS: POLICE 8/15-8/29 DOC SHRED SVCS: POLICE 7/18-8/1 DOC SHRED SVCS: POLICE 6/20-7/5 DOC SHRED SVCS: POLICE 210496 10/27/2022 015235 SMOKE GUARD CALIFORNIA, SMOKE GUARD SVCS: PW INC. 210497 10/27/2022 000537 SO CALIF EDISON RELEASE & STTLMNT OF CLAIM 202204882 210498 10/27/2022 000537 SO CALIF EDISON SEP 700276704365 MAIN ST SEP 700039423268 VARI LOCATIONS 210499 10/27/2022 008337 STAPLES BUSINESS CREDIT MISC OFC SUPPLIES: THEATER: TCSD MISC OFC SUPPLIES: LAND DEV 210500 10/27/2022 017814 STC TRAFFIC INC PROF SVCS: ROUNDABOUT DSGN: PW 210501 10/27/2022 003599 T Y LIN INTERNATIONAL ENG & CONSULT SVCS: FVP PH II 210502 10/27/2022 014885 TEMECULA CATERING RFRSHMNTS: TVE2 ANNIVERSARY 210503 10/27/2022 022046 TURBOSCAPE INC LANDSCAPE MULCH: SANTA GERTRUDIS: PW 210504 10/27/2022 010046 TV CONVENTION &VISITORS AUG '22 BUS. IMPRV DISTRICT BUREAU, DBA VISIT TEMECULA ASMNTS VALLEY 210505 10/27/2022 011659 ULINE INC STORAGE SHELVING: CLASSES: TCSD 210506 10/27/2022 002110 UNITED RENTALNORTH MAINT EQUIP RENTAL: FACILITIES AMERICA INC 210507 10/27/2022 002702 USPS - POC, AUG '22 POSTAGE METER DEPOSIT ACCOUNT#8089685 Amount Paid Check Total 2,612.51 2,612.51 946.03 946.03 44.36 66.54 46.58 46.58 38.07 242.13 1,500.00 1,500.00 50,000.00 50,000.00 479.52 1,030.32 1,509.84 216.85 37.46 254.31 13,889.00 13,889.00 31,209.50 31,209.50 1,187.03 1,187.03 2,480.00 2,480.00 192, 662.57 192, 662.57 440.11 440.11 151.74 151.74 1,174.73 1,174.73 Page:5 apChkLst Final Check List Page: 6 10/27/2022 3:45:08PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 210508 10/27/2022 014850 VALLEY PRINTING SERVICES, PRINTING SVCS: CITY MGR 169.65 169.65 INC. 210509 10/27/2022 001890 VORTEX INDUSTRIES INC ROLL UP DOOR REPAIR: JRC 1,269.60 1,269.60 210510 10/27/2022 001342 WAXIE SANITARY SUPPLY INC CLEANING SUPPLIES: CIVIC CENTER 836.61 836.61 Grand total for UNION BANK: 1,158,352.52 Page6 apChkLst Final Check List Page: 7 10/27/2022 3:45:08PM CITY OF TEMECULA 87 checks in this report. Grand Total All Checks: 1,158,352.52 Page:? Item No. 4 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Jennifer Hennessy, Director of Finance DATE: November 15, 2022 SUBJECT: Approve City Treasurer's Report as of July 31, 2022 and August 31, 2022 PREPARED BY: Jordan Snider, Senior Accountant RECOMMENDATION: That the City Council approve and file the City Treasurer's Report as of July 31, 2022 and August 31, 2022. BACKGROUND: Government Code Sections 53646 and 41004 require reports to the City Council regarding the City's investment portfolio, receipts, and disbursements respectively. Adequate funds will be available to meet budgeted and actual expenditures of the City for the next six months. Current market values are derived from the Local Agency Investment Fund (LAIF) reports, Union Bank of California trust and custody statements, and from US Bank trust statements. Attached is the City Treasurer's Report that provides this information. The City's investment portfolio is in compliance with the statement of investment policy and Government Code Sections 53601 and 53635 as of as of July 31, 2022 and August 31, 2022. FISCAL IMPACT: None ATTACHMENTS: City Treasurer's Report as of July 31, 2022 and August 31, 2022 Portfolio Managment Treasury Report Portfolio Management Portfolio Summary July 31, 2022 City of Temecula 41000 Main Street Temecula, CA 92590 (951)694-6430 Par Market Book % of Days to YTM YTM Investments Value Value Value Portfolio Term Maturity 360 Equiv. 365 Equiv. Managed Pool Accounts 50,077,839.48 50,077,839.48 50,077,839.48 23.85 1 1 0.860 0.872 Retention Escrow Account 653,457.18 653,457.18 653,457.18 0.31 1 1 0.062 0.063 Letter of Credit 3.00 3.00 3.00 0.00 1 1 0.000 0.000 Trust Accounts 17,293,394.59 17,293,394.59 17,293,394.59 8.24 1 1 1.509 1.530 Local Agency Investment Funds 121,948,954.16 120,378,911.86 121,948,954.16 58.08 1 1 0.287 0.291 Federal Agency Callable Securities 17,000,000.00 15,931,380.00 16,997,500.00 8.10 1,590 1,172 0.723 0.733 Federal Agency Bullet Securities 3,000,000.00 2,906,490.00 3,000,000.00 1.43 1,278 594 0.999 1.013 209,973,648.41 207,241,476.11 209,971,148.41 100.00% 148 104 0.569 0.577 Investments Cash Passbook/Checking (not included in yield calculations) Total Cash and Investments Total Earnings 21, 953,428.98 231,927,077.39 July 31 Month Ending 21,953,428.98 21,953,428.98 229,194,905.09 Fiscal Year To Date Current Year 93,782.70 93,782.70 Average Daily Balance 235,102,437.39 235,102,437.39 Effective Rate of Return 0.47% 0.47% 231,924,577.39 1 1 0.000 0.000 Reporting period 07/01/2022-07/3112022 Portfolio TEME Data Updated: SET_MTH: 10/19/2022 10:16 NL! CP Run Date: 10/19/2022 - 10:16 PM (PRF_PM1) 7.3.0 Report Ver. 7.3.6.1 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Investments July 31, 2022 Page 1 Average Purchase Stated YTM YTM Days to Maturity CUSIP Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Managed Pool Accounts 233358001-6 01-2 BOND F First Amer Govt Oblig Fund Cl 5,675.84 5,675.84 5,675.84 1.830 1.805 1.830 1 233358006-6 01-2 REF RES First Amer Govt Oblig Fund Cl 503,940.87 503,940.87 503,940.87 1.830 1.805 1.830 1 233358000-6 01-2 REF ST First Amer Govt Oblig Fund Cl 892,444.61 892,444.61 892,444.61 1.830 1.805 1.830 1 276213009-6 03-02 COI First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 276213008-6 03-02 IMPR First Amer Govt Oblig Fund Cl 518.07 518.07 518.07 1.830 1.805 1.830 1 276213006-6 03-02 RES First Amer Govt Oblig Fund Cl 742,111.94 742,111.94 742,111.94 1.830 1.805 1.830 1 164741029-0 03-03 22 COI First Amer Govt Oblig Fund Cl 13,247.25 13,247.25 13,247.25 1.830 1.805 1.830 1 164741028-0 03-03 22 IF First Amer Govt Oblig Fund Cl 194,392.82 194,392.82 194,392.82 1.830 1.805 1.830 1 164741010-0 03-03 22 SPE First Amer Govt Oblig Fund Cl 07/01/2022 18,296,931.25 18,296,931.25 18,296,931.25 0.000 0.000 1 164741026-6 03-03 22 SRB First Amer Govt Oblig Fund Cl 413,704.54 413,704.54 413,704.54 1.830 1.805 1.830 1 164741020-0 03-03 22 STIR First Amer Govt Oblig Fund Cl 844,032.77 844,032.77 844,032.77 1.830 1.805 1.830 1 164741002-6 03-03 BOND F First Amer Govt Oblig Fund Cl 14.83 14.83 14.83 0.620 0.612 0.620 1 164741008-6 03-03IMP First Amer Govt Oblig Fund Cl 23.51 23.51 23.51 0.620 0.612 0.620 1 164741006-6 03-03RES First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.180 0.178 0.180 1 164741000-6 03-03SPEC First Amer Govt Oblig Fund Cl 111.30 111.30 111.30 0.620 0.612 0.620 1 164742002-6 03-06 BOND F First Amer Govt Oblig Fund Cl 26,054.38 26,054.38 26,054.38 1.830 1.805 1.830 1 164742000-6 03-06SPEC First Amer Govt Oblig Fund Cl 261,096.93 261,096.93 261,096.93 1.830 1.805 1.830 1 229462007-6 03-1 2012 RF First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 229462002--6 03-1 BOND FD First Amer Govt Oblig Fund Cl 2,595.20 2,595.20 2,595.20 1.830 1.805 1.830 1 229462009-6 03-1 COI First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 229462006-6 03-1 RESERV First Amer Govt Oblig Fund Cl 17,241.49 17,241.49 17,241.49 1.830 1.805 1.830 1 229462000-6 03-1 SPECF First Amer Govt Oblig Fund Cl 751,309.85 751,309.85 751,309.85 1.830 1.805 1.830 1 94669921-6 03-1ACQ11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.870 0.858 0.870 1 94669911-6 03-1ACQA11 First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94669917-6 03-1 RES First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94669916-6 03-1 RESB11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 94669000-6 03-1 SPTAX11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 276213002-6 03-2 REFU First Amer Govt Oblig Fund Cl 227.37 227.37 227.37 1.820 1.795 1.820 1 276213000-6 03-2 SPEC First Amer Govt Oblig Fund Cl 650,324.10 650,324.10 650,324.10 1.830 1.805 1.830 1 94686001-6 03-4ADMIN11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.060 0.059 0.060 1 94686005-6 03-4PREP11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.070 0.069 0.070 1 94686000-6 03-4RED11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.050 0.049 0.050 1 94686006-6 03-4RES11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.060 0.059 0.060 1 276213022-6 16-01 BOND F First Amer Govt Oblig Fund Cl 967.36 967.36 967.36 1.830 1.805 1.830 1 276213023-6 16-01 CAPINT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.870 0.858 0.870 1 276213029-6 16-01 COI First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 Data Updated: SET_MTH: 10/19/2022 10:16 Run Date: 10/19/2022 - 10:16 Portfolio TEME NL! CP PM (PRF_PM2) 7.3.0 Report Ver. 7.3.6.1 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Investments July 31, 2022 Page 2 Average Purchase Stated YTM YTM Days to Maturity CUSIP Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Managed Pool Accounts 276213028-6 16-01 IMP First Amer Govt Oblig Fund Cl 6,734,034.94 6,734,034.94 6,734,034.94 1.830 1.805 1.830 1 276213026-6 16-01 RESERV First Amer Govt Oblig Fund Cl 3,157,961.62 3,157,961.62 3,157,961.62 1.830 1.805 1.830 1 276213020-6 16-01 SPECF First Amer Govt Oblig Fund Cl 2,054,829.57 2,054,829.57 2,054,829.57 1.830 1.805 1.830 1 218848001-6 2017A&B INT First Amer Govt Oblig Fund Cl 143.29 143.29 143.29 1.830 1.805 1.830 1 218848008-6 2017ABPRIORP First Amer Govt Oblig Fund Cl 17,986.03 17,986.03 17,986.03 1.830 1.805 1.830 1 218848013-2 2017B COI First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 218848000-6 2017B IDS First Amer Govt Oblig Fund Cl 1,033.59 1,033.59 1,033.59 1.830 1.805 1.830 1 218848002-6 2017B PRIN First Amer Govt Oblig Fund Cl 992.30 992.30 992.30 1.830 1.805 1.830 1 218848009-6 2017B_PROJ First Amer Govt Oblig Fund Cl 5,185,170.77 5,185,170.77 5,185,170.77 1.830 1.805 1.830 1 233358009-6 233358009-6 First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94434160-6 RDA-021NT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 94434161-6 RDA-02PRIN First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 107886000-6 RDA-06AINT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 107886001-6 RDA06APRIN First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 107886010-6 RDA06BINT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 107886011-6 RDA06BPRIN First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.680 0.671 0.680 1 107886016-6 RDA06BRES First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.940 0.927 0.940 1 107886020-6 RDA071NT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 107886021-6 RDA07PRIN First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.930 0.917 0.930 1 107886028-6 RDA07PROJ First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.940 0.927 0.940 1 107886026-6 RDA07RES First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.940 0.927 0.940 1 136343008-6 RDA10APROJ First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 136343018-6 RDA10BPROJ First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 136343000-6 RDA10INT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 136343001-6 RDA10PRIN First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 136343006-6 RDA10RSRV First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 146161000-6 RDA11AINT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 146161001-6 RDA11APRIN First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 94669902-3 03-1 BOND3 First American Treasury 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94434160-1 RDA 02 INT1 First American Treasury 0.00 0.00 0.00 0.010 0.010 0.010 1 94434161-2 RDA 02 PRIN2 First American Treasury 0.00 0.00 0.00 0.010 0.010 0.010 1 136343018-2 RDA 10B CIP2 First American Treasury 0.00 0.00 0.00 0.010 0.010 0.010 1 146161008-3 RDA11APROJ Federated Institutional Tax Fr 0.00 0.00 0.00 0.800 0.789 0.800 1 146161006-3 RDA11ARSRV Federated Institutional Tax Fr 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94669921-5 03-01 ACQ11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 94669911-5 03-01 ACQA11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 Data Updated: SET_MTH: 10/19/2022 10:16 Run Date: 10/19/2022 - 10:16 Portfolio TEME NL! CP PM (PRF_PM2) 7.3.0 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Investments July 31, 2022 Page 3 CUSIP Investment # Average Issuer Balance Purchase Date Par Value Market Value Book Value Stated Rate YTM 360 YTM 365 Days to Maturity Maturity Date Managed Pool Accounts 94669917-5 03-01 RES Federated Tax Free Obligations 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94669906-5 03-01 RESA11 Federated Tax Free Obligations 0.00 0.00 0.00 0.001 0.001 0.001 1 94669916-5 03-01 RESB11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 94669000-5 03-01SPTAX11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 164742006-5 03-06 RES Federated Tax Free Obligations 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 164742000-5 03-06 SPEC Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 94669902-5 03-1bond fd Federated Tax Free Obligations 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94686001-5 03-4 ADMIN11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 94686005-5 03-4 PREP11 Federated Tax Free Obligations 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94686006-5 03-4 RES11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 94669917-1 03-01-1 RES CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 276213008-1 03-02 IMP CA Local Agency Investment Fun 8,182,048.80 8,182,048.80 8,182,048.80 0.221 0.218 0.221 1 164742006-1 03-06 RES-1 CA Local Agency Investment Fun 307,572.28 307,572.28 307,572.28 1.830 1.805 1.830 1 229462007-1 03-1 2012 RE CA Local Agency Investment Fun 818,664.58 818,664.58 818,664.58 0.221 0.218 0.221 1 94669911-1 03-1 ACQ A2 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 94669921-1 03-1 ACQ B2 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 744727011-1 03-3 ACQ 2 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 164741006-1 0303-1 RES CA Local Agency Investment Fun 172.03 172.03 172.03 0.620 0.612 0.620 1 107886028-1 RDA 07 PRO-1 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 107886026-1 RDA 07 RES-1 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 136343018-1 RDA 10B CIP1 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 229462020-0 03-01 CASH USBANK 263.40 263.40 263.40 0.000 0.000 1 164742006-0 03-06 Cash USBANK 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 233358050-1 01-2 SPECESC U.S. Treasury 0.00 0.00 0.00 0.360 0.355 0.360 1 Subtotal and Average 50,189,247.40 50,077,839.48 50,077,839.48 50,077,839.48 0.860 0.872 1 Retention Escrow Account NOBEL COMPANY 3354 Banner Bank 0.00 0.00 0.00 0.150 0.148 0.150 1 218848050-0 2002 ESCROW USBANK 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 218848060-0 2006AESCRO USBANK 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 218848070-0 2006BESCRO USBANK 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 218848080-0 2007ESCROW USBANK 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 229462020-2 03-01 ESCROW U.S. Treasury 653,457.18 653,457.18 653,457.18 0.063 0.062 0.063 1 Subtotal and Average 653,457.18 653,457.18 653,457.18 653,457.18 0.062 0.063 1 Portfolio TEME Data Updated: SET_MTH: 10/19/2022 10:16 NL! CP Run Date: 10/19/2022 - 10:16 PM (PRF_PM2) 7.3.0 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Investments July 31, 2022 Page 4 Average Purchase Stated YTM YTM Days to Maturity CUSIP Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Letter of Credit 164741026-1 03-03 22 Res ASSURED GUARANTY MUNICIPAL COR 07/01/2022 1.00 1.00 1.00 0.000 0.000 1 218848006-1 2017B RESER ASSURED GUARANTY MUNICIPAL COR 07/01/2022 1.00 1.00 1.00 0.000 0.000 1 233358006-1 01-2 REFRESI ASSURANCE CO BOND INSURANCE 07/01/2022 1.00 1.00 1.00 0.000 0.000 1 Subtotal and Average 3.00 3.00 3.00 3.00 0.000 0.000 1 Trust Accounts 6746058700 PARS Pension US Bank Trust 17,293,394.59 17,293,394.59 17,293,394.59 1.530 1.509 1.530 1 Subtotal and Average 16,535,872.19 17,293,394.59 17,293,394.59 17,293,394.59 1.509 1.530 1 Local Agency Investment Funds SYSCITY CITY CA Local Agency Investment Fun 56,872,004.11 56,139,800.60 56,872,004.11 0.206 0.203 0.206 1 SYSRDA RDA CA Local Agency Investment Fun 1,898.30 1,873.86 1,898.30 0.365 0.360 0.365 1 SYSTCSD TCSD CA Local Agency Investment Fun 65,075,051.75 64,237,237.40 65,075,051.75 0.365 0.360 0.365 1 Subtotal and Average 136,236,286.57 121,948,954.16 120,378,911.86 121,948,954.16 0.287 0.291 1 Federal Agency Callable Securities 3133EMQGO 01259 Federal Farm Credit Bank 02/10/2021 1,000,000.00 935,600.00 1,000,000.00 0.320 0.316 0.320 924 02/10/2025 3133EMK92 01265 Federal Farm Credit Bank 06/23/2021 1,000,000.00 932,590.00 1,000,000.00 0.580 0.572 0.580 1,057 06/23/2025 3133EMN57 01266 Federal Farm Credit Bank 06/28/2021 1,000,000.00 949,650.00 1,000,000.00 0.440 0.434 0.440 697 06/28/2024 3133EMP22 01267 Federal Farm Credit Bank 06/30/2021 1,000,000.00 934,230.00 1,000,000.00 0.910 0.898 0.910 1,429 06/30/2026 3133ENAP5 01273 Federal Farm Credit Bank 10/14/2021 1,000,000.00 936,020.00 1,000,000.00 0.800 0.789 0.800 1,170 10/14/2025 313OAKQ41 01258 Federal Home Loan Bank 01/28/2021 1,000,000.00 923,320.00 1,000,000.00 0.520 0.513 0.520 1,276 01/28/2026 3130ALEU4 01260 Federal Home Loan Bank 02/25/2021 1,000,000.00 937,760.00 1,000,000.00 0.350 0.345 0.350 847 11/25/2024 3130ALWV2 01261 Federal Home Loan Bank 04/21/2021 1,000,000.00 948,070.00 1,000,000.00 0.550 1.011 1.025 1,359 04/21/2026 3130AM2V3 01262 Federal Home Loan Bank 04/29/2021 1,000,000.00 947,590.00 1,000,000.00 0.700 0.690 0.700 1,002 04/29/2025 3130AMNMO 01263 Federal Home Loan Bank 05/27/2021 1,000,000.00 935,690.00 1,000,000.00 0.500 0.493 0.500 1,395 05/27/2026 3130AMM90 01264 Federal Home Loan Bank 06/10/2021 1,000,000.00 945,750.00 1,000,000.00 0.500 1.973 2.000 1,409 06/10/2026 3130AN4N7 01268 Federal Home Loan Bank 07/14/2021 1,000,000.00 938,440.00 1,000,000.00 0.720 0.710 0.720 1,078 07/14/2025 3130ANAZ3 01269 Federal Home Loan Bank 07/28/2021 1,000,000.00 942,390.00 1,000,000.00 0.600 0.592 0.600 1,001 04/28/2025 3130AP3M5 01270 Federal Home Loan Bank 09/28/2021 1,000,000.00 934,510.00 1,000,000.00 0.550 0.542 0.550 970 03/28/2025 3134GXJL9 01257 Federal Home Loan Mtg Corp 12/30/2020 1,000,000.00 929,480.00 1,000,000.00 0.500 0.493 0.500 1,247 12/30/2025 3130APBV6 01271 Union Bank 10/07/2021 1,000,000.00 934,560.00 999,000.00 1.000 1.007 1.021 1,528 10/07/2026 3130APAM7 01272 Union Bank 10/14/2021 1,000,000.00 925,730.00 998,500.00 0.900 0.918 0.931 1,535 10/14/2026 Subtotal and Average 16,997,500.00 17,000,000.00 15,931,380.00 16,997,500.00 0.723 0.733 1,172 Portfolio TEME Data Updated: SET_MTH: 10/19/2022 10:16 NL! CP Run Date: 10/19/2022 - 10:16 PM (PRF_PM2) 7.3.0 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Investments July 31, 2022 Page 5 Average Purchase Stated YTM YTM Days to Maturity CUSIP Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Federal Agency Bullet Securities 3133ELMA9 01254 Federal Farm Credit Bank 02/07/2020 1,000,000.00 984,420.00 1,000,000.00 1.420 1.401 1.420 371 08/07/2023 3133ELTU8 01256 Federal Farm Credit Bank 03/18/2020 1,000,000.00 970,250.00 1,000,000.00 0.920 0.907 0.920 595 03/18/2024 3133ENCA6 01274 Federal Farm Credit Bank 10/25/2021 1.000.000.00 951,820.00 1.000.000.00 0.700 0.690 0.700 816 10/25/2024 Subtotal and Average Total and Average Data Updated: SET_MTH: 10/19/2022 10:16 Run Date: 10/19/2022 - 10:16 3,000,000.00 235,102,437.39 3,000,000.00 2,906,490.00 3,000,000.00 0.999 1.013 594 209,973,648.41 207,241,476.11 209,971,148.41 0.569 0.577 104 Portfolio TEME NL! CP PM (PRF_PM2) 7.3.0 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Cash July 31, 2022 Page 6 Average Purchase Stated YTM YTM Days to CUSIP Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Passbook/Checking Accounts 1453718479 WORKERS BANK OF AMERICA MERRILL LYNC 07/01/2022 7,333.90 7,333.90 7,333.90 0.000 0.000 1 SYSPetty Cash Petty Cash City of Temecula 07/01/2022 3,911.00 3,911.00 3,911.00 0.000 0.000 1 SYSGen Ck Acct Gen Ck Acct Union Bank of California 21,905,965.51 21,905,965.51 21,905,965.51 0.000 0.000 1 SYSParking Ck PARKING CITA Union Bank of California 07/01/2022 36,218.57 36,218.57 36,218.57 0.000 0.000 1 Average Balance 0.00 Total Cash and Investments 235,102,437.39 0 231,927,077.39 229,194,905.09 231,924,577.39 0.569 0.577 104 Portfolio TEME Data Updated: SET_MTH: 10/19/2022 10:16 NL! CP Run Date: 10/19/2022 - 10:16 PM (PRF_PM2) 7.3.0 Cash and Investments Report CITY OF TEMECULA Through July 2022 Fund 9 Fund Name Beginning Balance Receipts Disbursements Fund Total 001 GENERAL FUND $ 61,852,506.94 $ 15,544,075.28 $ 20,078,497.14 $ 57,318,085.08 002 MEASURE S FUND 36,120,017.25 4,255,400.66 8,333,257.54 32,042,160.37 006 FIRE FACILITY ACQUISITION FUND 1,500,000.00 1,752.59 - $ 1,501,752.59 100 STATE GAS TAX FUND 2,559,041.65 210,549.40 2,559,041.65 210,549.40 102 RMRA-ROAD MAINTENANCE REHABILITATION ACT 3,604,131.94 206,336.86 2,248,004.49 1,562,464.31 103 STREETS MAINTENANCE FUND 4,911,425.72 517,840.79 5,429,266.51 105 NPDES 1,937.94 3.79 1,941.73 106 UPTOWN TEMECULA NEW STREETS IN LIEU FEES 886,276.68 3,329.55 - 889,606.23 110 COVID-19 PANDEMIC COMMUNITY REINVESTMENT 7,037,759.21 - 4,409.12 7,033,350.09 120 DEVELOPMENT IMPACT FUND 7,769,809.63 410,467.72 113,178.90 8,067,098.45 125 PEG PUBLIC EDUCATION & GOVERNMENT 663,353.06 36,621.66 20,893.19 679,081.53 145 TEMECULA ENERGY EFFICIENCY ASSET TEAM 831,140.98 3,130.26 - 834,271.24 150 AB 2766 FUND 256,303.61 641.61 6,513.54 250,431.68 160 SUPPLEMENTAL LAW ENFORCEMENT SERVICES 363,917.40 412.15 363,917.40 412.15 161 TEMECULA MAJOR CRIMES REWARD FUND 26,923.23 41.24 26,923.23 41.24 165 AFFORDABLE HOUSING 1,827,961.33 3,720,604.21 23,195.68 5,525,369.86 170 MEASURE A FUND 11,096,299.17 795,680.89 2,825,000.15 9,066,979.91 190 TEMECULA COMMUNITY SERVICES DISTRICT 2,511,741.80 889,254.60 1,286,689.72 2,114,306.68 191 TCSD SERVICE LEVEL "B" STREET LIGHT REPLACEMENT 853,926.46 87.42 853,839.04 192 TCSD SERVICE LEVEL "B" STREET LIGHTS 1,123,316.39 1,841.24 875,533.26 249,624.37 194 TCSD SERVICE LEVEL "D" REFUSE/RECYCLING 175,145.15 163,112.09 10,873.50 327,383.74 195 TCSD SERVICE LEVEL "R" STREET/ROAD MAINT 27,191.45 103.39 - 27,294.84 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 451,092.45 2,001.07 21,566.68 431,526.84 197 TEMECULA LIBRARY FUND 462,186.13 170,599.79 82,349.89 550,436.03 198 PUBLIC ART 131,664.17 5,468.27 - 137,132.44 210 CAPITAL IMPROVEMENT PROJECT FUND 1,754,110.62 12,202,435.03 1,719,087.26 12,237,458.39 275 CFD 03-3 WOLF CREEK IMPROVEMENT FUND 211,377.28 213.42 211,590.70 277 CFD-RORIPAUGH 8,309,949.31 15,827.62 8,325,776.93 278 CFD-RORIPAUGH II 6,728,874.60 5,160.34 - 6,734,034.94 300 INSURANCE FUND 1,068,284.82 378,992.60 153,595.09 1,293,682.33 305 WORKER'S COMPENSATION 1,697,925.76 4,596.51 29,720.89 1,672,801.38 310 VEHICLES AND EQUIPMENT FUND 2,629,822.02 220,150.72 - 2,849,972.74 320 INFORMATION TECHNOLOGY 1,033,072.95 676,965.58 515,075.67 1,194,962.86 325 TECHNOLOGY REPLACEMENT FUND 2,023,840.60 182,236.21 - 2,206,076.81 330 CENTRAL SERVICES - 87,121.52 57,843.28 29,278.24 335 CENTRAL SERVICES 277,790.60 42,419.15 - 320,209.75 340 FACILITIES 409,075.25 357,481.07 121,899.56 644,656.76 350 FACILITY REPLACEMENT FUND 216,198.38 129,338.54 - 345,536.92 380 SARDA DEBT SERVICE FUND 5,981,473.49 5,031.12 1,076,176.63 4,910,327.98 381 REDEVELOPMEN PROPERTY TAX TRUST 3,878,727.65 3,539.99 3,734,995.20 147,272.44 460 CFD 88-12 DEBT SERVICE FUND 94,422.98 355.63 - 94,778.61 472 CFD 01-2 HARVESTON A&B DEBT SERVICE 1,642,042.58 2,317.50 1,678.50 1,642,681.58 473 CFD 03-1 CROWNE HILL DEBT SERVICE FUND 2,260,630.64 2,867.02 1,678.50 2,261,819.16 474 AD 034 JOHN WARNER ROAD DEBT SERVICE 4,945.16 18.63 - 4,963.79 475 CFD 03-3 WOLF CREEK DEBT SERVICE FUND 19,639,693.19 1,700.87 3,588.51 19,637,805.55 476 CFD 03-6 HARVESTON 2 DEBT SERVICE FUND 628,627.13 944.32 1,690.22 627,881.23 477 CFD 03-02 RORIPAUGH DEBT SERVICE FUND 1,411,388.85 1,265.77 1,814.55 1,410,840.07 478 CFD-RORIPAUGH II 5,925,836.64 6,452.13 1,678.92 5,930,609.85 479 CFD 19-01 CYPRESS RIDGE 1,147.50 - 1,147.50 - 501 SERVICE LEVEL"C"ZONE 1 SADDLEWOOD 22,137.06 55.15 5,532.72 16,659.49 502 SERVICE LEVEL"C"ZONE 2 WINCHESTER CREEK 120,240.86 435.75 4,511.60 116,165.01 503 SERVICE LEVEL"C"ZONE 3 RANCHO HIGHLANDS 61,461.38 192.86 4,387.59 57,266.65 504 SERVICE LEVEL"C"ZONE 4 THE VINEYARDS 6,467.23 15.03 714.46 5,767.80 505 SERVICE LEVEL"C"ZONE 5 SIGNET SERIES 25,381.28 95.03 4,359.91 21,116.40 506 SERVICE LEVEL"C"ZONE 6 WOODCREST COUNTRY 41,372.80 147.10 2,016.92 39,502.98 507 SERVICE LEVEL"C"ZONE 7 RIDGEVIEW 9,089.97 34.91 1,733.83 7,391.05 508 SERVICE LEVEL"C"ZONE 8 VILLAGE GROVE 135,780.75 311.69 20,350.36 115,742.08 509 SERVICE LEVEL"C"ZONE 9 RANCHO SOLANA 32,248.58 119.59 277.08 32,091.09 510 SERVICE LEVEL"C"ZONE 10 MARTINIQUE 15,073.06 50.60 881.06 14,242.60 511 SERVICE LEVEL"C"ZONE 11 MEADOWVIEW 3,699.43 13.39 223.10 3,489.72 512 SERVICE LEVEL"C"ZONE 12 VINTAGE HILLS 96,422.68 270.57 12,396.87 84,296.38 513 SERVICE LEVEL"C"ZONE 13 PRESLEY DEVELOP 37,635.93 90.20 3,325.90 34,400.23 514 SERVICE LEVEL"C"ZONE 14 MORRISON HOMES 16,125.95 46.59 4,211.38 11,961.16 515 SERVICE LEVEL"C"ZONE 15 BARCLAY ESTATES 12,630.86 44.38 933.91 11,741.33 516 SERVICE LEVEL"C"ZONE 16 TRADEWINDS 84,021.43 221.15 2,499.51 81,743.07 517 SERVICE LEVEL"C"ZONE 17 MONTE VISTA 2,735.57 8.53 199.91 2,544.19 518 SERVICE LEVEL"C"ZONE 18 TEMEKU HILLS 60,313.51 175.80 9,498.66 50,990.65 519 SERVICE LEVEL"C"ZONE 19 CHANTEMAR 93,587.67 233.74 6,662.94 87,158.47 520 SERVICE LEVEL"C"ZONE 20 CROWNE HILL 274,060.57 677.52 20,890.15 253,847.94 521 SERVICE LEVEL"C"ZONE 21 VAIL RANCH 2O8,447.81 504.98 27,178.00 181,774.79 522 SERVICE LEVEL"C"ZONE 22 SUTTON PLACE 11,600.40 40.15 506.55 11,134.00 523 SERVICE LEVEL"C"ZONE 23 PHEASENT RUN 27,804.64 92.80 595.43 27,302.01 524 SERVICE LEVEL"C"ZONE 24 HARVESTON 75,717.84 163.65 15,606.01 60,275.48 525 SERVICE LEVEL"C"ZONE 25 SERENA HILLS 74,462.52 190.52 4,626.64 70,026.40 526 SERVICE LEVEL"C"ZONE 26 GALLERYTRADITION 2,141.22 6.54 280.98 1,866.78 527 SERVICE LEVEL"C"ZONE 27 AVONDALE 10,831.36 32.47 1,225.63 9,638.20 528 SERVICE LEVEL"C"ZONE 28 WOLF CREEK 665,878.19 1,703.53 59,938.35 607,643.37 529 SERVICE LEVEL"C"ZONE 29 GALLERY PORTRAIT 8,612.07 26.97 394.50 8,244.54 530 SERVICE LEVEL"C"ZONE 30 FUTURE ZONES 35,925.98 135.30 - 36,061.28 701 PENSION RATE STABILIZATION FUND $ 16,510,621.44 782,773.15 - $ 17,293,394.59 Grand Total: $ 232,802,931.32 $ 42,909,536.50 $ 46,517,562.73 $ 229,194,905.09 Journal Entries completed after June's Treasurer's Report was issued are reflected in the Receipts I Disbursements columns. Portfolio Managment Treasury Report Portfolio Management Portfolio Summary August 31, 2022 City of Temecula 41000 Main Street Temecula, CA 92590 (951)694-6430 Par Market Book % of Days to YTM YTM Investments Value Value Value Portfolio Term Maturity 360 Equiv. 365 Equiv. Managed Pool Accounts 49,317,957.02 49,317,957.02 49,317,957.02 22.34 1 1 1.218 1.235 Retention Escrow Account 654,000.00 654,000.00 654,000.00 0.30 1 1 0.062 0.063 Letter of Credit 3.00 3.00 3.00 0.00 1 1 0.000 0.000 Trust Accounts 16,828,470.50 16,828,470.50 16,828,470.50 7.62 1 1 1.509 1.530 Local Agency Investment Funds 128,948,954.16 127,288,789.76 128,948,954.16 58.42 1 1 0.282 0.286 Money Market 1,008,466.67 1,008,466.67 1,008,466.67 0.46 1 1 2.091 2.120 Medium Term Notes 2,000,000.00 2,001,100.00 2,000,000.00 0.91 257 256 3.398 3.445 Federal Agency Callable Securities 17,000,000.00 15,556,050.00 16,997,500.00 7.70 1,590 1,141 0.723 0.733 Federal Agency Bullet Securities 3,000,000.00 2,885,810.00 3,000,000.00 1.36 1,278 563 0.999 1.013 Miscellaneous Discounts -At Cost 2,000,000.00 1,980,220.00 1,980,208.33 0.90 125 119 2.878 2.918 220,757,851.35 217,520,866.95 220,735,559.68 100.00% 144 100 0.688 0.697 Investments Cash Passbook/Checking (not included in yield calculations) Total Cash and Investments 14,453,302.08 14,453,302.08 14,453,302.08 1 1 0.000 0.000 235,211,153.43 231,974,169.03 235,188,861.76 144 100 0.688 0.697 Total Earnings August 31 Month Ending Fiscal Year To Date Current Year 104,678.04 198,543.61 Average Daily Balance 235,675,329.18 235,452,616.19 Effective Rate of Return 0.52% 0.50% Reporting period 08/01/2022-08/31/2022 Portfolio TEME Data Updated: SET_MTH: 10/19/2022 07:39 NLI CP Run Date: 10/19/2022 - 07:39 PM (PRF_PM1) 7.3.0 Report Ver. 7.3.6.1 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Investments August 31, 2022 Page 1 Average Purchase Stated YTM YTM Days to Maturity CUSIP Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Managed Pool Accounts 233358001-6 01-2 BOND F First Amer Govt Oblig Fund Cl 7,054.91 7,054.91 7,054.91 2.010 1.982 2.010 1 233358006-6 01-2 REF RES First Amer Govt Oblig Fund Cl 503,156.10 503,156.10 503,156.10 2.010 1.982 2.010 1 233358000-6 01-2 REF ST First Amer Govt Oblig Fund Cl 902,630.15 902,630.15 902,630.15 2.010 1.982 2.010 1 276213009-6 03-02 COI First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 276213008-6 03-02 IMPR First Amer Govt Oblig Fund Cl 518.67 518.67 518.67 1.830 1.805 1.830 1 276213006-6 03-02 RES First Amer Govt Oblig Fund Cl 742,518.75 742,518.75 742,518.75 2.010 1.982 2.010 1 164741029-0 03-03 22 COI First Amer Govt Oblig Fund Cl 13,262.70 13,262.70 13,262.70 2.010 1.982 2.010 1 164741028-0 03-03 22 IF First Amer Govt Oblig Fund Cl 194,643.03 194,643.03 194,643.03 2.010 1.982 2.010 1 164741010-0 03-03 22 SPE First Amer Govt Oblig Fund Cl 07/01/2022 18,296,931.25 18,296,931.25 18,296,931.25 0.000 0.000 1 164741026-6 03-03 22 SRB First Amer Govt Oblig Fund Cl 414,187.00 414,187.00 414,187.00 2.010 1.982 2.010 1 164741020-0 03-03 22 STIR First Amer Govt Oblig Fund Cl 877,664.47 877,664.47 877,664.47 2.010 1.982 2.010 1 164741002-6 03-03 BOND F First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.620 0.612 0.620 1 164741022 03-03STRB First Amer Govt Oblig Fund Cl 08/01/2022 1,408.76 1,408.76 1,408.76 2.010 1.982 2.010 1 164741008-6 03-03IMP First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.620 0.612 0.620 1 164741006-6 03-03RES First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.180 0.178 0.180 1 164741000-6 03-03SPEC First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.620 0.612 0.620 1 164742002-6 03-06 BOND F First Amer Govt Oblig Fund Cl 26,084.76 26,084.76 26,084.76 2.010 1.982 2.010 1 164742000-6 03-06SPEC First Amer Govt Oblig Fund Cl 263,778.96 263,778.96 263,778.96 2.010 1.982 2.010 1 229462007-6 03-1 2012 RF First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 229462002--6 03-1 BOND FD First Amer Govt Oblig Fund Cl 2,598.23 2,598.23 2,598.23 2.010 1.982 2.010 1 229462009-6 03-1 COI First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 229462006-6 03-1 RESERV First Amer Govt Oblig Fund Cl 17,261.60 17,261.60 17,261.60 2.010 1.982 2.010 1 229462000-6 03-1 SPECF First Amer Govt Oblig Fund Cl 763,462.16 763,462.16 763,462.16 2.010 1.982 2.010 1 94669921-6 03-1ACQ11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.870 0.858 0.870 1 94669911-6 03-1ACQA11 First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94669917-6 03-1 RES First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94669916-6 03-1 RESB11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 94669000-6 03-1 SPTAX11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 276213002-6 03-2 REFU First Amer Govt Oblig Fund Cl 686.26 686.26 686.26 2.010 1.982 2.010 1 276213000-6 03-2 SPEC First Amer Govt Oblig Fund Cl 670,654.79 670,654.79 670,654.79 2.010 1.982 2.010 1 94686001-6 03-4ADMIN11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.060 0.059 0.060 1 94686005-6 03-4PREP11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.070 0.069 0.070 1 94686000-6 03-4RED11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.050 0.049 0.050 1 94686006-6 03-4RES11 First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.060 0.059 0.060 1 276213022-6 16-01 BOND F First Amer Govt Oblig Fund Cl 968.49 968.49 968.49 2.010 1.982 2.010 1 276213023-6 16-01 CAPINT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.870 0.858 0.870 1 Data Updated: SET_MTH: 10/19/2022 07:39 Run Date: 10/19/2022 - 07:39 Portfolio TEME NL! CP PM (PRF_PM2) 7.3.0 Report Ver. 7.3.6.1 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Investments August 31, 2022 Page 2 Average Purchase Stated YTM YTM Days to Maturity CUSIP Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Managed Pool Accounts 276213029-6 16-01 COI First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 276213028-6 16-01 IMP First Amer Govt Oblig Fund Cl 6,741,887.94 6,741,887.94 6,741,887.94 2.010 1.982 2.010 1 276213026-6 16-01RESERV First Amer Govt Oblig Fund Cl 3,161,644.33 3,161,644.33 3,161,644.33 2.010 1.982 2.010 1 276213020-6 16-01 SPECF First Amer Govt Oblig Fund Cl 2,090,308.86 2,090,308.86 2,090,308.86 2.010 1.982 2.010 1 218848001-6 2017A&B INT First Amer Govt Oblig Fund Cl 143.44 143.44 143.44 2.010 1.982 2.010 1 218848008-6 2017ABPRIORP First Amer Govt Oblig Fund Cl 18,007.00 18,007.00 18,007.00 2.010 1.982 2.010 1 218848013-2 2017B COI First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 218848000-6 2017B IDS First Amer Govt Oblig Fund Cl 1,034.76 1,034.76 1,034.76 2.010 1.982 2.010 1 218848002-6 2017B PRIN First Amer Govt Oblig Fund Cl 993.46 993.46 993.46 2.010 1.982 2.010 1 218848009-6 2017B_PROJ First Amer Govt Oblig Fund Cl 4,295,916.67 4,295,916.67 4,295,916.67 2.010 1.982 2.010 1 233358009-6 233358009-6 First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94434160-6 RDA-021NT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 94434161-6 RDA-02PRIN First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 107886000-6 RDA-06AINT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 107886001-6 RDA06APRIN First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 107886010-6 RDA06BINT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 107886011-6 RDA06BPRIN First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.680 0.671 0.680 1 107886016-6 RDA06BRES First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.940 0.927 0.940 1 107886020-6 RDA071NT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 107886021-6 RDA07PRIN First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.930 0.917 0.930 1 107886028-6 RDA07PROJ First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.940 0.927 0.940 1 107886026-6 RDA07RES First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.940 0.927 0.940 1 136343008-6 RDA10APROJ First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 136343018-6 RDA10BPROJ First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 136343000-6 RDA10INT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 136343001-6 RDA10PRIN First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 136343006-6 RDA10RSRV First Amer Govt Oblig Fund Cl 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 146161000-6 RDA11AINT First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 146161001-6 RDA11APRIN First Amer Govt Oblig Fund Cl 0.00 0.00 0.00 0.000 0.000 1 94669902-3 03-1 BOND3 First American Treasury 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94434160-1 RDA 02 INT1 First American Treasury 0.00 0.00 0.00 0.010 0.010 0.010 1 94434161-2 RDA 02 PRIN2 First American Treasury 0.00 0.00 0.00 0.010 0.010 0.010 1 136343018-2 RDA 10B CIP2 First American Treasury 0.00 0.00 0.00 0.010 0.010 0.010 1 146161008-3 RDA11APROJ Federated Institutional Tax Fr 0.00 0.00 0.00 0.800 0.789 0.800 1 146161006-3 RDA11ARSRV Federated Institutional Tax Fr 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94669921-5 03-01 ACQ11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 Data Updated: SET_MTH: 10/19/2022 07:39 Run Date: 10/19/2022 - 07:39 Portfolio TEME NL! CP PM (PRF_PM2) 7.3.0 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Investments August 31, 2022 Page 3 CUSIP Investment # Average Issuer Balance Purchase Date Par Value Market Value Book Value Stated Rate YTM 360 YTM 365 Days to Maturity Maturity Date Managed Pool Accounts 94669911-5 03-01 ACQA11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 94669917-5 03-01 RES Federated Tax Free Obligations 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94669906-5 03-01 RESA11 Federated Tax Free Obligations 0.00 0.00 0.00 0.001 0.001 0.001 1 94669916-5 03-01 RESB11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 94669000-5 03-01SPTAX11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 164742006-5 03-06 RES Federated Tax Free Obligations 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 164742000-5 03-06 SPEC Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 94669902-5 03-1bond fd Federated Tax Free Obligations 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94686001-5 03-4 ADMIN11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 94686005-5 03-4 PREP11 Federated Tax Free Obligations 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 94686006-5 03-4 RES11 Federated Tax Free Obligations 0.00 0.00 0.00 0.250 0.247 0.250 1 94669917-1 03-01-1 RES CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 276213008-1 03-02 IMP CA Local Agency Investment Fun 8,182,048.80 8,182,048.80 8,182,048.80 2.010 1.982 2.010 1 164742006-1 03-06 RES-1 CA Local Agency Investment Fun 307,572.74 307,572.74 307,572.74 2.010 1.982 2.010 1 229462007-1 03-1 2012 RE CA Local Agency Investment Fun 818,664.58 818,664.58 818,664.58 0.221 0.218 0.221 1 94669911-1 03-1 ACQ A2 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 94669921-1 03-1 ACQ B2 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 744727011-1 03-3 ACQ 2 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 164741006-1 0303-1 RES CA Local Agency Investment Fun 0.00 0.00 0.00 0.620 0.612 0.620 1 107886028-1 RDA 07 PRO-1 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 107886026-1 RDA 07 RES-1 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 136343018-1 RDA 10B CIP1 CA Local Agency Investment Fun 0.00 0.00 0.00 0.339 0.334 0.339 1 229462020-0 03-01 CASH USBANK 263.40 263.40 263.40 0.000 0.000 1 164742006-0 03-06 Cash USBANK 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 233358050-1 01-2 SPECESC U.S. Treasury 0.00 0.00 0.00 0.360 0.355 0.360 1 Subtotal and Average 49,555,416.51 49,317,957.02 49,317,957.02 49,317,957.02 1.218 1.235 1 Retention Escrow Account NOBEL COMPANY 3354 Banner Bank 0.00 0.00 0.00 0.150 0.148 0.150 1 218848050-0 2002 ESCROW USBANK 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 218848060-0 2006AESCRO USBANK 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 218848070-0 2006BESCRO USBANK 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 218848080-0 2007ESCROW USBANK 07/01/2022 0.00 0.00 0.00 0.000 0.000 1 229462020-2 03-01 ESCROW U.S. Treasury 654,000.00 654,000.00 654,000.00 0.063 0.062 0.063 1 Subtotal and Average 653,474.69 654,000.00 654,000.00 654,000.00 0.062 0.063 1 Portfolio TEME Data Updated: SET_MTH: 10/19/2022 07:39 NL! CP Run Date: 10/19/2022 - 07:39 PM (PRF_PM2) 7.3.0 Portfolio Managment Treasury Report Portfolio Management Page Portfolio Details - Investments August 31, 2022 Average Purchase Stated YTM YTM Days to Maturity CUSIP Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Letter of Credit 164741026-1 03-03 22 Res ASSURED GUARANTY MUNICIPAL COR 07/01/2022 1.00 1.00 1.00 0.000 0.000 1 218848006-1 2017B RESER ASSURED GUARANTY MUNICIPAL COR 07/01/2022 1.00 1.00 1.00 0.000 0.000 1 233358006-1 01-2 REFRESI ASSURANCE CO BOND INSURANCE 07/01/2022 1.00 1.00 1.00 0.000 0.000 1 Subtotal and Average 3.00 3.00 3.00 3.00 0.000 0.000 1 Trust Accounts 6746058700 PARS Pension US Bank Trust 16,828,470.50 16,828,470.50 16,828,470.50 1.530 1.509 1.530 1 Subtotal and Average 17,278,397.04 16,828,470.50 16,828,470.50 16,828,470.50 1.509 1.530 1 Local Agency Investment Funds SYSCITY CITY CA Local Agency Investment Fun 63,872,004.11 63,049,678.50 63,872,004.11 0.206 0.203 0.206 1 SYSRDA RDA CA Local Agency Investment Fun 1,898.30 1,873.86 1,898.30 0.365 0.360 0.365 1 SYSTCSD TCSD CA Local Agency Investment Fun 65,075,051.75 64,237,237.40 65,075,051.75 0.365 0.360 0.365 1 Subtotal and Average 136,462,093.02 128,948,954.16 127,288,789.76 128,948,954.16 0.282 0.286 1 Money Market 31846V542 Money Mkt USBANK 08/31/2022 1,008,466.67 1,008,466.67 1,008,466.67 2.120 2.091 2.120 1 Subtotal and Average 32,531.18 1,008,466.67 1,008,466.67 1,008,466.67 2.091 2.120 1 Medium Term Notes 14913Q2L2 01276 Caterpillar Financial Service 08/31/2022 2,000,000.00 2,001,100.00 2,000,000.00 3.450 3.398 3.445 256 05/15/2023 Subtotal and Average 64,516.13 2,000,000.00 2,001,100.00 2,000,000.00 3.398 3.445 256 Federal Agency Callable Securities 3133EMQGO 01259 Federal Farm Credit Bank 3133EMK92 01265 Federal Farm Credit Bank 3133EMN57 01266 Federal Farm Credit Bank 3133EMP22 01267 Federal Farm Credit Bank 3133ENAP5 01273 Federal Farm Credit Bank 313OAKQ41 01258 Federal Home Loan Bank 3130ALEU4 01260 Federal Home Loan Bank 3130ALWV2 01261 Federal Home Loan Bank 3130AM2V3 01262 Federal Home Loan Bank 3130AMNMO 01263 Federal Home Loan Bank 3130AMM90 01264 Federal Home Loan Bank Data Updated: SET_MTH: 10/19/2022 07:39 Run Date: 10/19/2022 - 07:39 02/10/2021 1,000,000.00 920,720.00 06/23/2021 1,000,000.00 915,960.00 06/28/2021 1,000,000.00 942,270.00 06/30/2021 1,000,000.00 900,850.00 10/14/2021 1,000,000.00 913,590.00 01/28/2021 1,000,000.00 905,480.00 02/25/2021 1,000,000.00 927,160.00 04/21/2021 1,000,000.00 913,630.00 04/29/2021 1,000,000.00 933,980.00 05/27/2021 1,000,000.00 915,790.00 06/10/2021 1,000,000.00 913,460.00 1,000,000.00 0.320 0.316 0.320 893 02/10/2025 1,000,000.00 0.580 0.572 0.580 1,026 06/23/2025 1,000,000.00 0.440 0.434 0.440 666 06/28/2024 1,000,000.00 0.910 0.898 0.910 1,398 06/30/2026 1,000,000.00 0.800 0.789 0.800 1,139 10/14/2025 1,000,000.00 0.520 0.513 0.520 1,245 01/28/2026 1,000,000.00 0.350 0.345 0.350 816 11/25/2024 1,000,000.00 0.550 1.011 1.025 1,328 04/21/2026 1,000,000.00 0.700 0.690 0.700 971 04/29/2025 1,000,000.00 0.500 0.493 0.500 1,364 05/27/2026 1,000,000.00 0.500 1.973 2.000 1,378 06/10/2026 Portfolio TEME NL! CP PM (PRF_PM2) 7.3.0 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Investments August 31, 2022 Page 5 Average Purchase Stated YTM YTM Days to Maturity CUSIP Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Date Federal Agency Callable Securities 3130AN4N7 01268 Federal Home Loan Bank 07/14/2021 1,000,000.00 913,990.00 1,000,000.00 0.720 0.710 0.720 1,047 07/14/2025 3130ANAZ3 01269 Federal Home Loan Bank 07/28/2021 1,000,000.00 929,030.00 1,000,000.00 0.600 0.592 0.600 970 04/28/2025 3130AP3M5 01270 Federal Home Loan Bank 09/28/2021 1,000,000.00 921,180.00 1,000,000.00 0.550 0.542 0.550 939 03/28/2025 3134GXJL9 01257 Federal Home Loan Mtg Corp 12/30/2020 1,000,000.00 899,370.00 1,000,000.00 0.500 0.493 0.500 1,216 12/30/2025 3130APBV6 01271 Union Bank 10/07/2021 1,000,000.00 896,650.00 999,000.00 1.000 1.007 1.021 1,497 10/07/2026 3130APAM7 01272 Union Bank 10/14/2021 1,000,000.00 892,940.00 998,500.00 0.900 0.918 0.931 1,504 10/14/2026 Subtotal and Average 16,997,500.00 17,000,000.00 15,556,050.00 16,997,500.00 0.723 0.733 1,141 Federal Agency Bullet Securities 3133ELMA9 01254 Federal Farm Credit Bank 02/07/2020 1,000,000.00 980,370.00 1,000,000.00 1.420 1.401 1.420 340 08/07/2023 3133ELTU8 01256 Federal Farm Credit Bank 03/18/2020 1,000,000.00 963,260.00 1,000,000.00 0.920 0.907 0.920 564 03/18/2024 3133ENCA6 01274 Federal Farm Credit Bank 10/25/2021 1,000,000.00 942,180.00 1,000,000.00 0.700 0.690 0.700 785 10/25/2024 Subtotal and Average 3,000,000.00 3,000,000.00 2,885,810.00 3,000,000.00 0.999 1.013 563 Miscellaneous Discounts -At Cost 912796R27 01275 U.S. Treasury 08/26/2022 2,000,000.00 1,980,220.00 1,980,208.33 2.850 2.878 2.918 119 12/29/2022 Subtotal and Average 383,266.13 2,000,000.00 1,980,220.00 1,980,208.33 2.878 2.918 119 Total and Average Data Updated: SET_MTH: 10/19/2022 07:39 Run Date: 10/19/2022 - 07:39 235,675,329.18 220,757,851.35 217,520,866.95 220,735,559.68 0.688 0.697 100 Portfolio TEME NL! CP PM (PRF_PM2) 7.3.0 Portfolio Managment Treasury Report Portfolio Management Portfolio Details - Cash August 31, 2022 Page 6 Average Purchase Stated YTM YTM Days to CUSIP Investment # Issuer Balance Date Par Value Market Value Book Value Rate 360 365 Maturity Passbook/Checking Accounts 1453718479 WORKERS BANK OF AMERICA MERRILL LYNC 07/01/2022 18,098.76 18,098.76 18,098.76 0.000 0.000 1 SYSPetty Cash Petty Cash City of Temecula 07/01/2022 3,711.00 3,711.00 3,711.00 0.000 0.000 1 SYSGen Ck Acct Gen Ck Acct Union Bank of California 14,395,965.32 14,395,965.32 14,395,965.32 0.000 0.000 1 SYSParking Ck PARKING CITA Union Bank of California 07/01/2022 35,527.00 35,527.00 35,527.00 0.000 0.000 1 Average Balance 0.00 Total Cash and Investments 235,675,329.18 0 235,211,153.43 231,974,169.03 235,188,861.76 0.688 0.697 100 Portfolio TEME Data Updated: SET_MTH: 10/19/2022 07:39 NL! CP Run Date: 10/19/2022 - 07:39 PM (PRF_PM2) 7.3.0 Cash and Investments Report CITY OF TEMECULA Through August 2022 Fund 9 Fund Name Beginning Balance Receipts Disbursements Fund Total 001 GENERAL FUND $ 57,318,085.08 $ 21,054,955.25 $ 24,817,071.97 $ 53,555,968.36 002 MEASURE S FUND 32,042,160.37 2,664,190.74 22,988.68 34,683,362.43 006 FIRE FACILITY ACQUISITION FUND 1,501,752.59 - 994.73 $ 1,500,757.86 100 STATE GAS TAX FUND 210,549.40 250,833.38 - 461,382.78 102 RMRA-ROAD MAINTENANCE REHABILITATION ACT 1,562,464.31 184,541.53 1,157.18 1,745,848.66 103 STREETS MAINTENANCE FUND 5,429,266.51 - 3,596.22 5,425,670.29 105 NPDES 1,941.73 1.29 1,940.44 106 UPTOWN TEMECULA NEW STREETS IN LIEU FEES 889,606.23 589.25 889,016.98 108 ARPA - 7,039,753.50 - 7,039,753.50 110 COVID-19 PANDEMIC COMMUNITY REINVESTMENT 7,033,350.09 - 2,911.85 7,030,438.24 120 DEVELOPMENT IMPACT FUND 8,067,098.45 620,802.29 5,754.66 8,682,146.08 125 PEG PUBLIC EDUCATION & GOVERNMENT 679,081.53 34,509.42 6,248.94 707,342.01 145 TEMECULA ENERGY EFFICIENCY ASSET TEAM 834,271.24 - 552.60 833,718.64 150 AB 2766 FUND 250,431.68 165.88 250,265.80 160 SUPPLEMENTAL LAW ENFORCEMENT SERVICES 412.15 - 412.15 161 TEMECULA MAJOR CRIMES REWARD FUND 41.24 0.03 41.21 165 AFFORDABLE HOUSING 5,525,369.86 26,493.07 5,498,876.79 170 MEASURE A FUND 9,066,979.91 - 7,217.43 9,059,762.48 190 TEMECULA COMMUNITY SERVICES DISTRICT 2,114,306.68 422,460.24 1,398,263.53 1,138,503.39 191 TCSD SERVICE LEVEL "B" STREET LIGHT REPLACEMENT 853,839.04 - 565.56 853,273.48 192 TCSD SERVICE LEVEL "B" STREET LIGHTS 249,624.37 7,874.99 23,569.05 233,930.31 194 TCSD SERVICE LEVEL "D" REFUSE/RECYCLING 327,383.74 129,138.31 6,525.19 449,996.86 195 TCSD SERVICE LEVEL "R" STREET/ROAD MAINT 27,294.84 - 18.08 27,276.76 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 431,526.84 4,501.36 33,395.45 402,632.75 197 TEMECULA LIBRARY FUND 550,436.03 5,822.75 58,879.64 497,379.14 198 PUBLIC ART 137,132.44 7,089.45 95.53 144,126.36 210 CAPITAL IMPROVEMENT PROJECT FUND 12,237,458.39 47,612.63 854,643.29 11,430,427.73 275 CFD 03-3 WOLF CREEK IMPROVEMENT FUND 211,590.70 226.70 11.38 211,806.02 277 CFD-RORIPAUGH 8,325,776.93 0.60 94.86 8,325,682.67 278 CFD-RORIPAUGH II 6,734,034.94 7,853.00 - 6,741,887.94 300 INSURANCE FUND 1,293,682.33 92,096.98 1,385,779.31 305 WORKER'S COMPENSATION 1,672,801.38 22,230.95 232,572.10 1,462,460.23 310 VEHICLES AND EQUIPMENT FUND 2,849,972.74 - 1,887.76 2,848,084.98 320 INFORMATION TECHNOLOGY 1,194,962.86 393.56 380,480.02 814,876.40 325 TECHNOLOGY REPLACEMENT FUND 2,206,076.81 - 1,461.25 2,204,615.56 330 CENTRAL SERVICES 29,278.24 5,884.35 35,162.59 - 335 CENTRAL SERVICES 320,209.75 - 6,092.55 314,117.20 340 FACILITIES 644,656.76 1,547.63 150,467.45 495,736.94 350 FACILITY REPLACEMENT FUND 345,536.92 - 4,364.15 341,172.77 380 SARDA DEBT SERVICE FUND 4,910,327.98 901,640.77 895,435.71 4,916,533.04 381 REDEVELOPMEN PROPERTY TAX TRUST 147,272.44 - - 147,272.44 460 CFD 88-12 DEBT SERVICE FUND 94,778.61 - 62.78 94,715.83 472 CFD 01-2 HARVESTON A&B DEBT SERVICE 1,642,681.58 19,924.63 9,304.17 1,653,302.04 473 CFD 03-1 CROWNE HILL DEBT SERVICE FUND 2,261,819.16 78,603.42 65,897.26 2,274,525.32 474 AD 034 JOHN WARNER ROAD DEBT SERVICE 4,963.79 2,182.38 4.73 7,141.44 475 CFD 03-3 WOLF CREEK DEBT SERVICE FUND 19,637,805.55 67,887.61 32,693.50 19,672,999.66 476 CFD 03-6 HARVESTON 2 DEBT SERVICE FUND 627,881.23 5,450.23 2,759.32 630,572.14 477 CFD 03-02 RORIPAUGH DEBT SERVICE FUND 1,410,840.07 40,768.69 19,584.34 1,432,024.42 478 CFD-RORIPAUGH II 5,930,609.85 159,096.13 33,615.35 6,056,090.63 501 SERVICE LEVEL"C"ZONE 1 SADDLEWOOD 16,659.49 946.87 7,576.65 10,029.71 502 SERVICE LEVEL"C"ZONE 2 WINCHESTER CREEK 116,165.01 651.16 2,222.75 114,593.42 503 SERVICE LEVEL"C"ZONE 3 RANCHO HIGHLANDS 57,266.65 838.63 3,437.20 54,668.08 504 SERVICE LEVEL"C"ZONE 4 THE VINEYARDS 5,767.80 46.00 397.74 5,416.06 505 SERVICE LEVEL"C"ZONE 5 SIGNET SERIES 21,116.40 810.19 2,772.42 19,154.17 506 SERVICE LEVEL"C"ZONE 6 WOODCREST COUNTRY 39,502.98 303.56 1,281.04 38,525.50 507 SERVICE LEVEL"C"ZONE 7 RIDGEVIEW 7,391.05 89.00 1,040.21 6,439.84 508 SERVICE LEVEL"C"ZONE 8 VILLAGE GROVE 115,742.08 2,052.78 9,578.40 108,216.46 509 SERVICE LEVEL"C"ZONE 9 RANCHO SOLANA 32,091.09 69.00 216.60 31,943.49 510 SERVICE LEVEL"C"ZONE 10 MARTINIQUE 14,242.60 58.00 606.00 13,694.60 511 SERVICE LEVEL"C"ZONE 11 MEADOWVIEW 3,489.72 - 190.42 3,299.30 512 SERVICE LEVEL"C"ZONE 12 VINTAGE HILLS 84,296.38 1,940.85 6,127.48 80,109.75 513 SERVICE LEVEL"C"ZONE 13 PRESLEY DEVELOP 34,400.23 307.15 2,908.37 31,799.01 514 SERVICE LEVEL"C"ZONE 14 MORRISON HOMES 11,961.16 226.95 1,097.42 11,090.69 515 SERVICE LEVEL"C"ZONE 15 BARCLAY ESTATES 11,741.33 - 584.81 11,156.52 516 SERVICE LEVEL"C"ZONE 16 TRADEWINDS 81,743.07 366.62 1,393.95 80,715.74 517 SERVICE LEVEL"C"ZONE 17 MONTE VISTA 2,544.19 23.00 160.35 2,406.84 518 SERVICE LEVEL"C"ZONE 18 TEMEKU HILLS 50,990.65 1,279.82 5,912.00 46,358.47 519 SERVICE LEVEL"C"ZONE 19 CHANTEMAR 87,158.47 923.06 5,158.35 82,923.18 520 SERVICE LEVEL"C"ZONE 20 CROWNE HILL 253,847.94 1,986.97 12,624.18 243,210.73 521 SERVICE LEVEL"C"ZONE 21 VAIL RANCH 181,774.79 3,494.08 17,003.11 168,265.76 522 SERVICE LEVEL"C"ZONE 22 SUTTON PLACE 11,134.00 116.00 371.09 10,878.91 523 SERVICE LEVEL"C"ZONE 23 PHEASENT RUN 27,302.01 100.00 467.78 26,934.23 524 SERVICE LEVEL"C"ZONE 24 HARVESTON 60,275.48 1,371.68 21,595.77 40,051.39 525 SERVICE LEVEL"C"ZONE 25 SERENA HILLS 70,026.40 910.98 2,808.01 68,129.37 526 SERVICE LEVEL"C"ZONE 26 GALLERYTRADITION 1,866.78 135.00 166.03 1,835.75 527 SERVICE LEVEL"C"ZONE 27 AVONDALE 9,638.20 - 890.42 8,747.78 528 SERVICE LEVEL"C"ZONE 28 WOLF CREEK 607,643.37 3,833.99 20,303.87 591,173.49 529 SERVICE LEVEL"C"ZONE 29 GALLERY PORTRAIT 8,244.54 - 220.79 8,023.75 530 SERVICE LEVEL"C"ZONE 30 FUTURE ZONES 36,061.28 23.89 36,037.39 701 PENSION RATE STABILIZATION FUND $ 17,293,394.59 464,924.09 $ 16,828,470.50 Grand Total: $ 229,194,905.09 $ 33,902,754.81 $ 31,123,490.87 $ 231,974,169.03 Journal Entries completed after July's Treasurer's Report was issued are reflected in the Receipts I Disbursements columns. Item No. 5 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Randi Johl, Director of Legislative Affairs/City Clerk DATE: November 15, 2022 SUBJECT: Adopt the 2022 Conflict of Interest Code PREPARED BY: Randi Johl, Director of Legislative Affairs/City Clerk RECOMMENDATION: That the City Council adopt a resolution entitled: RESOLUTION NO. 2022- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ADOPTING THE CITY' S 2022 CONFLICT OF INTEREST CODE BACKGROUND: Government Code Section 87306.5 requires the biennial adoption of a Conflict of Interest Code. As the Code reviewing body under the Political Reform Act, the City Council accepted the Notice of Draft Amendments and reviewed the proposed changes to the City's Conflict of Interest Code at its September 13, 2022 City Council meeting. The attached resolution makes the proposed changes to the Code based on conditions occurring since the last update in 2020. The Notice of Intent was published for the requisite public comment period. No comments were received. The proposed amendments reflect title changes of positions that already exist in the Code and/or the addition of positions based on an examination of their involvement in the decision -making process. The City Attorney, City Clerk and Executive Management staff have reviewed the proposed changes and concur with the recommendation. FISCAL IMPACT: None ATTACHMENTS: 1. Biennial Notice 2. Resolution 3. Exhibit A 4. Notice of Intent 2022 Local Agency Biennial Notice Name of Agency: City Of Temecula Mailing Address: Contact Person 41000 Main Street, Temecula, CA 92590 Randi Johl, City Clerk Email: randi.johI@temeculaca.gov Phone No Alternate Email: 951-694-6444 N/A Accurate disclosure is essential to monitor whether officials have conflicts of interest and to help ensure public trust in government. The biennial review examines current programs to ensure that the agency's code includes disclosure by those agency officials who make or participate in making governmental decisions. This agency has reviewed its conflict of interest code and has determined that (check one BOX): ❑ An amendment is required. The following amendments are necessary: (Check all that apply.) 0 Include new positions ❑ Revise disclosure categories ❑ Revise the titles of existing positions 0 Delete titles of positions that have been abolished and/or positions that no longer make or participate in making governmental decisions ❑ Other (describe) ❑ The code is currently under review by the code reviewing body. ❑ No amendment is required. (If your code is over five years old, amendments may be necessary.) Verification (to be completed if no amendment is required) This agency's code accurately designates all positions that make or participate in the making of governmental decisions. The disclosure assigned to those positions accurately requires that all investments, business positions, interests in real property, and sources of income that may foreseeably be affected materially by the decisions made by those holding designated positions are reported. The code includes all other provisions required by Government Code Section 87302. Signature of Chief Executive Officer Date All agencies must complete and return this notice regardless of how recently your code was approved or amended. Please return this notice no later than October 3, 2022, or by the date specified by your agency, if earlier, to: (PLACE RETURN ADDRESS OF CODE REVIEWING BODY HERE) PLEASE DO NOT RETURN THIS FORM TO THE FPPC. www.fppc.ca.gov FPPC Advice: adviceC@fppc.ca.gov (866.275.3772) Page 1 of 1 RESOLUTION NO. 2022- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ADOPTING THE CITY'S 2022 CONFLICT OF INTEREST CODE THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY RESOLVE AS FOLLOWS: Section 1. The City Council of the City of Temecula has previously adopted a Conflict of Interest Code to apply to certain officers and employees of the City with an Exhibit A designating certain positions within the City that require the filing of economic disclosure forms. Section 2. The City Council of the City of Temecula does hereby amend the Conflict of Interest Code for the City of Temecula by deleting Exhibit A and substituting in its place a new Exhibit A, which is attached hereto and incorporated herein by this reference. Section 3. The City Clerk shall certify the adoption of this resolution. PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 15th day of November, 2022. ATTEST: Randi Johl, City Clerk [SEAL] Matt Rahn, Mayor 1 STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Randi Johl, City Clerk of the City of Temecula, do hereby certify that the foregoing Resolution No. 2022- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 15th day of November, 2022, by the following vote: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: Randi Johl, City Clerk SECTION 2. EXHIBIT A DESIGNATED CITY OF TEMECULA EMPLOYEES AND DISCLOSURE CATEGORIES The following positions entail the making or participating in the making of decisions which could have a material effect on financial interests. Designated Position Disclosure Categories Assistant City Manager 1 Assistant Director of Community Development 1 Assistant Director of Community Services 1 Assistant Director of Finance 1 Assistant Director of Information Technology and Support Services 1 Assistant to the City Manager 1 Building Official 1 Chief of Police 1 Community Services Superintendent 1 Deputy City Manager 1 Designated Consultant* 1 Director of Community Development 1 Director of Community Services 1 Director of Finance 1 Director of Human Resources and Risk Management 1 Director of Information Technology and Support Services 1 Director of Legislative Affairs / City Clerk 1 Director of Public Works/City Engineer 1 Economic Development Manager 1 Engineering Manager 1 Exempt Officials 0 Fire Chief Finance Manager Fiscal Services Manager Information Technology Manager Maintenance Manager Planning Manager Principal Civil Engineer Principal Management Analyst Senior Civil Engineer Senior Management Analyst Senior Planner Members of all City Commissions, Boards, and Committees (Other than Government 87200 Filers) DESIGNATED CONSULTANTS: Consultants who fit into one or more of the following categories shall be included in the list of designated employees as "Designated Consultants": 1. Consultants who make (not just recommend) governmental decisions, such as whether to approve a rate, rule, or regulation, whether to issue, deny, suspend, or revoke any permit, license, application, certificate or similar authorization, adopt or grant City approval to a plan, design, report, study, or adopt or grant City approval of policies, standards, or guidelines for the City or any subdivision thereof. 2. Consultants who serve in a staff capacity with the City, and in that capacity participate in making a governmental decision by providing information, an opinion, or a recommendation for the purpose of affecting the decision without significant intervening substantive review. 3. Consultants who perform the same or substantially all the same duties for the City that would otherwise be performed by an individual holding a designated position in the City's Conflict of Interest Code. When the consultant is a corporation, partnership, or limited liability company, only individuals who fit into one of the three categories of "Designated Consultants" described above must file disclosure statements. Designated Consultant shall report all reportable interests in real property in the jurisdiction; reportable income and business positions; reportable investments; and reportable gifts within the disclosure category applicable to Designated Consultants unless the City Manager determines in writing that a particular consultant is hired to perform a range of duties that is limited in scope and thus is not required to fully comply with the disclosure requirements described in the section. If the City Manager determines in writing that a particular consultant is not required to fully comply with the requisite disclosure requirements, then such written determination shall include a description of the consultant's duties and based upon that description, a statement of the extent of disclosure requirements. The City Manager's determination is a public record and shall be retained for public inspection in the same manner and location as this Conflict of Interest Code. ** The Mayor, City Council, Members of the Planning Commission, City Manager, City Attorney, and City Treasurer are all required to file disclosure statements pursuant to (Government Code 87200) and are thus not included herein. NOTICE OF INTENT TO AMEND THE CONFLICT OF INTEREST CODE NOTICE IS HEREBY GIVEN that the City of Temecula intends to amend its existing conflict of interest code. Revisions to the existing conflict of interest code and list of designated employees who are required to file Statement of Economic Interests may include position title changes, reclassifications, vacancies, and/or the addition and deletion of positions based on an examination of their involvement in the decision making process. A full copy of the proposed amended conflict of interest code is available in the Office of the City Clerk for review and inspection. NOTICE IS FURTHER GIVEN that the City of Temecula has established a written comment period for interested persons to submit comments pertaining to the proposed amended conflict of interest code. Comments must be submitted in writing to the Office of the City Clerk no later than November 8, 2022, at 5:00 p.m. to be considered by the City Council when it takes action on the proposed amended conflict of interest code. The City Council is scheduled to take action on the proposed conflict of interest code on November 15, 2022, at 6:00 p.m. Inquiries concerning the proposed amended conflict of interest code may be directed to the Office of the City Clerk at (951) 694-6444 or by email to rand i.iohl(a�temeculaca.gov. Item No. 6 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Isaac Garibay, Director of Human Resources and Risk Management DATE: November 15, 2022 SUBJECT: Approve Amendment to the City of Temecula Section 125 Cafeteria Plan PREPARED BY: Nicole Collins, Senior Human Resources Analyst RECOMMENDATION: That the City Council adopt a resolution entitled: RESOLUTION NO. 2022- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA AMENDING THE CITY OF TEMECULA SECTION 125 CAFETERIA PLAN BACKGROUND: The City Council originally adopted the City of Temecula Flexible Benefits Plan document on September 18, 1990, to provide a benefit plan compliant with Internal Revenue Code Section 125. The plan includes Healthcare Flexible Spending Accounts, a Dependent Care Assistance Program, and group health, dental and vision insurance for eligible employees. The Amendment being recommended by staff is only an administrative update to be in compliance with IRS regulations, and does not enhance or reduce any benefits provided to City employees by the City. In response to the COVID-19 pandemic, the Consolidated Appropriation Act of 2021 was signed into law providing temporary relief for Healthcare and Dependent Care Flexible Spending Accounts (FSA's) for the 2020 and 2021 plan years. The Plan Document has been amended for the 2020 plan year as follows: A. To allow prospective election changes for Healthcare and Dependent Care FSA's; B. To incorporate an unlimited carryover of unused Healthcare FSA funds; C. To extend the grace period for Dependent Care Assistance Program Extended Grace Period/Claims Extension Period; and D. To allow the Spend Down of Healthcare FSA once participation has ceased. Approval of the Adoption Agreement will provide the framework for staff to take such actions that are deemed necessary and proper in order to implement the Plan, and to setup adequate accounting and administrative procedures to provide employee benefits under the Plan. FISCAL IMPACT: No fiscal impact. ATTACHMENTS: 1. Resolution 2. Section 125 Cafeteria Plan Document Amendment RESOLUTION NO.2022- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA AMENDING THE CITY OF TEMECULA SECTION 125 CAFETERIA PLAN THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY RESOLVE AS FOLLOWS: Section 1. The City Council adopted the City of Temecula Flexible Benefits Plan Document on September 18, 1990, to provide a Section 125 Cafeteria plan, including any applicable Healthcare Flexible Spending Account Plan, Dependent Care Assistance Program, and group health, dental and vision insurance to eligible employees. Section 2. The attached Amendment to City of Temecula Section 125 Cafeteria Plan Document revises the Plan Document as follows: A. To allow prospective election changes for Healthcare and Dependent Care Flexible Spending Accounts; B. To incorporate an unlimited carryover of unused Healthcare Flexible Spending Account funds; C. To extend the grace period for Dependent Care Assistance Program Extended Grace Period/Claims Extension Period; and D. To allow the Spend Down of Healthcare Flexible Spending Account once participation has ceased. Section 3. Approval of the Plan Document Amendment will provide the framework for staff to take such actions that are deemed necessary and proper in order to implement the Plan, and to setup adequate accounting and administrative procedures to provide employee benefits under the Plan. PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 15th day of November, 2022. Matt Rahn, Mayor ATTEST: Randi Johl, City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Randi Johl, City Clerk of the City of Temecula, do hereby certify that the foregoing Resolution No. 2022- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 151h day of November, 2022, by the following vote: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: Randi Johl, City Clerk AMENDMENT TO CITY OF TEMECULA SECTION 125 CAFETERIA PLAN DOCUMENT, AS AMENDED AND RESTATED ON JANUARY 1, 2019 CONSOLIDATED APPROPRIATIONS ACT OF 2021 AMENDMENT 1.1 AMENDMENT TO PLAN The City of Temecula ("Employer") hereby amends the Section 125 Cafeteria Plan Document, as amended and restatement on January 1, 2019 (the "Plan"), in good faith compliance with the Consolidated Appropriations Act of 2021 (CAA, 2021), IRS Notice 2021-15, the American Rescue Plan Act of 2021 (ARPA), and other applicable law and guidance, unless otherwise specifically stated herein. This amendment supersedes any inconsistent provisions of the Plan for eligible Plan Years provided by the CAA, IRS Notice 2021-15, the ARPA, and other applicable law and guidance. a) Prospective Change of Election Prospective election changes can be made to a Participant's Healthcare Flexible Spending Account and/or Dependent Care Assistance Program accounts during the 2020 Plan Year. 2. This Amendment is effective on January 1, 2020, and is in effect for eligible Plan Years provided by the CAA, IRS Notice 2021-15, the ARPA, and other applicable law and guidance. b) Healthcare Flexible Spending Account Carryover 1. The maximum amount Participants may carryover in their Healthcare Flexible Spending Account from the plan year beginning in 2020 to the plan year beginning in 2021 is unlimited up to the amount of contributions for the plan year beginning in 2020. 2. This Amendment is effective on January 1, 2020, and is in effect for eligible Plan Years provided by the CAA, IRS Notice 2021-15, the ARPA, and other applicable law and guidance. c) Dependent Care Assistance Program Extended Grace Period/Claims Extension Period The claims extension period (grace period) for participants to use funds in their Dependent Care Assistant Program from the plan year beginning in 2020 to the plan year beginning in 2021 is extended from 2'/2 months to 12 months after the end of the plan year beginning in 2020. 10171500.1 TE060-011-8/22/22 2. This Amendment is effective on January 1, 2020, and is in effect for eligible Plan Years provided by the CAA, IRS Notice 2021-15, the ARPA, and other applicable law and guidance. d) Spend Down of Healthcare Flexible Spending Account 1. The Participants may continue to receive reimbursements from unused contributions in their Healthcare Flexible Spending Account for expenses incurred through the end of the plan year in which such Participant ceased participation. 2. This Amendment is effective on January 1, 2020, and is in effect for eligible Plan Years provided by the CAA, IRS Notice 2021-15, the ARPA, and other applicable law and guidance. 2 10171500.1 TE060-011-8/22/22 Item No. 7 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Luke Watson, Deputy City Manager DATE: November 15, 2022 SUBJECT: Adopt Resolution Declaring City Owned Parcels Located at 28725 and 28731 Pujol Street to be Exempt from the Surplus Land Act PREPARED BY: Haide Urias, Housing and Real Estate Analyst RECOMMENDATION: That the City Council adopt a resolution entitled: RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA DECLARING A CITY -OWNED PARCEL LOCATED AT 28725 AND 28731 PUJOL STREET IN THE CITY OF TEMECULA TO BE EXEMPT SURPLUS LAND PURSUANT TO GOVERNMENT CODE SECTIONS 54221(b)(1) AND 54221(f)(1)(A), FINDING THE DECLARATION EXEMPT FROM THE CALIFORNIA ENVIRONMENTAL QUALITY ACT, AND TAKING RELATED ACTIONS BACKGROUND: The City of Temecula is the owner of vacant property located at 28725 and 28731 Pujol Street. The Property is approximately 0.46 acres in size, located within the Old Town Specific Plan and is zoned Neighborhood Residential (NR). The City desires to sell the Property to Habitat for Humanity Inland Valley, Inc., a California nonprofit public benefit corporation, for the development of an affordable housing project. Per the Surplus Land Act (Government Code Sections 54220-54234), the City Council must declare the property to be surplus land or exempt surplus land before any action is taken. As part of the Surplus Land Act guidelines the City has requested approval of exempt surplus land from the California Department of Housing and Community Development (HCD). On September 29th, 2022, HCD has determined that the property located at 28725 and 28731 Pujol Street qualifies as exempt surplus land. FISCAL IMPACT: There is no current fiscal impact. ATTACHMENTS: 1. Resolution 2. HCD Approval of Surplus Land Act RESOLUTION NO.2022- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA DECLARING A CITY -OWNED PARCEL LOCATED AT 28725 AND 28731 PUJOL STREET IN THE CITY OF TEMECULA TO BE EXEMPT SURPLUS LAND PURSUANT TO GOVERNMENT CODE SECTIONS 54221(b)(1) AND 54221(f)(1)(A), FINDING THE DECLARATION EXEMPT FROM THE CALIFORNIA ENVIRONMENTAL QUALITY ACT, RELATED ACTIONS RECITALS: AND TAKING WHEREAS, the City of Temecula ("City") is the owner in fee simple of that certain real property in the City located at 28725 and 28731 Pujol Street and described on Exhibit "A", which is attached hereto and incorporated herein by reference ("Property"). The Property is currently vacant, is approximately 0.46 acres in size, and is zoned Neighborhood Residential; and WHEREAS, the City desires to sell the Property for the development of an affordable housing project thereon in order to provide needed housing in the City and to meet its Regional Housing Needs Assessment allocations for people of all income levels; and WHEREAS, pursuant to Section 54221(b)(1) of the Surplus Land Act (Government Code Sections 54220-54234), the City Council must declare the Property to be "surplus land" or "exempt surplus land" before the City Council takes action to dispose of the Property; and WHEREAS, Government Code Section 54221(f)(1)(A) defines "exempt surplus land" to include surplus land that is transferred pursuant to Government Code Section 37364; and WHEREAS, Government Code Section 37364 authorizes a city to sell, lease, exchange, quitclaim, convey, or otherwise dispose of real property to provide housing affordable to persons and families of low or moderate income provided that the following conditions are met: (a) Not less than 80 percent of the area of the parcel will be used for the development of housing; and (b) Not less than 40 percent of the total number of those housing units developed on the parcel shall be affordable to households whose incomes are equal to, or less than, 75 percent of the maximum income of lower income households, and at least half of which shall be affordable to very low income households; and (c) Dwelling units produced for persons and families of low or moderate income under Government Code Section 37364 shall be restricted by regulatory agreement to remain continually affordable to those persons and families for the longest feasible time, but not less than 30 years, with such regulatory agreement recorded in the office of the county recorder in which the housing development is located; and WHEREAS, Habitat for Humanity Inland Valley, Inc., a California nonprofit public benefit corporation, has proposed to purchase the Property from the City for the purpose of developing an affordable housing project on the Property that complies with Government Code Section 37364; and WHEREAS, because the proposed housing development will meet the requirements of Government Code Section 37364, staff has recommended that the City Council declare the Property to be exempt surplus land pursuant to Government Code Section 542221(f)(1)(A). THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY RESOLVE AS FOLLOWS: Section 1. The above recitals are true and correct and are a substantive part of this Resolution. Section 2. The City Council hereby declares pursuant to Government Code Sections 54221(b)(1) and 5422 1 (f)(1)(A) that the Property is exempt surplus land because the City intends to sell the Property to Habitat for Humanity Inland Valley, Inc., a California nonprofit public benefit corporation, pursuant to Government Code Section 37364 for the development of an affordable housing project on the Property that complies with the requirements of Section 37364. Section 3. The City Council finds that it can be seen with certainty that there is no possibility that declaring the Property exempt surplus land may have a significant effect on the environment, and thus this declaration is not subject to the California Environmental Quality Act (CEQA). Further, any proposed project on the Property will be subject to environmental review as required by CEQA. Section 4. Staff is hereby authorized and directed to provide a copy of this Resolution to the Department of Housing and Community Development ("HCD") in the manner required by HCD. Section 5. The staff and officers of the City are hereby authorized, jointly and severally, to take such actions as they deem necessary or proper to effectuate the purposes of this Resolution and all actions previously taken are hereby ratified Section 6. The City Clerk shall certify as to the adoption of this Resolution. PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 15th day of November, 2022. Matt Rahn, Mayor ATTEST: Randi Johl, City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Randi Johl, City Clerk of the City of Temecula, do hereby certify that the foregoing Resolution No. 2022- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 15th day of November, 2022, by the following vote: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: Randi Johl, City Clerk EXHIBIT "A" LEGAL DESCRIPTION OF SITE THE LAND REFERRED TO HEREIN BELOW IS SITUATED IN THE CITY OF TEMECULA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA AND IS DESCRIBED AS FOLLOWS: LOT 5 OF BLOCK 34 OF THE TOWNSITE OF TEMECULA, IN THE CITY OF TEMECULA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS SHOWN BY MAP ON FILE IN BOOK 15, PAGE 726 OF MAPS, RECORDS OF SAN DIEGO COUNTY, CALIFORNIA. TOGETHER WITH THAT PORTION OF AN ANNEXED STREET ADJACENT AND ON THE SOUTH SIDE OF SAID LOTS, AS VACATED BY RESOLUTION FILED DECEMBER 8,1936 IN BOOK 304, PAGE 356 OF OFFICIAL RECORDS OF RIVERSIDE COUNTY, CALIFORNIA. (APN: 922-062-016) AND LOT 6 OF BLOCK 34 OF THE TOWNSITE OF TEMECULA, IN THE CITY OF TEMECULA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS SHOWN BY MAP ON FILE IN BOOK 15, PAGE 726 OF MAPS, -IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. TOGETHER WITH THAT PORTION OF AN ANNEXED STREET ADJACENT AND ON THE SOUTH SIDE OF SAID LOT AS VACATED BY RESOLUTION FILED DECEMBER 8,1936 IN BOOK 304, PAGE 356 OF OFFICIAL RECORDS OF RIVERSIDE COUNTY, CALIFORNIA. (APN: 922-062-010) -5- 11086-0111 \25 57672v l . doc Haide Urias From: Wahid, Imaez@HCD <Imaez.Wahid@hcd.ca.gov> Sent: Thursday, September 29, 2022 7:34 AM To: Haide Urias Cc: Luke Watson Subject: RE: HCD Approval of Surplus Land Act Attachments: Temecula - Pujol - CC Resolution Declaring Property Exempt Surplus Land.DOCX CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Dear Haide, Thank you for notifying the California Department of Housing and Community Development of the City of Temecula's (City) determination of the property located at 28725 and 28731 Pujol Street (Property) as "exempt surplus land." And thank you for submitting the attached draft Resolution (Resolution) to HCD pursuant to Section 400(e)(2) of the Surplus Land Act (SLA) Guidelines. My name is Imaez Wahid. I am a housing specialist with the Surplus Land Act team. I process notices of determination of exempt surplus land. The Resolution provides that the City intends to sell the Property to Habitat for Humanity Inland Valley, Inc., a California nonprofit public benefit corporation, for the development of an affordable housing project on the Property pursuant to Government Code section 37364. Based on this information, the Property qualifies as "exempt surplus land" under Government Code section 54221(f)(1)(A). As required by Section 400(e) of the SLA Guidelines, please submit the adopted and approved Resolution to HCD at least 30 days prior to disposition. HCD will complete its formal review of the Resolution and issue a finding letter. Please feel free to reach out to me if you have any questions. Sincerely, V ��trpoze�'4'• HOUSING IS KEY Imaez Wahid Housing Specialist I, Housing Policy Development Housing and Community Development 2020 W. El Camino Avenue, Suite 500 1 Sacramento, CA 95833 Phone: 916.776.7496 From: Haide Urias <Haide.Urias@temeculaca.gov> Sent: Wednesday, September 21, 2022 12:17 PM To: PublicLands@HCD <publiclands@hcd.ca.gov> Cc: Luke Watson <luke.watson@temeculaca.gov> Subject: HCD Approval of Surplus Land Act To whom it may concern, The City of Temecula is looking to receive your approval of the attached resolution relating to releasing City owned land for the development of affordable housing. Feel free to reach out to me directly if you have any questions or concerns. Haide Urias Housing Analyst City of Temecula (951)693-3918 Haide.Urias@temeculaca.gov 41nnn Main St TPmPridn CA 9?59O Please note that email correspondence with the City of Temecula, along with attachments, may be subject to the California Public Records Act, and therefore may be subject to disclosure unless otherwise exempt. Item No. 8 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Patrick Thomas, Director of Public Works/City Engineer DATE: November 15, 2022 SUBJECT: Approve First Amendment to the Minor Maintenance Agreement with Craftsmen Plumbing Heating & Cooling, Inc. PREPARED BY: Stacey Biddle, Management Assistant Julie Tarrant, Principal Management Analyst RECOMMENDATION: That the City Council approve the first amendment to the minor maintenance agreement with Craftsmen Plumbing Heating & Cooling, Inc., to amend the scope of services to include additional general contracting services, and to amend the payment terms for a total agreement value for the term of the agreement. BACKGROUND: On July 1, 2020, City Council approved a Minor Maintenance Agreement with Craftsmen Plumbing, Heating, & Cooling, Inc., for the repairs and maintenance of plumbing, heating, and cooling systems at the various locations upon real and personal property of the City. Craftsmen Plumbing Heating & Cooling, Inc., has proven to be one of our most reliable contractors, providing exceptional service at a competitive price. Additional general contracting services are needed to support all divisions of the Public Works Department to include, but are not limited to, concrete, roofing, building and tenant improvements, electrical and fire systems services, inspections, various materials and supplies, and installations, renovations, and rehabilitations. Craftsmen Plumbing Heating & Cooling, Inc. has shown they are capable and responsive to the needs of the city to provide a variety of maintenance services and offer an efficient and economical means of completing the work. The First Amendment will also amend the Payment Terms to allow for a total Agreement value, removing the annual allowance that is currently limited to $325,000 per fiscal year. The original term of the Agreement will remain unchanged and will be in effect through June 30, 2025, unless otherwise amended in the future. FISCAL IMPACT: There is no fiscal impact to amend the Minor Maintenance Agreement to expand the scope of services for general contracting services. ATTACHMENTS: First Amendment FIRST AMENDMENT TO AGREEMENT BETWEEN CITY OF TEMECULA AND CRAFTSMEN PLUMBING HEATING & COOLING, INC. ROUTINE MAINTENANCE SERVICES THIS FIRST AMENDMENT is made and entered into as of November 15, 2022 by and between the City of Temecula , a municipal corporation (hereinafter referred to as "City"), and Craftsmen Plumbing Heating & Cooling, Inc., a Corporation (hereinafter referred to as "Contractor"). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: This Amendment is made with the respect to the following facts and purposes: a. On July 1, 2020, the City and Contractor entered into that certain Agreement entitled "Agreement for Routine Maintenance Services," in the amount of $325,000 each fiscal year, for a total Agreement amount of $1,625,000. b. The parties now desire to update the scope of work and to amend the Agreement as set forth in this Amendment. 2. Section 3 of the Agreement entitled "PAYMENT" at paragraph "a" is hereby amended to read as follows: The City agrees to pay Contractor monthly, in accordance with the payment rates and schedules and terms set forth in Exhibit B, Payment Rates and Schedule, attached hereto and incorporated herein by this reference as though set forth in full, based upon actual time spent on the above tasks. Any terms in Exhibit B, other than the payment rates and schedule of payment, are null and void. This amount shall not exceed One Million Six Hundred Twenty - Five Thousand Dollars ($1,625,000) for the total term of this agreement unless additional payment is approved as provided in this Agreement. 3. Exhibit A Scope of Work and Exhibit B Payment Rates and Schedule to the Agreement is hereby amended by adding thereto the items set forth on Attachment "A" to this Amendment, which is attached hereto and incorporated herein as though set forth in full. 4. Except for the changes specifically set forth herein, all other terms and conditions of the Agreement shall remain in full force and effect. 08/09/2021 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above written. CITY OF TEMECULA By: Matt Rahn, Mayor ATTEST: By: Randi Johl, City Clerk APPROVED AS TO FORM: By: CRAFTSMEN PLUMBING HEATING & COOLING, INC. (Two Signatures of corporate officers required unless corporate documents authorize only one person to sign the agreement on behalf of the corporation.) By: Laura McKee, Treasurer Peter M. Thorson, City Attorney CONTRACTOR Craftsmen Plumbing Contact Person: Dan 27636 Ynez Road Heatinc,�& Cooling, Inc. iv McKee Temecula, CA 92591 Phone Number: (951) 676-6838 craftsmeninc@hotmail.com City Purchasing Mgr. Initials and Date�2- - _2 -- r. 08/09/2021 ATTACHMENT A EXHIBIT A Contractor recognizes and agrees that this Agreement is for the purpose of establishing a contractual relationship between the City of Temecula and the Contractor for the future repairs, and maintenance of plumbing, heating and cooling systems, and a variety of general contracting services to include, but not limited to; concrete, roofing, building & tenant improvements, electrical services, fire systems, inspections, various materials and supplies, and installations, renovations, and rehabilitations at the various locations upon real and personal property of the City. Work will also include maintenance services, and emergency call -out. The procedure for assigning work is set forth as follows: 1. The City Manager or his designee shall submit to Contractor a written "Request for Work". The Request for Work shall include a description of the work to be completed, the time for completion of the work, and the plans and specifications, if any, work. 2. Within five (5) business days of the date of the Request for Work, Contractor shall respond in writing to the Request for Work and advise the City Manager whether it can perform the work and specify the cost of material which will be required and the estimated cost of labor and equipment necessary to complete the work in accordance with the labor and equipment rates set forth in Exhibit "B" to this Agreement. 3. In the event emergency work is required, the City Manager may transmit the Request for Work orally to the Contractor. As soon as practical following the emergency, the Contractor and Director shall in good faith confirm in writing the scope of the emergency work undertaken. 4. Upon acceptance of the Contractor's response by the City Manager, the Contractor shall proceed with the work. The performance of the work shall be pursuant to the terms of this Agreement. 08/09/2021 EXHIBIT "B" PAYMENT RATES AND SCHEDULE The cost of such services, labor, materials or supplies, while not guaranteed per Section 3 of this Agreement, shall not exceed $1,625,000 for the total term of the Agreement, unless additional payment is approved as provided in this Agreement. General Contracting Services to include, but not limited to: Plumbing, heating and cooling systems, and a variety of general contracting services to include, but not limited to; concrete, roofing, building & tenant improvements, electrical services, fire systems, inspections, various materials and supplies, and installations, renovations, and rehabilitations. Contractor will provide to the City a quote or estimate for the work to be performed, when and as requested by city staff/representatives for each work task, inclusive of total cost of work to complete the task or project. 08/09/2021 Item No. 9 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Luke Watson, Deputy City Manager DATE: November 15, 2022 SUBJECT: Approve First Amendment for General Plan Update City -Wide Traffic Analysis Services PREPARED BY: Brandon Rabidou, Principal Management Analyst RECOMMENDATION: That the City Council approve the first amendment to the agreement with Fehr and Peers for General Plan Update City -Wide Traffic Analysis Services and increase the agreement amount by $7,500, for a total contract amount of $137,500. BACKGROUND: Fehr and Peers is provided comprehensive Community Transportation Benchmarking Services for the City of Temecula. These services are provided in anticipation of a future General Plan update. Staff has requested additional work on the project, resulting in the need for a contract amendment. FISCAL IMPACT: $7,500, which has been adequately budgeted in 210.265.777.5801 ATTACHMENTS: 1 st Amendment FIRST AMENDMENT TO AGREEMENT BETWEEN CITY OF TEMECULA AND FEHR & PEERS INC. TRANSPORTATION DISCOVERY/BENCHMARKING EXISTING CONDITIONS TO SUPPORT CIRCULATION ELEMENT UPDATE THIS FIRST AMENDMENT is made and entered into as of November 15, 2022, by and between the City of Temecula, a municipal corporation (hereinafter referred to as "City"), and Fehr and Peers Inc., a Corporation (hereinafter referred to as "Consultant"). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: This Amendment is made with the respect to the following facts and purposes: a. On December 1, 2020, the City and Consultant entered into that certain Agreement entitled "Agreement for Transportation Discovery/Benchmarking Existing Conditions to Support Circulation Element Update," in the amount of $130,000.00. b. The parties now desire to add scope of work, extend the term of the agreement to June 30, 2023, increase the payment in the amount of $7,500.00, and to amend the Agreement as set forth in this Amendment. 2. Section 1 of the Agreement entitled "TERM" is hereby amended to read as follows: "This Agreement shall remain and continue in effect until tasks herein are completed, but in no event later than June 30, 2023, unless sooner terminated pursuant to the provisions of this Agreement. 3. Section 4 of the Agreement entitled "PAYMENT" at paragraph "a" is hereby amended to read as follows: The City agrees to pay Consultant monthly, in accordance with the payment rates and schedules and terms set forth in Exhibit B, Payment Rates and Schedule, attached hereto and incorporated herein by this reference as though set forth in full, based upon actual time spent on the above tasks. Any terms in Exhibit B, other than the payment rates and schedule of payment, are null and void. The First Amendment amount shall not exceed Seven Thousand Five Hundred Dollars and Zero Cents ($7,500.00), for additional scope of work for a total Agreement amount of One Hundred Thirty -Seven Thousand Five Hundred Dollars and Zero Cents ($137,500.00). 4. Exhibit A to the Agreement is hereby amended by adding thereto the items set forth on Attachment "A" to this Amendment, which is attached hereto and incorporated herein as though set forth in full. 5. Except for the changes specifically set forth herein, all other terms and conditions of the Agreement shall remain in full force and effect. 08/09/2021 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above written. CITY OF TEMECULA By: Matt Rahn, Mayor ATTEST: By: Rand! Johl, City Clerk APPROVED AS TO FORM: FEHR & PEERS INC. By: QJ'1z' rah randenberg, Prin ' al By: Steve Brown, Principal By: Peter M. Thorson, City Attorney CONSULTANT Fehr & Peers Inc. Attn: Katy Cole, Principal 555 West Beech Street Suite 302 San Diego, CA 92101 k.cole@fehrandpeers.com 619 234-3190 City Purchasing Mgr. Initials and Date: 2'- 2 08/09/2021 ATTACHMENT A EXHIBIT A Attached hereto and incorporated herein as though set forth in full is the additional scope of work as provided by the Consultant. 08/09/2021 FEHR� PEERS Se pte m be r 15, 2022 Matt Peters, Principal Planner City of Temecu la 41000 Main Street Temecula, CA 92590 Subject: Additional Services for Temecula Discovery /6enchmarking Dear Matt: We appreciate the continued partnership with the City of Temecula. This proposal is for additional services to respond to City requests related to the transportation discovery/bench marking projects. We will perform the following tasks: • Create an Executive Summary document suitable for use in public settings and/or Council briefings. • Attend City meeting to review Executive Summary. • Respond to two rounds of comments on the Executive Summary. • Attend additional weekly''/2 hourcheck-In meetings (10). • Provide an online CIS Web -map in additional to the written report. • Provide AM and PM peak hour level ofservlceestimates using available data for up to three (3) Intersections under existing and future baseline conditions. Fee and Schedule These services will be performed based on the Agreement for Consultant Services dated December 1, 2020. The additional services will be performed on a time and materials basis per our contract for a maximum cost of $7,500. This Includes approximately 36 hours of professional staff time. 555 West Beech Street l Suite 302 1 San Diego, CA gzioi l (61g) 234-3190 1 Fax-(619) 702-9345 l w .fehrandpeers.com 4 08/09/2021 Matt Peters September 15, 2022 FT ,T Page 2 of 2 Please call Katy Cole at (619) 158-3001 if you have any questions. We appreciate the opportunityto assist the city with transportation study review. Sincerely, FEHR & PEERRSS K!1�1 aty Principal (D ur mission is to empower every employee to develop effective and innovative transportation solutions that improve communities 08/09/2021 Item No. 10 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Patrick Thomas, Director of Public Works/City Engineer DATE: November 15, 2022 SUBJECT: Approve Increase to Contingency Authorization for Fiber Optic Communication System Upgrade Project, PW18-05 PREPARED BY: Nick Minicilli, Senior Civil Engineer Julie Tarrant, Principal Management Analyst RECOMMENDATION: That the City Council: 1. Approve an increase to the contingency for the Fiber Optic Communication System Upgrade Project, PW18-05 by $40,000; and 2. Increase the City Manager Authority to approve change orders to the contract by $40,000. BACKGROUND: The Fiber Optic Communication System Upgrade Project is a Capital Improvement Program (CIP) project that will upgrade the City's fiber optic communication and traffic signal system. Currently, the construction phase is nearing completion and the signal timing coordination is about to commence. The Fiber Optic Communication System Upgrade project will install fiber optic communication system upgrades including conduits, cables, closed circuit television (CCTV) cameras, traffic signal controllers, and related communication equipment to improve safety and operations along the corridors of Winchester Road, Rancho California Road, and Temecula Parkway. As part of the project, the corridors will be optimized with traffic signal coordination timing to enhance safety and operations. On September 14, 2021, the City Council awarded the construction contract to JFL Electric, Inc (JFL), Inc in the amount of $690,340.50 and authorized the City Manager to approve contract change orders up to $69,034.05 for the project. During construction, the contractor has encountered existing fiber optic cable slack issues that necessitates ordering additional fiber optic cable to continue the fiber splicing work. Additional contractor work includes proofing the existing fiber optic cable along all project corridors, repulling existing fiber, installation of new fiber optic cable, and additional construction work required by Caltrans within their Right -of -Way. These additions exceed the original contingency amount and staff therefore recommends to approve an increase to the contingency, and to increase City Manager's authority to approve change orders up to a total contingency amount of $109,034.05. FISCAL IMPACT: The Fiber Optic Communication System Upgrade Project is identified in the City's Capital Improvement Program (CIP) Budget for Fiscal Years 2023-2027 with funds including Highway Safety Improvement Program (HSIP) grant funding and Measure S. There are sufficient funds in the project budget to allow for an increase of $40,000 to the contingency. ATTACHMENTS: CIP Budget Sheet ANk Tf,F �•-.�r. r�' S:,u�I,Frn i.:: f::rni� City of Temecula Fiscal Years 2023-27 Capital Improvement Program FIBER OPTIC COMMUNICATION SYSTEM UPGRADE Infrastructure Project Project Description: This project will install fiber optic communication system upgrades including conduit, cable, closed circuit television (CCTV) cameras, traffic signal controllers and related communication equipment to improve safety and operations with optimized traffic signal timing coordination. Various signalized intersections will be improved along the Winchester Road, Rancho California Road and Temecula Parkway corridors. Benefit: This project will upgrade the City's fiber optic communication and traffic signal system equipment. Core Value: A Safe and Prepared Community Project Status: This project will be completed in Fiscal Year2022-23. Department: Public Works - Account No. 210.265.999.550 / PW18-05 Level: I A Project Cost: Prior Years Actuals 2022-23 2021-22 Adopted 2023-24 2024-25 2025-26 2026-27 Adjusted Budget Projected Projected Projected Projected Total Project Cost Administration 254 25,000 25,254 Construction 842,446 842,446 Construction Engineering 275,100 275,100 Design & Environmental 119,770 30 119,800 Furnishings & Equipment 338,600 338,600 Total Expenditures 1 120,0241 1,481,176 1,601,200 Source of Funds: HSIP-Highway Safety 1,208,200 1,208,200 Improvement Program Measure S 113,000 280,000 393,000 Total Funding 113,000 1,488,200 - 1,601,200 Future Operating & Maintenance Costs: Total Operating Costs Notes : 1. The negative budget amount in FY21-22 reflects the transfer of Construction costs to Furnishings & Equipment costs. 2. Highway Safety Improvement Program - HSIPL 5459(026) 3. Fiscal Year2021-22 adds construction oversight costs - City administration, consultant -construction management/inspection services and the purchase of specialized equipment (FF&E). 135 Item No. 11 ACTION MINUTES TEMECULA COMMUNITY SERVICES DISTRICT MEETING COUNCIL CHAMBERS 41000 MAIN STREET TEMECULA, CALIFORNIA OCTOBER 25, 2022 CALL TO ORDER at 7:32 PM: Vice President Zak Schwank ROLL CALL: Alexander, Edwards, Rahn, Schwank, Stewart CSD PUBLIC COMMENTS -None CSD CONSENT CALENDAR Unless otherwise indicated below, the following pertains to all items on the Consent Calendar. Approved the Staff Recommendation (5-0): Motion by Edwards, Second by Rahn. The vote reflected unanimous approval. 11. Approve Action Minutes of October 11, 2022 Recommendation: That the Board of Directors approve the action minutes of October 11, 2022. CSD DIRECTOR OF COMMUNITY SERVICES REPORT CSD GENERAL MANAGER REPORT CSD BOARD OF DIRECTORS REPORTS CSD ADJOURNMENT At 7:34 PM, the Community Services District meeting was formally adjourned to Tuesday, November 15, 2022 at 4:30 PM for a Closed Session, with a regular session commencing at 6:00 PM, City Council Chambers, 41000 Main Street, Temecula, California. James Stewart, President ATTEST: Randi Johl, Secretary [SEAL] Item No. 12 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Luke Watson, Deputy City Manager DATE: November 15, 2022 SUBJECT: Approve Community Development Block Grant (CDBG) Substantial Amendment to the 2022-23 CDBG Annual Action Plan for the Reallocation of CDBG Funds to the Mary Phillips Senior Center PREPARED BY: Brandon Rabidou, Principal Management Analyst RECOMMENDATION: That the City Council adopt the resolution entitled: RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING THE SUBSTANTIAL AMENDMENT TO THE 2022-23 COMMUNITY DEVELOPMENT BLOCK GRANT ANNUAL ACTION PLAN AND FINDING THE ACTIONS TO BE EXEMPT FROM FURTHER ENVIRONMENTAL REVIEW UNDER THE CALIFORNIA ENVIRONMENTAL QUALITY ACT (CEQA) AND NATIONAL ENVIRONMENTAL PROTECTION ACT (NEPA) BACKGROUND: The U.S. Department of Housing and Urban Development (HUD) requires all entitlement communities receiving Community Development Block Grant (CDBG) funds, such as the City of Temecula, to prepare and submit a Consolidated Plan every five years to establish a unified, strategic vision for community development, housing and economic development actions. The Consolidated Plan encompasses the analysis of local community needs and coordinates appropriate responses to those needs and priorities. The Temecula City Council adopted its most recent Five -Year Consolidated Plan for Fiscal years 2022-26 on April 26, 2022, which also includes the first Action Plan of that cycle (2022-23 Annual Action Plan) on April 26, 2022. The Consolidated Plan is carried out through Annual Action Plans, which provide a concise summary of the actions, activities, and the specific federal and non-federal resources that will be used each year to address the priority needs and specific goals identified by the Consolidated Plan. Per the City's Citizen Participation Plan, a Substantial Amendment to an Annual Action Plan is required when a "substantial" change is proposed, which includes: • To carry out a project not previously described in the Annual Action Plan using funds covered by the Consolidated Plan, including program income. • To substantially amend the purpose, scope, location, or beneficiaries of a project. • To substantially amend the allocation priorities or the method of distributing funds. SUBSTANTIAL AMENDMENT PROPOSED CHANGES: The Substantial Amendment to the 2022-2023 Action Plan is necessary because the City is proposing to carry out a project not previously described in the Annual Action Plan using funds covered by the Annual Action Plan. The City's 2022-2023 annual action plan previously accounted for the funds to be used for the "removal of architectural barriers for public right of ways in roadways, public facilities" on a capital improvement project. This Substantial Amendment No. 1 to the 2022-2023 Annual Action Plan officially assigns these funds ($331,014) identified in the Action Plan to the ADA Improvements Project at the Mary Phillips Senior Center (PW20-13). The project's current CDBG budget is $726,569.78, with the additional assignment of funds the projects total CDBG contribution is $1,057,583.78. Measure S funds in the amount of $258,425 are also being provided for the project. NOTICING A Notice of Public Hearing and the commencement of the 30-day public review period was published in the Press Enterprise on October 15, 2022, informing the public of the proposed substantial amendment. FISCAL IMPACT: The approval of the Substantial Amendment will allow the expenditure of the City's appropriation of federal CDBG funds for the 2022-23 Program year. ATTACHMENTS: 1. Resolution — Substantial Amendment No. 1 to the 2022-2023 Annual Action Plan 2. Exhibit A — Substantial Amendment 3. Notice of Public Hearing RESOLUTION NO. 2022- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING THE SUBSTANTIAL AMENDMENT TO THE 2022-23 COMMUNITY DEVELOPMENT BLOCK GRANT ANNUAL ACTION PLAN AND FINDING THE ACTIONS TO BE EXEMPT FROM FURTHER ENVIRONMENTAL REVIEW UNDER THE CALIFORNIA ENVIRONMENTAL QUALITY ACT (CEQA) AND NATIONAL ENVIRONMENTAL PROTECTION ACT (NEPA) THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY RESOLVE AS FOLLOWS: Section 1. Procedural Findings. The City Council of the City of Temecula does hereby find, determine and declare that: A. The City of Temecula has participated directly within the federal Department of Housing and Urban Development (HUD) as an entitlement jurisdiction for Community Development Block Grant (CDBG) funds since July 1, 2012; B. The City of Temecula has prepared all documents, notices, and forms required by HUD for participation in the CDBG Program by entitlement jurisdictions; C. On April 26, 2022, the City Council adopted the updated Citizen Participation Plan that sets forth the City's policies and procedures for citizen participation in the development of its Five -Year Consolidated Plan, Annual Action Plans, Annual Performance Reports, and any substantial amendments deemed necessary for direct administration of federal CDBG funds; D The Citizen Participation Plan included policies and procedures for amending Annual Action Plans where CDBG-funded activities may be added or deleted, and funding for activities may be increased; E. It was determined that the changes for activities listed required a substantial amendment in accordance with the City's adopted Citizen Participation Plan; F. The Substantial Amendment was presented to the City Council at a public hearing held on November 15, 2022; G. The City Council, at a regular meeting, considered the Substantial Amendment on November 15, 2022, at a duly noticed public hearing as prescribed by law, at which time the City staff and interested persons had an opportunity to and did testify either in support or in opposition to this matter. H. At the conclusion of the City Council hearing and after due consideration of the testimony, the City Council approved the Substantial Amendment, subject to and based upon the findings set forth hereunder. I. All legal preconditions to the adoption of this Resolution have occurred. Section 2. Further Findings. The City Council, in approving the Plan hereby finds, determines and declares that: A. Pursuant to Title 24, Housing and Urban Development, of the Code of Federal Regulations, Subtitle A Office of the Secretary, Department of Housing and Urban Development, Part 91 Consolidated Submissions For Community Planning And Development Programs (24 CFR Part 91) each entitlement jurisdiction shall amend its approved Annual Action plan whenever it plans to carry out a project not previously described in the Annual Action Plan using funds covered by the Consolidated Plan, including program income, to substantially amend the purpose, scope, location, or beneficiaries of a project, and when it plans to substantially amend the allocation priorities or the method of distributing funds. Section 3. Environmental Findings. The proposed action on the Substantial Amendment is exempt ftom National Environmental Policy Act (NEPA) pursuant to the provisions of the National Environmental Policy Act and specifically 24 CFR 58.34(a)(1) because the Substantial Amendment is a resource identification study and the development of plans and strategies for the prioritization and funding of proposed programs through CDBG and the proposed action involves the feasibility and planning studies to determine prioritization and CDBG funding to begin the development of certain projects. The potential projects discussed in the proposed actions that might involve physical activity have been reviewed under NEPA or the California Environmental Quality Act (CEQA) as part of the development of those projects. The proposed action is also exempt from CEQA per CEQA Guidelines Section 15262 and 15378(b)(4). Section 4. Approvals. A. The City Council hereby approves the Substantial Amendment as set forth as Exhibit A attached hereto, and any and all other documents deemed necessary by HUD to obtain the annual CDBG allocation of the federal CDBG funds and authorizes and directs the City Manager, or his designee, to serve as the Certifying Officer for all environmental review procedures associated with the various CDBG projects, and Certifying Officer for the purpose of signing correspondence, agreements, and other required documents. B. The City Council hereby approves the reprogram of the funds as set forth in Exhibit A. Section 5. Certification. The City Clerk shall certify to the adoption of this Resolution. 2 PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 15th day of November, 2022. Matt Rahn, Mayor ATTEST: Randi Johl, City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Randi Johl, City Clerk of the City of Temecula, of the City of Temecula, do hereby certify that the foregoing Resolution No. 2022- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 15th day of November, 2022, by the following vote: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: Randi Johl, City Clerk SUBSTANTIAL AMENDMENT TO 2022-2023 ANNUAL ACTION PLAN A. EXECUTIVE SUMMARY The U.S. Department of Housing and Urban Development (HUD) requires all entitlement communities receiving Community Development Block Grant (CDBG) funds, such as the City of Temecula, to prepare and submit a Consolidated Plan every five years to establish a unified, strategic vision for community development, housing and economic development actions. The Consolidated Plan encompasses the analysis of local community needs and coordinates appropriate responses to those needs and priorities. The Temecula City Council adopted its most recent Five Year Consolidated Plan for Fiscal years 2022-26 on April 26, 2022 which also includes the first Action Plan of that cycle (2022-23 Annual Action Plan) on April 26, 2022. The Consolidated Plan is carried out through Annual Action Plans, which provide a concise summary of the actions, activities, and the specific federal and non-federal resources that will be used each year to address the priority needs and specific goals identified by the Consolidated Plan. Per the City's Citizen Participation Plan, a Substantial Amendment to an Annual Action Plan is required when a "substantial" change is proposed, which includes: a. To carry out a project not previously described in the Annual Action Plan using funds covered by the Consolidated Plan, including program income. b. To substantially amend the purpose, scope, location, or beneficiaries of a project. c. To substantially amend the allocation priorities or the method of distributing funds. The Substantial Amendment to the 2022-2023 Action Plan is necessary because the City is proposing to carry out a project not previously described in the Annual Action Plan using funds covered by the Annual Action Plan. The City's 2022-2023 annual action plan previously accounted for the funds to be used for the "removal of architectural barriers for public right of ways in roadways, public facilities" on a capital improvement project. This Substantial Amendment No. 1 to the 2022-2023 Annual Action Plan officially assigns these funds ($331,014) identified in the Action Plan to the ADA Improvements Project at the Mary Phillips Senior Center (PW20-13). The projects current CDBG budget is $726,569.78, with the additional assignment of funds the projects total CDBG contribution is $1,057,583.78. Measure S funds in the amount of $258,425 are also being provided for the project. B. CITIZEN PARTICIPATION A Notice of Public Hearing and the commencement of the 30-day public review period was published in the newspaper on October 15, 2022, informing the public of the proposed Substantial Amendment and inviting comments at the public hearing that will be held on November 15, 2022, at City of Temecula City Council Chambers. The public review period began on October 15, 2022, and ends November 15, 2022. Citizens were able to review copies of the Draft Substantial Amendment at the Ronald H. Roberts Temecula Public Library, Temecula City Hall (City Clerk's Office and Community Development Department) City of Temecula 2022-2023 Action Plan Pg. 1 Substantial Amendment— November 15, 2022 and on the City's website at http://www.TemeculaCA.gov/CDBG On November 15, 2022, the Temecula City Council will hear public comments regarding the Substantial Amendment. C. CHANGES TO THE 2022-2023 ANNUAL ACTION PLAN ACTIVITIES This Substantial Amendment proposed to the following changes: Project Name CDBG Budget Proposed New CDBG Budget ADA Improvements Project (Unassigned Location) $331,014 $0 Mary Phillips Senior Center ADA Improvements (PW20-13) $726,569.78 *$1,057,583.78 *Proposed new CDBG budget does not include the proposed amount of Measure S funds to be included. Original CIP Project Description Proposed New CIP Project Description Removal of architectural barriers for public right Project funds will be assigned to remove of ways in roadways, public facilities. architectural barriers and ensure safe and proper access to those in need located at the Mary Phillips Senior Center. Project identified as (PW20-13). D. PUBLIC COMMENTS Any and all public comments made on this item will be summarized and included in the final version updated to the City's 2022-2023 Annual Action that is submitted to HUD. City of Temecula 2022-2023 Action Plan Pg. 2 Substantial Amendment— November 15, 2022 NOTICE OF PUBLIC HEARING AND AVAILABILITY FOR REVIEW OF DRAFT SUBSTANTIAL AMENDMENT NO. 1 TO THE 2022-2023 ANNUAL ACTION PLAN NOTICE IS HEREBY GIVEN that the City of Temecula has prepared a draft Substantial Amendment No. 1 to the 2022-2023 Annual Action Plan. The publication of this notice is the beginning of the 30-day public review period required under Federal Regulation 21 CFR 91.105 (b) (2). The public review and written comment period begins on October 15, 2022 and runs through November 15, 2022. NOTICE IS HEREBY FURTHER GIVEN that the City will conduct a Public Hearing when the Substantial Amendment is presented to the City Council for approval, on following date: DATE: Tuesday, November 15, 2022 TIME: 6:00 p.m. LOCATION: City of Temecula, Council Chambers, 41000 Main Street, Temecula, CA 92590 DRAFT 2022-2023 ANNUAL ACTION PLAN SUBSTANTIAL AMENDMENT NO. 1 The One -Year Action Plan sets forth specific activities to be funded through the Community Development Block Grant (CDBG) Program. The City proposes the following draft changes to activities included in the 2022-2023 Action Plan: Assign Program Year 2022-2023 Capital Improvement Project Funds in the amount of $331,014 to the ADA Improvements Project set to take place the City's Mary Phillips Senior Center (PW20-13). The City's 2022-2023 annual action plan previously accounted for the funds to be used for the "removal of architectural barriers for public right of ways in roadways, public facilities". This Substantial Amendment No. 1 to the 2022-2023 Annual Action Plan officially assigns these funds identified above to the ADA Improvements Project at the Mary Phillips Senior Center (PW20-13). The projects current CDBG budget is $726,569.78, with the additional assignment of funds the projects total CDBG contribution is $1,057,583.70. PUBLIC COMMENT Copies of the Draft Substantial Amendment will be available for public review at the following locations: City Hall, (Community Development Dept. & City Clerk's Office), 41000 Main Street, Temecula, CA 92590 • Ronald H. Roberts Temecula Public Library, 30600 Pauba Road, Temecula, CA 92592 http://www.TemeculaCA.gov/CDBG The public is invited to submit written comments on the Draft Substantial Amendment. Questions and written comments regarding the Draft Substantial Amendment may be addressed to Brandon Rabidou, Senior Management Analyst, Community Development Department, 41000 Main Street, Temecula, California 92590. You may also call (951) 506-5142 with any questions concerning the above documents. All comments relative to the draft document should be submitted no later than 4:00 p.m. November 15, 2022. ACCESSIBILITY TO MEETINGS AND DOCUMENTS It is the objective of the City to comply with Section 504 of the Rehabilitation Act of 1973, as amended, the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendment Act of 2008, the Fair Housing Act, and the Architectural Barriers Act in all respects. If you require public documents in an accessible format, the City will make reasonable efforts to accommodate your request. If you require a disability -related accommodation to attend or participate in a hearing or meeting, including auxiliary aids or services, please contact the City Clerk's Office at least 48 hours prior to the meeting at (951) 694-6444. LIMITED ENGLISH PROFICIENCY (LEP) Si necesita mas informaci6n sobre este aviso o la traducci6n de documentos en espanol, comuniquese con Brandon Rabidou al (951) 506-5142 (TTY: 951 308-6344) Kung kailangan mo ng higit pang impormasyon tungkol sa abisong ito o sa salin ng mga dokumento sa Tagalog, tawagan si Brandon Rabidou sa 951-506-5142 (TTY: 951-308-6344) Publish: October 15, 2022 Item No. 13 CITY OF TEMECULA AGENDA REPORT TO: City Council FROM: Aaron Adams, City Manager DATE: November 15, 2022 SUBJECT: Approve Recommendation for Community Service Funding - Reinvestment in Temecula Grant Program for Fiscal Year 2022-23 (At the Request of Subcommittee Members Mayor Pro Tern Schwank and Council Member Stewart) PREPARED BY: Betsy Lowrey, Assistant to the City Manager RECOMMENDATION: That the City Council: 1. Approve the Community Service Funding Ad Hoc Subcommittee's recommendation to allocate a total of $1,090,500 to fund grant applications received from nonprofit organizations for the Community Service Funding - Reinvestment in Temecula Grant Program Fiscal Year 2022-23; and 2. Approve a budget transfer of $1,000,000 from Fund 110 -Community Reinvestment Program Fund to Fund 001 - General Fund to program towards the Community Services Funding Program. BACKGROUND: The City Council appointed Mayor Pro Tem Zak Schwank and Council Member James Stewart to the Fiscal Year 2022-23 Community Service Funding Ad Hoc Subcommittee to recommend grant fund allocations up to $50,000 per non-profit organization for programs that provide services to the citizens of Temecula (only). The Community Service Funding Program adopted Fiscal Year 2022-23 budget is $1,100,000 inclusive of $1,000,000 from the Community Reinvestment Program budget. Community Service Funding has historically awarded up to $5,000 per nonprofit organization, for a total of $100,000 budgeted annually. This Fiscal Year, beginning July 1, 2022, and next Fiscal Year, beginning July 1, 2023, the program has been revitalized as "Community Service Funding — Reinvestment in Temecula," as part of the City's adopted $14,080,000 Community Reinvestment Program. Thus, the budgeted amount increased from $100,000 to $1,100,000 each Fiscal Year, for a total of $2,200,000 over two years, and nonprofit organizations can be awarded up to $50,000 each year. The "Community Service Funding - Reinvestment in Temecula Grant" Program information was e-mailed to non-profit organizations in the Temecula Valley area including all community -based charities in the City's database. In addition, advertisements were sent via a press release to the media, posted to the City's social media, emailed through eblast to approximately 42,000 recipients, and promoted on video shown at a Temecula Valley Chamber of Commerce event. The application and guidelines were also posted on the City's website. A total of 68 applications from 66 non-profit organizations were submitted to the City requesting a total of $1,090,500 in grant funding. The Ad Hoc Subcommittee, along with staff members, reviewed the requests for funding based on criteria adopted by the City Council to support non-profit organizations who offer charitable community -wide programs and services such as food, clothing, shelter, medical care, and are supportive of the arts, special needs community and similar types of charitable needs that must benefit Temecula citizens only. The Ad Hoc Subcommittee recommends that 51 programs receive grant funding ranging from $5,000 to $50,000 each, totaling $1,090,500 of the available $1,100,000 budget. Council Member Alexander will not participate in the Council discussion and action on the Birth Choice application. Birth Choice, Inc., has submitted an application for Community Reinvestment Funding. Council Member Alexander is an employee of Birth Choice and supervises its Temecula operations. Therefore, under State law, Council Member Alexander cannot participate in the Council's discussion and action on the Birth Choice application. In order to fulfill these obligations, the following procedures will be in place for this item: 1. The Mayor will call Item 13. 2. The City Attorney will explain that Council Member Alexander will not participate in the Council discussion or action on the Birth Choice application because she is employed by Birth Choice. 3. Council Member Alexander will leave the dais and the Council Chamber. 4. Staff will present the Agenda Report on Item 13 and Council will receive public comments on Item 13. 5. Following public comments on Item 13, Council will discuss the Birth Choice application and decide whether to approve, modify or deny the application. 6. Following Council action on the Birth Choice application, Council Member Alexander may return to the Council Chamber and take her place on the dais. 7. At this point, the Council, with Council Member Alexander participating, will consider the other applications for Community Reinvestment Funding. FISCAL IMPACT: Funds are available in the Fiscal Year 2022-23 Community Service Funding line item 001.101.999.5267 in the amount of $100,000 and in the Community Reinvestment Program line item in the amount of 1,000,0000. ATTACHMENTS: 1. Fiscal Year 2022-23 Application Summary Spreadsheet 2. Fiscal Year 2022-23 Applications COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA SUB- COMMITTEE RECOM- MENDATION TOTAL$ DIRECTORS OR :..•. MEMBERS OF ANY NONPROFIT ORGANIZATION 1,090,500 1a A PLACE FOR ALL 27890 Clinton Keith Rd, # D151, TEMECULA YOUTH BASKETBALL CHAMPIONS. Serves the special needs $ 5,000 $ - PIECES Murrieta, CA 92562 community with an 11-week program for K-12. Funding to be used for court Website: rental, pictures, facilitator, liability insurance, buddy shirts, materials, and end APLACEFORALLPIECES.ORG of season party. Estimated number of Temecula residents to benefit: 25-40. 1b A PLACE FOR ALL 27890 Clinton Keith Rd, # D151, INCLUSIVE HALLOWEEN TEEN/ADULT DANCE EVENT. Provide social skills, peer- NEW APPLICANT $ 51000 $ PIECES Murrieta, CA 92562 to -peer support for Temecula special needs families. Funds to be used for venue Website: ($1,600), decorations ($3,500), food ($1,500), DJ ($300). Estimated number of APLACEFORALLPIECES.ORG Temecula residents to benefit: 50-75. 2 AIM FOR GOOD NEW APPLICANT; $ 50,000 31493 Rancho Pueblo Road # 205 AIM FOR GOOD. For local individuals and nonprofits in need -- financial, public $ 10,000 Temecula, CA 92592 awareness, or volunteer support. Funds to be used for food, video marketing, SUBCOMMITTEE Website: AIMFORGOOD.ORG Autism art camps, video production equipment, and online marketing that RECOMMENDATION LIMITS supports special needs art camp, special needs programs and arts programs. FUNDS STRICTLY TO ASSIST Estimated number of Temecula residents to benefit: not identified "sky's the SPECIAL NEEDS ART CAMP; limit". Covid, inflation, and recession will, and does, impact all nonprofit SPECIAL NEEDS contributions. We haven't actively fundraised as we didn't want to compete for PROGRAMS; ARTS local dollars as local nonprofits build their strategies going forward. >$5K Our COMMUNITY PROGRAMS goal is to help whomever we can without red tape, so this grant would help kickstart that goal and funnel support via financial, marketing/promoting of needs, direct partnerships, and more. 3 ANIMAL FRIENDS 33571 Mission Trail Rd., Wildomar, TEMECULA HAS HEART FOR ANIMALS. Provides spay/neuter pet sterilization -- $ 50,000 $ 40,000 OF THE VALLEYS CA 92595 costing $60-130 (averaging $80) per dog and $50-60 per cat. The funds will Website: cover 100 spay/neuter surgeries (and stop an average of 570 animals from ANIMALFRINEDSOFTHEVALLEYS.0 roaming the streets or ending up in the shelter), pet micro -chipping, senior OM living visits, pet reading program to school -aged children in libraries. Estimated number of Temecula residents to benefit: 900. AFV lost over $170K, possibly more by not having three signature events during COVID. >$5K Will allow AFV to create a new Pet Walk event for citizens in Temecula. This will bring in much needed funding to the shelter for other Temecula events while supporting Temecula citizens, their pets and Temecula businesses. The grant will also allow AFV to offer the new Reading and Pet Education Program a few times a year, free of charge to Temecula Elementary School children and Temecula Families at both Temecula libraries. COUNCIL CSF ON N N N 0 0 0 0 Ql N O N N N N 0 0 0 0 L}L L}L L}L L}L 1,500 CDBG O O N 41 r O LL O N O N N L}L N O N N N O LL M O N N N O LL Page 1 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA 4 ASSISTANCE LEAGUE OF TEMECULA VALLEY 5 BIKE TEMECULA VALLEY CORP (BTV) I 28720 Via Montezuma, Temecula, 5 POINTS. Funding to reimburse $17,000 (March 2020 - present): Christmas presents at CA 92590 Rancho Damacitas, Emergency Clothing for foster children, supplies for Exceptional Website: Children's Christmas Program, Christmas presents and household items for Temecula ASSISTANCELEAGUE.ORG/TEMECU transitional housing (non -Minor dependents), backpacks for Community Mission of Hope, LA -VALLEY fidget toys/stress balls for Temecula School Counselors to hand out, clothing for students at Temecula Elementary School, Movie tickets for HUGS Foster Family Agency, Teddy Bears for Temecula Valley Hospital children in crisis, computer tablets for youth at Rancho Damacitas, Student Body ID Cards for foster/homeless at Great Oak High School, Famous Footwear Gift Cards for families residing at Rancho Damacitas, Mini refrigerator and microwave for Great Oak High School ROOTS program, Old Navy gift cards for Temecula Middle School students. Funding for 23K to go towards future programs including LCAP Program at Temecula Schools (Local Control and Accountability Plan) for foster/homeless, second language learners and youth in poverty, Support for Temecula Elementary Schools, Support for Special Needs Pre -School in TVUSD, support for Foster/Homeless Youth in Temecula, Rancho Damacitas families, Exceptional Children's Christmas Program, ALTV's Assist -Teens, Support CMOH, support children receiving care at TVH, - examples include healthy snacks, school supplies, student body cards, senior packages, special classes, hygiene kits, computer tablet, incentives for learning, support for extra programs, fidget toys/stress balls, food voucher, food, school supplies, emergency clothing, books, manipulatives (sensory and support), STEM items, social emotional learning supports, flexible seating, gross motor/fine motor equipment/supplies, (LCAP), educational support (special classes/programs or counseling), movie tickets, mini refrigerator & microwave for GOHS ROOTS program. Estimated number of Temecula residents to benefit: 2,100. >$5K COVID closures required ALTV to close their thrift store, which is the primary sources of income. ALTV has been in recovery since this loss. Also, inflation has significantly increased the costs to operate philanthropic programs. This grant will allow ALTV to continue providing the needs, services, and materials to children and families of Temecula. 31311 Canterbury Court, 'CYCLE FOR HOPE. Cycling event Fundraiser including three bicycle rides through Temecula, CA 92591 Temecula neighborhoods and wine country 8-11am October 2, 2022. The routes Website: TVBIKECOALITION.COM are 15, 25, or 50 miles for entry fees of $39, $85, and $125, respectively. The cycling event is to benefit the Community Mission of Hope/Rancho Damacitas to feed the hungry and help the homeless. Funds will purchase materials for route signage, sign frame holders, volunteer (100+) visibility vests & t-shirts, participant commemorative t-shirts, bike racks, Bike Temecula Valley accessories for sponsors and participants, and CHP and Temecula PD Traffic Division for route safety. Estimated number of Temecula residents to benefit: 500+. SUB- COMMITTEE RECOM- MENDATION $ 1,090,500 50,000 1 $ 50,000 5,000 1 $ 7,500 COUNCIL CSF ON 14 N r1i N N O O O O Ql 1-1 O N 14 N N N o N O N O N O N > LL > LL > LL > LL 920 3,420 3,500 CDBG C'4 N N N O O O O ON r O N 14 N N N 0 N o N O N O N LL LLLL LL LL 5,538 5,491 6,969.61 72,726 Page 2 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA SUB- COMMITTEE RECOM- MENDATION TOTAL$ DIRECTORS OR :..•. MEMBERS OF ANY NONPROFIT ORGANIZATION 1,090,500 6 BIRTH CHOICE OF 1 Ridge Gate Dr. #220, Temecula CLIENT CARE PROGRAMS. Client GaFe and fatheFheed PFOgFaFnS effeF SUBCOMMITTEE $ 50,000 $ 25,000 TEMECULA CA 92590 ffegnaney, paFenting, "`e `kills edueatien, ene en ene FnentOFORg, FnateFial RECOMMENDATION LIMITS Website: _,.sist_ne gFiegIes.......peFt and ...l_.ed .......: F.._,,:_.....:11 h..used to FUNDS. GRANT SHALL NOT BIRTHCHOICECENTERS.ORG Feplaee eld eampwteFS, IT Wppek goods for parenting BE USED FOR ANY PRINTED (needs (hygiene kits, diapers, wipes, formula, car seats, Park'n Plays, strollers, MATERIALS AND/OR clothing, gas, and food cards), MARKETING AND/OR OUTREACH. GRANT FUNDS lease ). Estimated number of Temecula residents to benefit: 120. >$5K For SHALL INCLUDE ONLY 2023, it is our intention to expand our existing programs and projects. Our ITEMS NEEDED FOR reality is that our programs are expanding without us trying to expand them. PREGNANT MOTHERS/NEW This grant will give us the ability to serve all residents without having to PARENTS AND decrease supplies to make them last. Over the last two years we provided BABIES/TODDLERS AS families with over $15K diapers, approx. 500 cans of formula and 500 bags of FOLLOWS: DIAPERS, WIPES, clothing as well as hundreds of goods, and 2022 is near surpassing this amount. FORMULA, CAR SEATS, PACK 'N PLAYS (PLAYPENS), needed goods f8F eUF families as 8UF seFViees aFe gFeatly expanding. Funds STROLLERS, MATERNAL ° . If the BeaFd AND/OR BABY/TODDLER wishes that the funds be used do ff .Fenti., (than e ffset leasing chaF. es) CLOTHING, GAS CARDS/ FOOD CARDS, HYGIENE NEEDS/KITS. *COUNCIL MEMBER ALEXANDER WILL NEED TO ABSTAIN 7 BNAI CHAIM 29500 Via Princesa, Murrieta, CA FIGHT ANTISEMITISM WITH EDUCATION. Inclusive culture learning hub $ 32,000 $ 92563 welcomes Temecula residents of all beliefs to the only standing Jewish Website: BNAICAIM.COM synagogue within 38-mile zone (Temecula & Murrieta border), to deter antisemitism through education at annual events including Hanukkah, Purim, and Passover. Funds will be used to help maintain safe events with security cameras, emergency roof access safe door, and a perimeter outside gate; replacement of air conditioning unit; and food, supplies, and decor for events. There is only one building built as a synagogue for all of the Temecula and Murrieta Jewish Community. We have experienced seven acts of vandalism in two years and wish to provide a safe place. Estimated number of Temecula residents to benefit: 180+ (30-80 per event) and will encourage more. >$5K More educational programs against antisemitism; more people will attend. More is being asked for security and being able to cool/keep building well ventilated. 8 BOY SCOUTS OF 2351 W. Lugonia Ave. Suite F, SCOUTING IN TEMECULA. Funding will cover the costs for membership and $ 50,000 $ AMERICA CA IE Temecula, CA 92374 fund the transportation costs (and food) for Scouts who live in Temecula's Sister COUNCIL 045 Website: CIECBSA.ORG City in Japan to travel to Temecula bringing international tourism revenue (TAHQUITZ through site -seeing and local businesses and shops in the City. Costs also DISTRICT) include materials shipping costs, food, and host family supplies. Estimated number of Temecula residents to benefit: 50-100. >$5K. These funds will help expand engagement with the residents of Temecula and give back to the community through Eagle Scout projects and a variety of other community service opportunities. These funds will additionally enable our program to provide Temecula's sister city in Japan the opportunity to visit Temecula and bring international awareness. COUNCIL CSF ON N N N O O O O M O N N N N o N O N O N o N > LL > LL > LL > LL 2,500 1,000 1,000 CDBG C'4 O N O N O N O M r 0 N O N o N 14 N O N N N O N > I LL > LL > LL > LL Page 3 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA SUB- COMMITTEE RECOM- MENDATION —TOTAL$ BOARDDIRECTORS OR 1,090,500 9 BOYS & GIRLS CLUB PO BOX 892349, Temecula, CA BEFORE & AFTER SCHOOL / DAY CAMP PROGRAM. Year -around for youth ages $ 50,000 $ 50,000 OF SOUTHWEST 92589 Website: BGCSWC.ORG 6-17. Funds will be used for supplies, equipment (including safety equipment), COUNTY transportation, food, marketing, and other necessary costs including insurance costs. Fund before and after school programs, and day camp. Estimated number of Temecula residents to benefit: 80. >$SKThe organization's annual revenue in 2020 decreased 60% or $900K from 2019 and had to lay off President/CEO and Director of Marketing; and faced capacity restrictions due to social distancing. Awarded funds will allow BGCSWC to continue existing programming. 10 CADENZA STRING 31927 Corte Pollensa, Temecula, YOUNG MUSICIAN DEVELOPMENT FUND. To provide more cultural events and $ 20,000 $ 5,000 ORCHESTRA CA 92592 provide quality music lessons to students in need at local and interstate competitions. Funds will be used for musical instruments (such as violin, viola, cello), rehearsal space rental, recording equipment (microphones, cables, generators, computer interface, computers), music accessories (such as strings, music stands), sheet music, and copyright licenses. Estimated number of Temecula residents to benefit: 300. $>5K Lost students due to parents not having income to go to music lessons; some students also moved out of state due to cost of living in CA. In need of financial support to provide free lessons and promote cultural arts in Temecula. The funding will provide jobs to local music teachers for lessons given to underprivileged students. It will promote cultural events. 11 CANINE SUPPORT 24480 Jenny Ln, Murrieta, CA PAWZ FOR WOUNDED VETERANS. Train dogs to support disabled veterans who $ 50,000 $ 25,000 TEAMS INC. 92562 are seeking enhanced mobility, independence, and companionship. It costs an Website: estimated 25k to prepare a dog for a life of service, so full funding will provide 2 CANINESUPPORTTEAMS.ORG veterans with a service dog. Funds will be spent on training equipment (leashes, collars, harnesses, vests, and training tools), canine care equipment (grooming, crates, microchip, housing), dog food, training supplies (treats, consumable tools, equipment), kennel supplies (food dishes, storage containers, specialized cleaning supplies), and veterinary care and prescriptions (monthly flea/tick/heartworm pills, general health, and emergency illness). Estimated number of Temecula residents to benefit: 9. >$5K Cost to raise/train a service dog is $25K. Over the next year, two eligible Temecula Veterans would be granted a service dog at not cost with these funds. 12 CAUSE FUR PAWS, 47200 DE PORTOLA, TEMECULA, CAUSE FUR PAWS HELPING ANIMALS WITH DIABETES. Provides Temecula pet NEW APPLICANT $ 10,000 $ 7,500 INC. CA 92592 owners with financial assistance for the cost of their pet with diabetes. Funds Website:CAUSEFURPAWS.ORG will be used to pay for (1) diabetic treatment for animals ($200-600), through the Temecula veterinarian's office, or reimbursement to the Temecula pet owner with verified Temecula receipt, (2) marketing and media, and (3) Temecula promotional event/fundraising costs. Estimated number of Temecula residents to benefit: 10,000. >$5K We will have the funds to educate (create pamphlets) the community about canine diabetes and distribute to all animal hospitals, vet offices. Petco. etc. COUNCIL CSF ON N N N O O O O M .--I O N N N N o N O N O N O N > LL > LL > LL > LL 2,160 CDBG ON N N N O O O O Ql r O N N N N 0 N o N O N O N LL LL LL LL 5,538 5,491 6,970 7,226 5,538 5,491 Page 4 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA 13 CULTIVATING INCLUSION INC 14 DORLAND MOUNTAIN ARTS COLONY INC. SUB- COMMITTEE RECOM- MENDATION DIRECTORS��, BOARD MEMBERS OF ANY NONPROFIT ORGANIZATION $ 1,090,500 31430 Loma Linda Rd. Temecula, CULTIVATING INCLUSION. Special needs adult programs to work in a garden. TVUSD $ 7,500 $ - CA 92592-1604 special needs students with the Adult Transition Programs (ATP) & special needs adults Website: CULTIVATING are clients of Care -Rite, Toward Max Independence (TMI) (day & vocational programs). INCLUSION FARM.COM Funds will be used for: (1) the property: weed abatement, pest control, tools, starter plants, shrubs, trees, & soil, and (2) the participants: water, healthy snacks, arts & crafts, copy services, & adult coloring books. Produce is donated to local food banks, St. Vincent de Paul, Western Eagle & CMOH. Estimated number of Temecula residents to benefit: 350. >$5K In addition to promotional items, supplies, general repairs, we would like to make Cultivating Inclusion accessible to those special needs adults who have mobility issues. The request for mobility has come from teachers and parents of special needs adults. As a result, we are providing a center walk at the farm, meaning from front fence to back of fence a strip of concrete to enable all special needs adults (i.e. wheelchair) the gardening experience. PO BOX 6 Temecula, CA 92593 Website: DORLANDARTSCOLONY.COM 15 1FINE ARTS THEATER 41391 Kalmia St. #200, Murrieta, NETWORK CA 92562 16 dba FIRST TEE INLAND EMPIRE (BRIGHTON HILL ACADEMY SPORTS AND LEARNING CENTER) Website: FANTHEATER.COM 215 N. D Street, #304, San Bernardino, CA 92401 Website: FIRSTTEEINLAN DEMPIRE.ORG 17 FRED FINCH CARES 8787 Complex Dr., #300, San INC. Diego, CA 92123 Website: FREDFINCH.ORG/CARES ASSOCIATE ARTIST PROGRAM. Supports local artists with exhibits at the Merc Gallery, INEWAPPLICANT Temecula Valley Museum, and others. Funding will be used for supplies, marketing, and the Community Studio/Gallery: new flooring and utility sink, facilities/rent/insurance. Estimated number of Temecula residents to benefit: 800-1,000. PUMP UP THE VOLUME. Provide wireless mic units to Old Town Temecula Community Theater (OTTCT). Funds will purchase 24 body microphone kits which includes the elements, battery pack, transmitter, and case to house all 24 units. Estimated number of Temecula residents to benefit: 50-100 annually. >$5K the funds will complement and replace seriously outdated equipment that verges on being obsolete. It will allow new and existing programs/productions to maintain the high caliber of sound expected. The pandemic stripped us of our reserves and any ability to purchase this equipment directly. The pandemic created a situation where we feel we are at ground zero, starting all over again building audiences, networking with performers, and training young theatrical enthusiasts. FIRST TEE INLAND EMPIRE. Teaches golf and character development to children ages 5- 18 during after -school programs on local golf courses. Curriculum focuses on social and emotional learning objectives, building higher self esteem and confidence (helps to reduce juvenile delinquency, gang affiliation, crime). Funding will be used for curriculum, supplies, hats, shirts, insurance, service costs, and snacks. Additional coaches will be needed which require background checks, training and additional program expenses. Estimated number of Temecula residents to benefit: 650. >$SK FTIE lost 60% of committed funds during COVID 19 resulting in reduced staff and programming. Inflation is impacting all costs. Charles Schwab is offering to match grant funds if Chapter receives 50% more donations than year before. FTIE will receive $32,500 in 2023. Objectives: Grow participant base by 50%; increase girl participation by 15%, and BIPOC by 25%; grow coach base by 50% to reach 650 more participants while increasing diversity of staff/coach/volunteers; increase after school programming location by 35%. TEMECULA BEHAVIOR EDUCATION & SKILLS TRAINING (BEST) EQUIPMENT AND MATERIALS. The BEST program will provide 10 participants with a paid training experience that will enhance their knowledge and skills in serving children, youth and families with developmental disabilities. We are seeking to train qualified bilingual providers in the Temecula area who can deliver high quality services Funds will purchase support material and equipment costs for the training. This program is in response to a dire need for cultural and linguistic diversity in mental health care. Fred Finch CARES seeks funding to support a bilingual behavior education and skills training program in order to meet the growing need for behavioral health workers in Temecula. Estimated number of Temecula residents to benefit: 10. 1►I��i%19l�[�7_1►11 4,558 $ 5,000 50,000 $ 10,000 50,000 $ 3,960 25,000 ANNUAL CSF Cn 1 O N N N N O O O O N N N N 00 of o N e CD N 0 0 0 0 COUNCIL CSF ON O 0 o N > LL N O N O N > LL N O N O N > LL N O N o N > LL 4,000 2,500 CDBG C'4 O Ql r 0 N > LL N O O N o N > LL N O N O N > LL N O N N O N > LL Page 5 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA 18 GOOD SAMARITAN 32127 Camino Rabago, Temecula, TEMECULA HUNGER RELIEF PROGRAM. For Temecula residents (families & pets) with NEW APPLICANT COMMUNITY FOOD CA 92592 food insecurity. Funding will be used to purchase food, meat, grains, dairy, fresh fruits, PANTRY Website: and vegetables. We drop off exclusively to Temecula residents in need directly to their GOODSAMARITANCOMMUNITY.O doorstep weekly and biweekly. We have found that many residents do not have RG reliable transportation so delivering food and essentials directly. Estimated number of Temecula residents to benefit: 1,000. >$5K By focusing on specific areas in Temecula we can provide residents with special dietary needs and restrictions for some. Food prices have doubled and the food we drop off weekly/biweekly has to be replenished. Funds from this grant will allow us to create new ways to add more residents in need and families with special needs. We can continue "Adopt a Family" "Adopt a Senior" programs during the Holidays. In addition to food, paper goods, cleaning supplies and pet food/supplies are also provided to families in need. 19 GREEN ACRES �35750 De Portola Road, Temecula, WALK, RIDE, RUN FOR GAIT. Therapeutic riding program. Funds will be used for horse I NEW APPLICANT INTERACTIVE CA 92592 boarding, care, and feeding; safety equipment (helmets, gloves, tack); clearing the trail; THERAPY INC. Website: GAITPROGRAM.ORG and water, snacks, and t-shirts. With funding, we can open up the ranch to Temecula residents to get involved with the program that might not have the funds to participate; serves special needs, PTSD for Veterans and other public servants, and families in need of group therapy because of adoption or group home facilities. Estimated number of Temecula residents to benefit: 75 >$5K During COVID, shut down facility, laid off employees and could not secure volunteers when doors opened again; had to use extensive funds to make environment safe; dealing with rising costs of fuel, horse feed and vet care but have not raised our prices to keep it affordable; the additional funds will help expand out program from virtual to a physical event (Walk Ride, Run for Gait - Virtual, 10K or 10 Mile Walk, Ride, Run Fundraiser) that the City of Temecula can participate in. 20 HABITAT FOR 27475 Ynez Rd #390, Temecula, CA TEMECULA REAL ESTATE AND EDUCATION CENTER. Provide home -buyer orientations, HUMANITY INLAND 92591 resource fairs, financial literacy training, and counseling services to help 371 Temecula VALLEY INC Website: HABITATIV.ORG residents with affordable homeownership. Funds will be spent on the Center's facility costs, rent, utilities, liability insurance; classroom supplies; materials for the workshops, including tables & chairs, minor improvements like shelving and partitions for the educational space; and marketing materials and signage for the Center and resource fairs. Estimated number of Temecula residents to benefit: 371. >$5K COVID impacted our ReStores, which provides a substantial source of revenue used to support and launch programs. The launch of the Temecula Real Estate and Education Center is part of a broader affordable homeownership solution as we collaborate with other agencies and advocate for residents by combining resources, along with Habitat IV support, to impact the affordable homeownership crisis. The Funding would launch the Temecula Real Estate and Education Center by providing funds for facilities along with classroom materials supplies, and marketing/signage. 21 HIS LITTLE FEET INC. 3445 N. Studebaker Rd., Long NEW ATHLETIC SHOES FOR YOUTH. His Little Feet (HLF) Program will use the funds to NEW APPLICANT Beach, CA 90808 purchase over 300 pairs of shoes: 100 pairs of shoes for Rose Again Foundation, 80 pairs Website: HISLITTLEFEET.ORG of shoes for Michelle's Place, 100 pairs of shoes for Oak Grove Center, and 100 pairs of shoes for SAFE Families. Estimated number of Temecula residents to benefit: 300. >$5K Inflation has caused the price of shoes to dramatically rise, even with HLF's discounts at partner retailers, the cost of each pair is approximately $50 now compared to $35. A grant of $10K will allow HLF to grow its scope of work in Temecula, almost tripling the number of those served and support the high cost of new shoes. SUB- COMMITTEE RECOM- MENDATION $ 1,090,500 50,000 1 $ 25,000 50,000 1 $ 44,094 1 $ 10,000 1 $ 30,000 45,000 ANNUAL CSF G1 1 O N N N N O O O O N N N N 00 of o N CD 0 N 0 0 0 0 COUNCIL CSF ON O 0) 1-1 o N > LL 14 N O O N O N > LL r1i N O 14 N O N > LL N O N N O N > LL CDBG C'4 N N N O O O O M r O N 14 N N N 0 N o N O N O N > LL > LL > LL > LL 52,662.72 49,724 Page 6 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA SUB- COMMITTEE RECOM- MENDATION TOTAL$ BOARDDIRECTORS OR 1,090,500 22 HOSPICE OF THE 25240 Hancock Ave #120, SENIOR ASSISTANCE PROGRAM. Provides compassionate hospice to the terminally ill $ 50,000 $ 50,000 VALLEYS Murrieta, CA 92562 patients and support to their families during times when end of life is imminent. Funds Website: will be used for patient care and costs not covered by Medicare, or other insurances HOSPICEOFTHEVALLEYS.ORG including /not limited to: medication delivery services, incontinence supplies, overbed tables, medication co -pays, and mobile shower equipment. Estimated number of Temecula residents to benefit: 240. >$5K An estimated 11,639 senior citizens in the City continue to age, there is a greater need for hospice services. In order to meet this anticipated demand, Hospice of the Valleys will continue to raise funds through grants, donations, fundraisers, community support and our planned giving program. 23 INLAND VALLEY PO BOX 637, Temecula, CA 92593 SEASON OF HOPE. Focuses on providing free concert tickets to local Temecula HAS NOT APPLIED $ 50,000 $ 5,000 SYMPHONY aka Website: residents: elderly, students & their families. Funds will be used for marketing and RECEENTLY TEMECULA VALLEY TEMECULAVALLEYSYMPHONY.OR outreach materials, website improvements, payment to various musicians for SYMPHONY G participating in the program; Some music selections composed by minority or female composers and include educational elements in the presentation of materials and/or the music performance itself. Estimated number of Temecula residents to benefit: 1,056. >$SK Were it not for a couple of pandemic related relief grants received from the State and County, we would have been forced to close down our organization completely. Due to lack of funds, we were unable to resume full concert scheduling for both the last and the upcoming season. Inflationary pressures have increased most of our basic general operating expenses as well as the cost of musicians because of the higher cost of living, especially gas prices. 24 INTERNATIONAL 41745 Rider Way, Suite 2, COMMUNITY COUNSELING. For those struggling with mental and behavioral concerns, NEW APPLICANT $ 18,160 $ 15,000 CHRISTIAN Temecula, CA 92590 trauma, and grief. Funds will be used for 80 sessions (8 client/family units at an average ADOPTIONS (ICA) Website: 4ACHILD.ORG of 10 sessions per client/family unit). Most of our counseling clients/families are referred through Riverside County for Foster Care and two other sources funded by California Dept. of Social Services (Unaccompanied Refugee Minor Foster Care Program and Trafficking Victim Assistance Program). The Child Trauma and Learning Center at ICA is to offer counseling services despite a client's inability to pay and depends on funding from other State and Grant programs to support its professional services and has a deficit of over 23K. Temecula residents to benefit: 8 families at an average of 10 sessions. >$5K In hopes of receiving grant funding from the City, and in order to continue providing existing services, ICA has expanded its program to include Purchase of 4 Ipad Pros for client use. The cost of $900 per Ipad is a small cost compared to the loss of services for the family members who could not afford electronic devices or for those who may not have transportation for inhouse services. 25 JACOB'S HOUSE 31525 Jedediah Smith Road, JACOB'S HOUSE. Funds will support operational costs for Temecula 170 guests seeking $ 50,000 $ 25,000 INC. Temecula, CA 92592 refuge while caring for a loved one in the hospital. Funds will support operational Website: expenses that include: inventory, maintenance, repairs, marketing, equipment, and JACOBSHOUSETEMECULA.ORG furnishings. Estimated number of Temecula residents to benefit: 170. >$5K Occupancy in 2021 increased 102% from 2020, and 2022 is turning out to be higher and services are being readjusted to accommodate the demand. With these funds, Jacobs House will be able to meet the increased demand/expansion of services. 26 JDS CREATIVE 39870 Camden Court, Temecula, DIGIFEST. Digital media festival, conference, and fundraising event that reinvents, in $ 48,000 $ 30,000 ACADEMY CA 92591 Temecula, the International Film and Music Festival 3-day event. Funding will pay for Website: speakers, travel, hotel accommodations, social media ads, Google ads, television JDSCREATIVEACADEMY.ORG commercial airtime, billboards, and new equipment such as lighting control boards, a camera, and LED lights. Estimated number of Temecula residents to benefit: 111,985. >$5K Expand JDS Creative Academy's efforts to bring high level speakers to DigiFest Temecula, and expand the organization's marketing and advertising efforts for the event. 2020 and 2021, due to COVID, JDS Creative Academy was unable to host in - person DigiFest Temecula. This caused the organization to miss out on its largest fundraising events. JDS hopes the funding will bring back in -person attendance. COUNCIL CSF ON O Ql o N > LL N O O N O N > LL N O N O N > LL N O N N O N > LL CDBG C'4 N N N O O O O M r O N 14 N N N 0 N o N O N O N LL LLLL LL LL 5,538 5,491 7,226 Applied and Not Awarded Aln AI. - A IUnt A—k, 1- �Vlaly COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA 27 LIVE CARE FOUNDATION INC. 43460 RIDGEPARK DRIVE, SUITE TEMECULA VALLEY SUPPORT PROJECT. Will subsidize the cost of assisted care with 200-S, TEMECULA, CA 92590 $100-500 monthly grants to Temecula -based licensed, certified, professional caregiving Website: LIVE CAR EGRANTS.ORG service providers that serve Temecula seniors, disabled persons, and veterans. This financial support reduces the out-of-pocket costs for Temecula care recipients and their families for a 3-6 month period. Assisted Care Grants are typically awarded in small increments which do not exceed $500 monthly, and are awarded with 3-6 month minimum support periods. Estimated number of Temecula residents to benefit: 25-50 care recipients, 50-100 family members. >$5K During COVID, demand spiked and ifundraisers curtailed. One of our care support programs provides assistance with burial and funeral costs on needs basis which needs spiked in requests. The project will limit is support to Temecula based senior citizens, veterans, disabled persons as well as Temecula -based families who currently provide monetary support for their loved ones with assisted care needs. To clarify, while the population are the ultimate beneficiaries, they are not direct grantees. Grants are exclusively issued to certified and licensed care - giving organizations. The grants are made on behalf of the intended beneficiaries in order to reduce the amount of direct cost billed to the recipient or his/her family. MAKE -A -WISH 13230 El Camino Real #100, Irvine, FOUNDATION OF CA 92602 ORANGE COUNTY Website: OCIE.ORG INC. (Federal) MAKE -A -WISH FOUNDATION OF ORANGE COUNTY AND THE INLAND EMPIRE INC. (State) WISH GRANTING IN CITY OF TEMECULA. Expands wish granting to Riverside and San Bernardino counties. Grant Funding will be used to fund expenses directly associated with granting the waiting wishes of Temecula wish children. Currently there are 9 Temecula children with critical illnesses waiting for their wishes to be granted. Funding for this project will allow us to grant a minimum of 2 wishes for children in the City of Temecula. >$5K Over 70% of the wishes we grant involve some sort of public transportation and/or large gatherings and given the health concerns for our immuno- compromised families, many wishes were put on hold. Make A Wish OCIE is in the midst of a 5 year strategic plan to expand and grant 450 wishes per year by 2025. 29 MICHELLE'S PLACE 41669 Winchester Rd., Temecula, CANCER SUPPORT SERVICES. Providing Temecula residents facing cancer with free CANCER RESOURCE CA 92590 Website: resources including early detection and patient navigation. MP will spend funding on CENTER MICHELLESPLACE.ORG supplies for support group/class (such as art therapy, cooking classes, yoga, and caregiver grief group), chemo kits & mastectomy kits, temporary financial assistance, transportation to medical appointments, and MRI & Lymphedema supplies not covered by insurance. Estimated number of Temecula residents to benefit: 425. >$5k During pandemic, many cancer patients struggled financially. The increased need added a financial burden to Michelle's Place. Transportation to medical appointments also became a huge need but was unavailable due to restrictions on the transportation companies. Now fuel costs are creating new financial hardships. Funding will expand the current programs for Temecula residents and be able to provide more transportation, more people in classes/programs and ensure families receive financial assistance through a new Program Calendar. This funding will enhance the program experience as well as serve all who need help with cancer in Temecula. NEW APPLICANT 1► I �titl_1» � i:�1_1► � � SUB- COMMITTEE RECOM- MENDATION $ 1,090,500 50,000 1 $ 25,000 20,000 1 $ 50,000 $ 50,000 30 MILVET 30777 Rancho CA RD #892521, 1- VETERAN CLAIM ASSISTANCE. Provides help with filing for veteran claims, rate HAS NOT APPLIED $ 10,000 $ 10,000 Temecula CA 92589 increases, and survivor benefits. Funding will purchase computers, printer, ink and RECEENTLY Website: MILVET.ORG supplies. 2- VETERAN EMERGENCY FUND. Provides immediate emergency financial support to veterans in need. Funding will purchase food and gas cards. BOTH PROGRAMS: Estimated number of Temecula residents to benefit: 1,000. >$5K COVID created a massive backlog in veteran benefit claims resulting in many veterans at risk of severe poverty and homelessness; our goal is to proactively reduce disadvantages in a post COVID economy; funding will enable us to continue our programs including veteran claim assistance support and emergency assistance for those who need it most. Funding will also provide 2 new computers, a printer and much needed supplies as well as the ability to help those in emergency situations. Our programs provide critical support and resources to encourage sustainability for those who served our country. n--- Q „- o ANNUAL CSF Cn 1 O N N N N O O O O N N N N 00 of o 1-1 N CD 0 N 0 0 0 0 COUNCIL CSF ON 14 N r1i N N O O O O 0) -I O N 14 N N N o N O N O N O N > LL > LL > LL > LL 2,000 500 2,000 CDBG C'4 N N N O O O O M r O N 14 N N N 0 N o N O N O N > LL > LL > LL > LL Legend: "-" = Applied and Not Awarded AI- Alin — A Mnt A—k, COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA SUB- COMMITTEE RECOM- MENDATION TOTAL$ BOARDDIRECTORS OR 1,090,500 31 MOTHERHOOD 44731 Corte Gutierrez, Temecula, RENTAL ASSISTANCE & FINANCIAL PROGRAM. Helps with housing attainment and NEW APPLICANT $ 50,000 $ - STEPS CA 92592 sustainability. Funding will be used for rental deposits, and financial/ budgeting/ credit Website: books, paper, ink, file folders, and marketing brochures for PowerPoint class. Estimated MOTH ERHOODSTEPS.ORG number of Temecula residents to benefit: 1-15. >$5k Being awarded this grant will give us ample opportunity to assist those in financial hardships associated with housing. Our program is still in infancy stage and with proper funding we can grow into fulfilling our vision to bring stability within the community. Providing rental assistance coupled with budgeting courses is our approach to guide citizens from homelessness towards a self- sufficient lifestyle. Motherhood Steps was born in 2021 painfully evident that families faced homelessness; donations have been low only allowing us to serve families with basic needs (food, diapers). This grant will relieve recipients the burden of possibly living on the streets by helping them attain and maintain housing. 32 MY SISTER'S KEEPER 41765 Rider Way, Temecula, CA MATH GENIUS PROGRAM. Pilot math tutoring hub at TVSUD high schools that will NEW APPLICANT $ 35,000 $ SUCCESS INSTITUTE 92590 provide mentoring, tutoring, and SEL coaching Temecula students in Math. Grant INC. Website: MSKSI.COM funding will purchase training for tutors/participating teachers, coaching/curriculum materials & online curriculum, insurance, copy/printing, and meals/snacks. Estimated number of Temecula residents to benefit: 500+. >$5K We will expand our program beyond 100%virtual participation to a hybrid program with 2 community hubs at participating Temecula schools to provide online instruction and in -person mentoring/tutoring, and family support services/coaching to ensure parents are partnering with kids. COVID impacted ability to serve Temecula because of reduction in volunteer staff. Inflationary concerns exacerbate the issue; space rental prices are increasing; gas costs are prohibitive for some parents to continue with in -person programming not hosted at their child's school. 33 NATIONAL CHARITY PO BOX 891381, Temecula, CA PROJECT WARIOR BAGS. Mastectomy kits for Michelle's Place clients who have $ 4,000 $ 5,000 LEAGUE - 92589 undergone mastectomies. Funds will purchase materials to make handmade items TEMECULA Website: (heart pillows, tote bags, rice packs, drain pockets, seat belt covers) fabric, pillow filling, CHAPTER MEMBERS.NATIONALCHARITYLEA rice, Velcro, belt material, batting, paper, printing, thread, journals, pens, grippy socks, GUE.ORG Chapstick, and ribbon. Estimated number of Temecula residents to benefit: 150. 34 NAVY LEAGUE OF PO BOX 361, Temecula, CA 92593- NAVY LEAGUE NJROTC/SEA CADET SUPPORT. TVUSD Chaparral High School program NEW APPLICANT $ 50,000 $ 10,000 THE UNITED 0361 supports activities for students from TVUSD Bella Vista Middle School. These activities STATES, INLAND Website: NAVYLEAGUE.ORG for — 200 Temecula youth ages 10-18 include SeaPerch (underwater robotics) and EMPIRE COUNCIL CyberPatriot (drone/UAS). Funds will be used for drone soccer classroom bundles, SeaPerch kits & tool kits, trophies, laptops, and uniforms. Estimated number of Temecula residents to benefit: 200. <$5K COVID forced cancellation of our annual fundraiser benefit night at Europa Village, as well as other fundraising opportunities. Funds will support the founding of a Sea Cadet program in Temecula. Sea Cadet Programs is a volunteer run leadership program for teens and relies upon volunteers and donors for their uniforms and activities; the IE Council has been organizing the Southern California SeaPerch Challenge since 2016; the intent is for the 2023 competition to be housed at Chaparral High School; the IE Council also sponsors local CyberPatriot (cybers security) teams and summer camps. The funds will allow the Council to expand those offerings. ANNUAL CSF Cn 1 O N N N N O O O O N N N N 00 of o N CD 0 N 0 0 0 0 COUNCIL CSF ON O Q1 o N > LL N O O N O N > LL N O 14 N O N > LL N O N N O N > LL CDBG C'4 O Ql r 0 N > LL N O O N o N > LL N O N O N > LL N O N N O N > LL Page 9 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA SUB- COMMITTEE RECOM- MENDATION TOTAL$ BOARDDIRECTORS OR 1,090,500 35 NEIGHBORHOOD 1 425 N Date St, Escondido, CA NHC GREAT STARTS PROGRAM. Provides prenatal and baby health and wellness NEW APPLICANT $ 50,000 $ - HEALTHCARE 92025 education, advertising, community outreach, baby care items to needy families, and Website: NHCARE.ORG two baby wellness events adjacent to the Temecula Health Centers. Funds will purchase: 70 infant car seats, 100 playpens, 120 highchairs, 100 strollers, 150 packages of diapers (size N-3), 300 packages of wipes, 150 new mother kits, 150 welcome baby kits, promotional items, brochures, and advertising & marketing. Estimated number of Temecula residents to benefit: 500. >$5K Covid triggered unemployment caused the percentage of uninsured patients to increase in 2020 and 2021; Medicaid (Med-Cal), the primary insurance for patients was slow in determining reimbursements for telehealth visits. If funds are granted, the program will be extended; will reach out to the Temecula community with critical information related to prenatal and infant care and provide infant supplies including diapers. 36 OAK GROVE 24275 Jefferson Ave., Murrieta, CULINARY CREATIONS PROGRAM. Unique vocational program designed to build $ 50,000 $ 30,000 CENTER CA 92562 vocational and hands-on culinary experience/skills, as well as provide jobs for at -risk, Website: OAKGROVECENTER.ORG vulnerable, special needs and disabled youth and toward maximum independence (TMI) young adults through a retail store in Temecula. Funds will be spent on the operating costs of the Bakery: rent, utilities, food for preparation, marketing, mileage, supplies (baking & kitchen supplies, takeout containers, bags, etc.), and telephone expenses. Estimated number of Temecula residents to benefit: 70. >$5K We could not accomplish this in 2021 due to pandemic; raising funds for the program will help offset costs and continue an existing program serving 70 Temecula students. 37 dba PROJECT 30141 Antelope Road, D103, EMERGENCY GAS/FOOD/SHELTER. Program to help (200 homeless) reunite families $ 50,000 $ 35,000 TOUCH Menifee, CA 92584 together with funding to purchase gasoline cards, bus passes, airline tickets. Program (GOD'S FAN CLUB) Website: for homeless prevention with funding to pay for rental assistance, seek and keep PROJECTTOUCHONLINE.COM employment for self-sufficiency. Program for purchase of food, necessities, and gift cards from local grocery stores for infants, children, seniors, veterans, and diabetics. Estimated number of Temecula residents to benefit: 200. >$5k clients of Project TOUCH had increased needs (masks, cleaning supplies, food) as many fell ill with COVID; in -kind donations decreased; concerns about funding leases with higher rents or landlords not willing to lease housing to homeless; funds will assist in continuing existing programs and also providing gas cards and bus passes to either be reunited with family or keep/gain employment. 38 ROCK YOUR RED 45571 Ponderosa Court, ROCK YOUR RED. Organizes defibrillator and blood pressure training to high schools, NEW APPLICANT $ 25,000 $ 5,000 Temecula, CA 92592 community, seniors, and those with special needs. Has outreach programs teaching Website: ROCKYOURRED.INFO warning signs of heart attacks, strokes, provides Blood pressure toolkits, dietitian, fitness coach, TVH, and ADA, has annual screening & assessment event with doctors & nurses. Funding will purchase medical kits, training & education, portable AEDs, dietitian, fitness coach, meal cards for post surgery cardiovascular patients, tickets to health event. Estimated number of Temecula residents to benefit: 15-25. >$5k Due to Pandemic, we were not able to host face to face events and this funding will allow our annual event to occur which provides one on one questions/answers with cardiologist, stroke physicians, nurses; Health fair attendees for Temecula community free of charge; a new program will purchase AED units and train residents, HOAs, schools, etc., on how to use; provide screening to lower income and special needs/disadvantaged. ANNUAL CSF Cn 1 O N N N N O O O O N N N N 00 of o N e CD N 0 0 0 0 COUNCIL CSF O N 14 N r4 N N O O O O Q1 O N 14 N N N o N O N O N O N > LL > LL > LL > LL 1,000 1,000 CDBG C'4 O M r 0 N > LL N O O N o N > LL N O 14 N O N > LL N O N N O N > LL Page 10 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA SUB- COMMITTEE RECOM- MENDATION TOTAL$ BOARDDIRECTORS OR 1,090,500 39 ROTARY CLUB OF PO BOX 64, Temecula, CA 92593 FOOD FOR LOW-INCOME SENIORS, VETERANS, AND STUDENTS. Monthly and/or $ 30,000 $ 30,000 TEMECULA Website: during cold weather months. TRANSPORTATION ASSISTANCE FOR LOW-INCOME FOUNDATION ROTARTYOFTEMECULA.COM SENIORS to access healthcare. Funding will be used for food boxes from local agency 5k, and food from local grocery store 5k, grocery gift cards 5k, transportation vouchers, 15k (for services like GOGO Grandparents, LYFT, UBER, and bus passes). Estimated number of Temecula residents to benefit: 660. >$5K Rotary Club of Temecula began the senior supplemental food box deliveries during COVID to help low income seniors (at risk) receive food at their home; now after the pandemic seniors still need food as food is much more expensive than prior to COVID and transportation is still another challenge. Funds will expand the existing programs by providing/serving an additional 25% of low income seniors, veterans, military and TVUSD students/families with either food boxes or grocery gift cards on an annual basis. Additional funds will support transportation assistance for low-income seniors needing access to healthcare appointments. 40 SANTA ROSA PO BOX 941, Murrieta, CA 92564 PROMOTION ENVIRONMENTAL PROTECTION THROUGH EDUCATION (PEPE). Engages $ 13,000 $ 13,000 PLATEAU Website: SRPNEF.ORG TVUSD high school students in a year -long research project studying climate change and EDUCATION fire on threatened and endangered plants and animals. Funding will purchase FOUNDATION equipment and services: transportation, Pocket Labs, backpacks, intern costs (excluding salaries), journaling supplies, chrome notebooks, and binoculars. Estimated number of Temecula residents to benefit: 100. >$5K closure of the Reserve from the Tenaja Fire coupled with COVID presented hardships. Onsite classroom programs were eliminated and we saw first-hand that children learn best about nature in nature in person. This program will focus on high school students gaining knowledge of climate change working with TVUSD and in person. 41 SCORE 503 3985 University Ave., Riverside, CA ENTREPRENEUR & LEADERSHIP SERIES. Help —150 entrepreneurs in business 0-3 years NEW APPLICANT $ 50,000 $ (SERVICE CORPS OF 92501 Website: via workshops; certified mentor sessions; expert panels; and resources. Funds will be RETIRED INLANDEMPIRESCORE.ORG used on a series of workshops; start-up business training materials resource kits 15k; EXECUTIVES food for ten days 10k; water & refreshments for 10 days 2k; marketing using social ASSOCIATION) media/text services/Alliance Marketing 7.5k; specialized business -related speaker fee; and materials 10k; >$5K SCORE Inland Empire partnered with SBA to respond to businesses in need during pandemic; we are now being asked to help navigate post covid with protocols/new business norms and this has drastically made our budget swell; we will serve Temecula community via webinars and mentoring. Funds will allow us to expand our service offering to include live in -person series of workshops designed to educate and support entrepreneurs in business 0-3 years. 42 SKYROCKET 43406 Calle Carabana, Temecula, PEDIATRIC DEVELOPMENT OUTREACH PROGRAM. Increases knowledge and resources NEW APPLICANT $ 50,000 $ PEDIATRIC THERAPY CA 92592 to identify children who may benefit from developmental services and utilize services FOUNDATION Website: already available in the community. Funds will be used to promote and expand current SKYROCKETTHERAPY.ORG outreach program by purchasing professional design and printing services (for brochures, flyers, signs, etc.), search engine optimization, targeted advertising on social media, educational in -services, equipment & supplies for in -services, and consultation costs. Estimated number of Temecula residents to benefit: 25,000 families. >$5k Skyrocket incorporated in 2021 and was not impacted by COVID; the grant will allow Skyrocket to expand the current capacity and reach of Pediatric Development Outreach Program. Since inception in June 2022, the Pediatric Outreach Program has been met by high demand beyond our capacity of volunteers. Grant funding would allow for expansion of current program to meet growing demand. COUNCIL CSF ON N N N O O O O M O N N N N o N O N O N o N > LL > LL > LL > LL 1,000 3,500 - CDBG ON O M r 0 N > LL N O O N o N > LL N O 14 N O N > LL N O N N O N > LL Page 11 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA x Z a NAME OF ADDRESS TO MAIL CHECK PROGRAM/PROJECT DESCRIPTION REQUESTED Li Nonprofits located outside Temecula NOTES J ORGANIZATION can still serve Temecula residents. can $ a „ � ri 43 SMILES BY ANGELS 42248 Via Nortada, Temecula, CA TEMECULA SMILES. Strengthen and expand relationships with Oak Grove, public FOUNDATION 92590 schools, Koinonia Family Services, Brandywood Foundation, youth of disadvantaged families, foster care, USA armed forces youth, and at -risk youth. Funding will be spent on buying 10,000 books (focused on skill development, community enhancement, self- improvement, diversity, etc.), clothing/food/entertainment for disadvantaged and at - risk students, internships, mentors, curriculum, and tutors. >$5k We moved to Temecula from LA in 2021; COVID impacted our ability to raise funds through events and other types of campaigns; inflation is limiting cash flow; this grant will help us create new programs and partnerships with local organizations for ongoing programs. NEW APPLICANT 44 SOUTHWEST 41145 Eagelmann Oak Street, EMPOWERING YOUNG WOMEN - FIND YOUR VOICE THROUGH SONG. Community NEW APPLICANT WOMEN'S CHORUS Murrieta, CA 92562 Event teaches three songs (middle and high school students and beyond); a one -day Website: seminar of three songs culminating in a performance at the Old Town Community SOUTHWESTWOMENSCHORUS.OR Theater. Funds will be used for rental of seminar venue, sheet music, meals, t-shirts, G accompanist, office supplies, and publicity. Estimated number of Temecula residents to benefit: 30-50. 45 SPECIAL OLYMPICS 41880 Kalmia St. #140, Murrieta, SPECIAL OLYMPICS SO. CAL TEMECULA. Cover facility rental fees, athlete uniforms, and SOUTHERN CA CA 92562 equipment for basketball, bocce, and flag football. Estimated number of Temecula INLAND EMPIRE residents to benefit: 90. 46 SPEECH & 43385 Business Park Drive #140, DEVELOPMENTAL SCREENINGS / THERAPIES. 80 children from low income families to LANGUAGE Temecula, CA 92590 receive developmental assessments, social skills classes, behavioral counseling and DEVELOPMENT Website: SLDC.NET intervention. Funds will be spent on assessments, screenings, and rent. Virtually all of CENTER INC. the assessment and session costs are to pay licensed teachers and therapists; there is a lack of these services in Temecula. Through our research, we found that families needing these services had to travel 40 miles; we'll deliver in Temecula. Estimated number of Temecula residents to benefit: 80. >$5K we launched Stage 1 of our program in Dec. 2021. The virus impacted us financially and in our physical environment and there is an even greater need for services. The program is now in Stage 2 and SLDC has committed to building out its services in the Temecula Valley over the next 3 years. We look to continue to provide speech, language/behavior services and also provide occupational/physical/mental/family therapy. 47 SPERO VINEYARDS 2076 Lincoln Ave., Pasadena, CA SPERO VINEYARDS. Provides instruction and meaningful workforce development and INC. 91103 training for young adults with disabilities interested in careers in Temecula's wine and hospitality industry including history, science, hospitality, business/marketing, and agriculture aspects of the wine making business. Funds will be used to purchase equipment, and expand curriculum beyond the essential elements of viticulture and hospitality. Estimated number of Temecula residents to benefit: 15-30+. >$5K The pandemic displaced a significant portion of our volunteer and donor base; rising fuel, water and vineyard management costs threaten the program; the wine lab curriculum will expand necessary training opportunities and allow us to offer next level skill training Ito students. 48 dba TEDX TEMECULA - INLAND VALLEY BUSINESS & COMMUNITY FOUNDATION 40497 Winsor Road, Temecula, CA TEDX TEMECULA. Local TEDx event in Old Town where public speakers give talks that 92591 have received over 2 million views. Funds will be used to pay for lunch, printing Website: TEDXTEMECULA.COM (program & other promotion), table and chair rental for theater courtyard, and video production. NEW APPLICANT $ 1,090,500 50,000 1 $ 5,000 I $ $ 5,000 $ $ 10,000 $ N 37,100 1 $ 5,000 1 $ 5,000 5,000 5,000 37,000 5,000 COUNCIL CSF ON O -I O } LL N O ON O } LL N O N O } LL N O N O } LL 1,000 CDBG C'4 O O N } LL N O ON O N } LL N O N O N } LL N O N O N } LL [Legend] "-" = Applied and N t Awarde Page 12 of 18 No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA SUB- COMMITTEE RECOM- MENDATION TOTAL$ BOARDDIRECTORS OR 1,090,500 49 TEMECULA PLAY 42690 Margarita Rd., Temecula, PALS BUDGET RELIEF. Co-op preschool for children ages 3-5 at Temecula United NEW APPLICANT $ 50,000 $ - AND LEARN CA 92592 Methodist Church. Funds will be invested in learning materials, educational toys, school SCHOOL INC. (PALS) Website: TEMECULAPALS.ORG supplies, parent training, update worn down furniture, office equipment, field trips, school events, and new playground equipment including a new sandbox and a new shade cover. Estimated number of Temecula residents to benefit: 30 families. >$5K Enrollment declined during pandemic but have increased again; as a nonprofit we rely on tuition, fundraising, personal donations and community support. This funding will support continuation of a safe environment, quality school supplies, equipment, furniture, field trip experiences, special events and educational opportunities. 50 TEMECULA SUNRISE PO BOX 2203 Temecula, CA 92590 CHRISTMAS DINNER. Funding will be used to purchase dinner -related equipment and $ 15,000 $ 15,000 ROTARY supplies including cargo trailer, oven, restaurant -quality pots/pans/utensils, and food. FOUNDATION This year's 2022 dinner will be at the MSJC Cafeteria (since Mary Phillips Senior Center is under construction). There are many Temecula families that depend on the Temecula Community Christmas Dinner. Estimated number of Temecula residents to benefit: 1,200. >$5K In early 2022, our 28 foot cargo trailer with all our equipment was stolen and we need to replace it with the oven, restaurant quality pots, pans and utensils. We need to purchase food and supplies. Estimate cost for all of this is approximately $42K. COVID restricted our ability to hold sit down dinners in 2020 and full capacity dinner in 2021; Now 2022 inflation has significantly increased the cost of food and supplies for this event. Grant will allow us to purchase necessary equipment to continue this event and provide food and supplies for the 2022 dinner. 51 TEMECULA 42051 Main Street, Temecula, CA ARTS CONNECTION NEW WORKS. Supports and expands outreach offering K-12 NEW APPLICANT $ 50,000 $ 50,000 THEATER 92590 Temecula students opportunities to experience theatrical productions/see live FOUNDATION Website: performances (multi -cultural productions in dance, music, plays, musicals) for free. TEMECULATHEATERFOUNDATION. Additionally, students will see work in its unfinished phase and be part of the process ORG through discussion, essay critique, and visual appreciation. Funds will be used for expenses including payment to presenting organizations, artists, curriculum materials for the teachers, and in-house production costs. Estimated number of Temecula residents to benefit: 4,000+ annually. >$5K March 2020-Sept. 2022 we have been unable to offer programs to our youth due to school's guidelines of social distancing. We are starting the program again, now that those restrictions have been lifted. Additionally, we have been unable to do annual fundraising or galas due to COVID; the addition of funds will supplement our currently depleted reserves, allow us to bring in more students, and create our New Works program. 52 TEMECULA VALLEY 27470 Commerce Center Dr. C, TV ALANO CLUB. Guides and supports coming out of rehabilitation centers for drugs or NEW APPLICANT $ 50,000 $ 5,000 ALANO CLUB Temecula, CA 92590 alcoholism. Funding will be used on rent for the facility, 12-step books, information pamphlets, workbooks, new coffee bar, new tables & chairs for the meeting hall used for 12-step meetings, pool table for fundraising events, cable & internet, couches, and tables. Estimated number of Temecula residents to benefit: 1,200-1,300. >$5K Most funding came from donations which decreased during COVID; and restrictions lessened the amount of people who could meet so members relapsed; costs of all supplies and utilities have increased. This funding would allow a new fundraising event and continuing to provide literature, books, outreach to those involved in the 12-step ANNUAL CSF Cn 1 O N N N N O O O O N N N N 00 of o N CD 0 N 0 0 0 0 COUNCIL CSF ON O Q1 o N > LL N O O N O N > LL N O 14 N O N > LL N O N N O N > LL CDBG C'4 O Ql r 0 N > LL N O O N o N > LL N O N O N > LL N O N N O N > LL Page 13 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA 53 TEMECULA VALLEY 28780 Old Town Front St., C1, TEMECULA BAND PROJECT. This is an expansion of the Temecula String Project and CONSERVATORY OF Temecula, CA 92593 offers free band class to 5th grade students at 2 TVUSD elementary schools during non - THE ARTS school hours, and open to all students. Funds will be used to purchase band instruments (7 flutes, 7 clarinets, 7 saxophones, 7 trumpets, 2 trombones) and to rent climate - controlled storage space to store instruments during the summer months when not in use. Estimated number of Temecula residents to benefit: 40 students/year. >$5K Pandemic prevented TVCA from conducting in -person events/fundraisers which reduced revenue for 2 years; also restricted TVCA's ability to do string classes in -person. TVCA will purchase new instruments for the beginning band program which is an expansion of the instrumental music program which has been a string program for the past 5 years. These instruments are expected to last many years. The 5-year goal is to make the 5th grade instrumental music program more equitable by offering either strings or band at every elementary school in the district. 54 TVHS GOLDEN BEAR PO BOX 892072, Temecula, CA AMPLIFY - CELEBRATION OF BLACK HISTORY. Inaugural attempt to bring FOUNDATION 92589-2072 students/families/community member to learn first person account stories from those who rode on the busses that we now refer to as the "The Freedom Riders." An organization from San Diego has artifacts, exhibit featuring a life-size replica of the bus, and a father -and -son -team to speak about their experiences. The 2nd night we hear from Director of Alabama Tourism/author/expert on The Road to Birmingham Lee Sentell. Each night will have music, poetry, reading, dancing, and re-enactments. Funds will be spent on: "The Buses are Coming" exhibit (10k), African drum dancers from Los Angeles (2k), Lee Sentell from Director of Alabama (500), A Poetic Tribute to the Freedom Riders" (500), David Dennis Sr. & Jr. speakers (3k), flights, housing, food for guest speakers (1,750), workshop for 10-12 graders by Miss Misipeka (1.5k). Estimated number of Temecula residents to benefit: 2,000 students/800 community. >$5K Pandemic info N/A. This will be the 1st year TVHS has attempted to host a Black History Celebration that is intentionally serving students and the community. The aim is to charge community members a minimal fee to access the evening programs so the program can expand and aim toward self-sufficiency. The aim is to continue this program year-to-year and have students and the community grow value and respect the contributions and sacrifices to the black community. 55 'TEMECULA VALLEY PO BOX 1293. Temecula, CA 92593 TEMECULA TALENT REVIVED. Funding will be spent on advertising/outreach, NEW APPLICANT PLAYHOUSE dba production costs, sound and lighting design, Penske truck rentals, furniture, costumes, TEMECULA VALLEY set items (lumber, paint, brushes, rollers, nails, screws, casters, etc.), set decorating PLAYERS items, batteries (for microphones), props, costumes, microphone rentals, dry ice machine and dry ice, rehearsal space, and other rental equipment. Estimated number of (Temecula residents to benefit: 2,500 based on attendance, business, creative team, actors. >$5K TVP completely shut down 3/20 — 8/21 during the pandemic. The remaining show for the 19/20 season were canceled and all 5 productions for the 20/21 season were canceled. Revenue comes predominately from ticket sales and the financial loss was devastating, reduced from a 190k average to $17,881. To remain solvent, TVP closed the warehouse and rented local storage for items required in future productions. Warehouse inventory was donated or stored at private residences of Board Members. TVP is applying for >$5K to create the project "Temecula Talent Revived!" TVP will actively cultivate partners during this time for advertising, fundraising, and other grant opportunities in order to sustain the project after grant funding has ended. Temecula actors will learn from industry professionals/quality theatre performers, providing intensive instruction in all areas of theatre including direction, musical direction, choreography (and receive feedback on acting, vocal and dance capabilities). SUB- COMMITTEE RECOM- MENDATION $ 1,090,500 27,000 1 $ 27,000 10,000 1 $ 47,000 1 $ 5,000 30,000 ANNUAL CSF Cn 1 O N N N N O O O O N N N N 00 of o N CD 0 N 0 0 0 0 COUNCIL CSF O N 14 N r4 N N O O O O 0) -I O N 14 N N N o N O N O N O N > LL > LL > LL > LL 1,000 CDBG C'4 O N O N O N O M r 0 N O N o N 14 N O N N N O N > LL > LL > LL > LL Page 14 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA 56 'TEMECULA VALLEY 'PO BOX 890367, Temecula, CA 1- PEACE AND FRIENDSHIP GARDEN. Six peace poles with a message: May Peace ROSE SOCIETY Website: Prevail on Earth" in 42 languages. An effort bean in 1955 by a Japanese philosopher TEMECULAVALLEYROSESOCIETY.O after WW2. The message is on each pole. Funds will be used for rose bushes, mulch, RG construction of pathways with maintenance, irrigation system & Equipment with maintenance, 6 peace poles with shipping, addition of 42 languages plus a Braille plaque, display case to recognize donors. 2 - GARDEN GAZEBO REPLACEMENT. For structure after 25 years of deterioration. Funds will be used for a gazebo unit, shipping, and installation. BOTH PROGRAMS - Estimated number of Temecula residents to benefit: 1,500. >$5K COVID involvement changed everything. Meetings and activities for both adults and children shut down. Outdoor meetings were attempted with little participation. Annual dues were not collected in 2021 resulting in a loss of revenue and membership interest. 1- PEACE AND FRIENDSHIP GARDEN was initiated in 2020. It will need constant maintenance by volunteers. 2 - GARDEN GAZEBO REPLACEMENT. The original decorative garden gazebo was installed about 25 years ago. It now needs to be replaced due to deterioration, as simple repair is not possible. This unit is important for income, is it is rented for family events, weddings, proposals, and is one of the main attractions for visitors on a hill for a spectacular view. 57 GFWC TEMECULA PO BOX 1056, Temecula, CA 92593 FUNDRAISER CANCELLATION COMPENSATION PROJECT. will increase membership and VALLEY WOMAN'S Website: TVWC.COM fundraising capabilities to host larger fundraisers, increase volunteering, contributing, CLUB and donating to the community. Funding would pay for operational costs of monthly meetings, fundraising events, membership engagement, public relations and local non- profit projects. Funding will be used for the HOME TOUR FUNDRAISER such as homemade soup/gourmet food/bakery supplies, waste management rentals, van rentals, traffic control rentals, print advertising, brochure printing, ticket & poster printing, catering, rentals (table & chair, portable toilet facility, venue), insurance fees, licenses, and permit costs. Estimated number of Temecula residents to benefit: 250,000. [to double-check; Temecula population—110K). >$5K At the end of 2019 TVWC had 120 members. In 2022, membership has declined to 80 members. The decreased membership reduced the number of charities supported, dollars donated, and hours volunteered to the community. This grant would assist TVWC in increasing membership and paying for fundraising costs to get back to pre -pandemic membership and return TVWC's contribution to the community to the higher level again. 58 THE 27262 Via Industria, Temecula, CA YOUTH MENTAL HEALTH COMMUNITY HEALTH WORKER PROGRAM. The EMPOWERMENT 92592 Empowerment Center's Mission is to help youth and families develop the resilience CENTER Website: THEEMPOWERMENT necessary to overcome challenges, discover the best of themselves and create healthier, CENTERINTL.COM happier patterns of living. An innovative approach to providing peer -to -peer mental health support for Temecula's youth. Grant funds will be used to cover the cost of mental health training, curriculum materials, and program participation incentives including meal provision for evening and weekend trainings and gift cards. Estimated number of Temecula residents to benefit: 100. >$5K The COVID-19 pandemic allowed the TEC to pivot services to virtual platforms, removing the barriers to attendance. Although TEC shut the doors to in -person programming, the pandemic allowed TEC to reach the most youth and families that have been reached in the last 5 years. The pivot has allowed TEC to expand service across the county, state, and country. The grant funds will create new programming. TEC has been invited by the California Workforce Development Board to provide Mental Health Worker training and employment preparation services to the adult workforce. It is TEC's goal to provide youth with the same opportunities through this Youth Mental Health Worker Project. SUB- COMMITTEE RECOM- MENDATION $ 1,090,500 50,000 1 $ 10,000 50,000 1 $ 50,000 $ 25,000 25,000 ANNUAL CSF Cn 1 O N N N N O O O O N N N N 00 of o 1-1 N CD 0 N 0 0 0 0 COUNCIL CSF ON O 14 N O r1i N O N O 0) -I o N O N O N 14 N O N N N O N > LL > LL > LL > LL CDBG C'4 O N O N O N O M r O N 14 N N N 0 N o N O N O N > LL > LL > LL > LL Legend] "-" = Apollied and N t Awarde Page 15 of 18 No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA 59a THE SALVATION ARMY -1OF2 APPLICATIONS 59L THE SALVATION ARMY -2OF2 APPLICATIONS 60 THE SHELLA FOUNDATION 40270 Los Alamos Rd., Murrieta, 'TEMECULA CHILD SPREE. Back -to -school event gives school aged children books a NEW APPLICANT CA 92562 breakfast and the opportunity to pick out $125 worth of new clothes, shoes, backpacks, Website: i and school supplies. Funding will assist with August 2022 & August 2023 expenses MURRIETA.SALVATIONARMY.ORG —$25/child for school supplies, $125 JC Penny gift cards (spent on the day of the spree). Targeted recipients are children (in low income families) living in the City of Temecula . Estimated number of Temecula residents to benefit: 90. >$5K Over the course of the COVID-19 pandemic TSA was called upon to serve significantly higher numbers of people with food, clothing and financial assistance more than any other time in its 25 years in SW Riverside County. While service needs, and as a result, program expenses increased dramatically, private donations have begun to decrease, combined with inflation (food & fuel), TSA has been challenged in operating its programs. The pandemic further affected the ability to utilize volunteers in carrying out programs, including Child Spree, which now have parents shopping with their children instead of volunteers. With the requested funding, the number of Temecula children served will increase the annual average of 15-50 (and overall total of 200 to 250 each year). The Child Spree will be the 25th year in 2023 and anticipate a big event with news coverage and more participation from Temecula children. 40270 Los Alamos Rd., Murrieta, TEMECULA HOMELESS PREVENTION. Provides up to 2 months of rental assistance, paid NEW APPLICANT CA 92562 directly to landlords (rental property owners and/or management companies) on behalf Website: of Temecula residents with past -due rent, experiencing financial crisis and are set for MURRIETA.SALVATIONARMY.ORG eviction, thus preventing homelessness. Estimated number of Temecula residents to benefit: 42. >$5K Over the course of the COVID-19 pandemic TSA was called upon to serve significantly higher numbers of people with food, clothing and financial assistance more than any other time in its 25 years in SW Riverside County. While service needs, and as a result, program expenses increased dramatically, private donations have begun to decrease, combined with inflation (food & fuel), TSA has been challenged in operating its programs. Funding will allow the homeless prevention program to expand from serving —18 Temecula residents annually to 42 residents during the proposed program term. PO BOX 263, Menifee, CA 92586 Website: SHELLAFOUNDATION.ORG IN -HOME PERSONAL CARE RESPITE SCHOLARSHIP. Helps those requiring care either NEW APPLICANT diagnosed at birth with disabilities or have been in an accident that caused a disability, or are senior citizens who cannot care for themselves. Funds will be used to provide —70 families with 24 hours of in -home personal care and respite support to Temecula families. Estimated number of Temecula residents to benefit: 70. >$5K The Shella Foundation receives 100% from donations. The pandemic prevented holding fundraising events due to lockdowns and social distancing. This also prevented providing in -home care. The monies used form this grant will be used to continue an existing program, providing in -home personal care respite reserved exclusively for Temecula populations, and awarding personal care scholarships to those that qualify. SUB- COMMITTEE RECOM- MENDATION $ 1,090,500 13,500 1 $ 23,500 36,500 1 $ 50,000 1 $ 20,000 5,000 ANNUAL CSF 01 1 O N N N N O O O O N N N N 00 of o N CD 0 N 0 0 0 0 COUNCIL CSF ON O N O N O N O 0) -I o N O N O N 14 N O N N N O N > LL > LL > LL > LL CDBG C'4 O N O N O N O M r 0 N O N o N 14 N O N N N O N > LL > LL > LL > LL Page 16 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA 61 'THE TEMECULA VALLEY MASTER CHORALE 62 THESSALONIKA PO BOX 890204, Temecula, CA MASTER CHORALE SEASON 22-23. Provides concerts through collaboration with I NEW APPLICANT 92589-0204 Temecula schools and businesses. Funding will be spent on concert venues, competition Website: venues, musical score purchases, program and flyer printing, independent contract TEMECUALVALLEYMASTERCHORA instrumentalists, food, and vendors. Estimated number of Temecula residents to LE.ORG benefit: 500. >$5K When the COVID-19 quarantine first started the season was cut short and not able to have the final concert. The next season had some members patriciate online practices with limited you tube video performance (no public performances). Last season (Sept 2021-April 2022) Master Chorale, with less members returning, practiced with masks, and had outdoor concerts. Fundraising activities were also limited. Grant funds would expand Master Chorale's opportunities to reach more of the Temecula community through involvement in choir, in audience capacity or as vendor of venues, supplies, or services. This creates an opportunity to collaborate with Temecula school choirs (public and private) and orchestras and their families. The dream is to eventually host a fine arts festival at the Community Recreation Center that would include school choirs, orchestras, and local vendors. 38950 Mesa Road, Temecula, CA FAMILY SERVICES 92592-8753 63 VETERANS SUPPLEMENTAL SUPPORT NETWORK (VSSN) Website: INFO@CMOH.NET CMOH FOOD PROGRAMS. Maintains food distribution warehouse and upkeep equipment to provide local food distribution services, paying drivers, rental fees for food delivery vans, workshop supplies, supplemental food items, and volunteer training costs [no salaries]. CMOH HOUSING is a residential program for homeless single mothers and their young children. Funds will be spent on capital expenditures [possibly; City needs more details] to improve classroom and childcare spaces at Empowerment Village - a residential program for homeless single mothers and their young children. Estimated number of Temecula residents to benefit: 2,000. >$5K Exacerbated by the pandemic, CMOH clients continue to face difficulty paying for basic needs. Today, more families than ever before are turning to CMOH. This increase in demand coupled with rising costs, necessitates that CMOH needs more funding to serve the community. Funding will allow CMOH to continue the Food Pantry and Housing Programs. CMOH annually spends over 2,700,000 on program costs, funded primarily though the generosity of the philanthropic community and in -kind donations. $50K in support from the City of Temecula will allow CMOH to continue its food pantry and housing programs. 41593 Winchester Rd #200, STOMPING THE STIGMA VETERAN OUTREACH. Hosts military and veteran family Temecula, CA 92590 outreach resource events to include annual Winter Wonderland, Cards for Vets, Daisy Website: VETSUPPORTNET.ORG Monument Walk, and the Hiring and Volunteer Fair. Funding will be used for storage unit rental space—$1800, equipment rental for events (tables, chairs, linen, canopies, sandbags, pipes, drapes) averaging—$6800, postcards printing & distributing (Cards for Vets)—$1400. Estimated number of Temecula residents to benefit: 11,698. >$5K When the COVID-19 pandemic hit, VSSN sprung into action to provide vital services including food deliveries, virtual mental health readjustment, suicide prevention case management, and resource and referrals. Core outreach events, which fuel the service delivery, were halted due to safety and budget restrictions; however, many volunteers continued to play key roles in regular services, including pandemic -related ones: vaccine education, without adequate funding. Since the pandemic VSSN experienced a 33% increase in demand. The rising inflation is continually impacting in -kind and monetary donations. Funds will help cover the costs of VSSN's well -attended outreach events and increasing warehouse storage fees. SUB- COMMITTEE RECOM- MENDATION $ 1,090,500 22,000 1 $ 50,000 $ 10,000 1 $ 50,000 10,000 ANNUAL CSF Cn 1 O N N N N O O O O N N N N 00 of o 1-1 N CD 0 N 0 0 0 0 COUNCIL CSF ON 14 N r1i N N O O O O 0) -I O N 14 N N N o N O N O N O N > LL > LL > LL > LL 2,000 CDBG C'4 O N O N O N O M r 0 N O N o N 14 N O N N N O N > LL > LL > LL > LL Page 17 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA SUB- COMMITTEE RECOM- MENDATION TOTAL$ 1,090,500 BOARDDIRECTORS OR 64 WESTERN EAGLE 40940 County Center Drive, FOOD BOXES. For-220 Temecula residents/month filled with staples: canned NEW APPLICANT $ 50,000 $ 50,000 FOUNDATION Temecula, CA 92591 vegetables and fruits, dry pasta and rice, cereals, spaghetti sauce, dried beans, soups, peanut butter, tostada shells, and packaged dinners. At an operational cost of $25/box times 220 Temecula residents take advantage of the food box a month. $5,500 per month. Annual Cost is $66K. Estimated number of Temecula residents to benefit: 2,640. >$5K COVID-19 affected Western Eagle's ability to get donated food from growers, farmers, and suppliers. Inventory and overflow of food was down; there was a lot of competition for donated food from other food banks ad transportation was costly and not always on schedule. Suppliers began charging for their overstock rather than just giving it away as they did before the pandemic. Western Eagle began buying more "staples" for the food box program and the store. This has caused an increase in operating and program expenses. Inflation has caused Western Eagle to let go of the truck driver, due to high cost of gasoline and employee retention. Western Eagle now uses a transportation service to pick up food and goods from suppliers, which causes delay in getting food picked up and brought back to the Western Eagle store. 65 WISHERS AND 31915 Rancho California Ro 200- VOLUNTEER SEWING EVENTS. Donates gowns to local hospitals. Funds will be used to NEW APPLICANT MUST $ 51000 $ DREAMERS INC 407, Temecula, CA 92591 purchase fabric and supplies including (not limited to) scissors, thread, packaging ONLY SERVE TEMECULA Website: WISHERSAND materials, postage, shipping, and sewing machines. Hosts in -person sewing events in ONLY MEDICAL DREAMERS.ORG the City of Temecula several times a year. Volunteers make and package hundreds of OFFICES/HOSPITALS FOR gowns donated to children and hospitals. The gowns from this grant will be earmarked THE BENEFIT OF TEMECULA to be donated to our local medical community including but not limited to LLUMC, CITIZENS Rady's Children, Temecula Valley Hospital, SW Healthcare System and local pediatric doctors and surgical centers Estimated number of Temecula residents to benefit: 1,000. 66 I WOMEN PO BOX 1382, Temecula, CA THE LYDIA PROJECT. Designed to educate, equip, and prepare young women to become self- NEW APPLICANT $ 50,000 $ 5,000 ORGANIZING 92593 reliant and/or self-employed. Learn strategies necessary for becoming successful business WOMEN INC Webslte: owners. Aid women in overcoming barriers/codependency on welfare systems; life coaching to become self-sufficient WOMENORGANIZINGWOMENINC. THE MOBILE KITCHEN SOCIAL ENTERPRISE. Break generational cycle of poverty. The Mobile ORG Kitchen is a food truck that is used to bring awareness, resources, tools and support. Food truck that provides revenues to fund local philanthropic missions (mission: evangelical outreach, mentoring/coaching, support for women & children). Funds will be spent on a commercial refrigerator —$2k, double deck commercial oven, commercial fryer, compartment sink —$700, freshwater tank —$200, grey water tank —$350, generator,—$1500, hand sink —$500, burner countertop range —$1k, burner griddle top —$250, countertop with backsplash —4k, pantry shelves—$2100, electric water heater—$1400, propane cylinder —$200, service window—$1500, hood with fan /fire suppression system—$5500, rear door—$1300, engineering & state licenses —$6500, storage fees for 1 year—$3k, maintenance supplies (pots &pans) and gas —$800. Estimated number of Temecula residents to benefit: 8,144 annually. >$5K Faith -based nonprofit that does not discriminate based on another belief system. Food insecurities are real. Project will create jobs, establish business partnerships, inspire entrepreneurs, work alongside other nonprofits, secure foods sources to local families. COVID-19 affected WOW's ability to serve the Temecula community based on the fear of the pandemic to interact with the public. Although not able to have annual fundraising events, WOW stayed diligent in praying for those grieving and suffering form depression, provided grief counselling, and connected virtually through social media outlets. WOW was able to give 2 grants (for $500 each) in 2021. Community inflationary concerns impact the small business owner and nonprofit organization from receiving business or $20 donations towards an organization mission initiative. The project will be one vehicle in providing a food source to families, income to small business, and donations to nonprofit organizations. TOTAL I I I $ 2,278,372 1 $ 1,090,500 ANNUAL CSF Cn 1 O N N N N O O O O N N N N 00 of o 1-1 N CD 0 N 0 0 0 0 COUNCIL CSF ON O N O N O N O Q1 o N O N O N 14 N O N N N O N > LL > LL > LL > LL CDBG C'4 O N O N O N O Q� r 0 N O N o N N O N N N O N > LL > LL > LL > LL Page 18 of 18 Legend: "-" = Applied and Not Awarded No Number = Did Not Apply FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # la A PLACE FOR ALL PIECES (A: YOUTH BASKETBALL) CITY OF TFAMECUTA FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 L__ PROJECT/PROGRAM INFORMATION Amount Requested: $ 5,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: TEMECULA YOUTH BASKETBALL CHAMPIONS Start Date: 12I0122 End Date: 2111123 Physical Address of Project/Program: TO BE DETERMINED (PREVIOUS LOCATION WAS TEMECULA CRC INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: A PLACE FOR ALL PIECES Mailing Address: 27880 CLINTON KEITH RD, SUITED 0151 MURRIETA, CA 82562 IORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant A PLACE FOR ALL PIECES Organization: Website: aplaceforallpleces.org Number of Paid Staff: 0 Year Founded: 2013 Social Media: FACEBOOK, INSTAGRAM Number of Volunteers: 30+ Geographic Area(s) the Organization Serves: TEMECULA VALLEY Geographic Area(s) the Project/Program Serves: TEMECULA VALLEY NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: _ IVY KIRSHBERG _ Title/Position: PRESIDENT Contact Person's Direct Telephone: 714 724 1010 Contact Person's Email: ikirshberg@yahoo.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes K] Date of Incorporation as a Nonprofit: "1212013 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 46-2012269 State Identification Number: 3646151 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: littpllapps.ii-s.gov/apr)/eosi 2. ❑ Attach State Entity Status Letter using this link: Iit[PS:l/www ftb.ca.gQ%/online/self serve entity status letter/index.asp 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool h tp./Irct__d6 ca.goylVeri€ication/Web/Search_aspx?[aciliiv Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No © Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No 0 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee 0 Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. A Place for All Pieces fosters a community of empowered children and adults. Our goal is to Increase the quality of life for people on the spectrum. By providing opportunities for social motivation, initiations, and peer to peer interaction. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No 0 Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT y AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP $ $ I $ J $ I OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No [X] Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT J f r' MONTH 'YEAR o�^ 1 .-��„�., NAME OF ENITY J City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. TYBL serves the disabled community In the Temecula Valley area. The demand for the program has doubled from last year. The 11 week program is geared towards children K-12 with special needs. Temecula High School volunteers receive volunteers hours, while gaining meaning relationship, learning compassion, and patience. Special Needs players learn social skills, and peer -to -peer Interactions. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The fee to join the program has increased since Inception. Cost of $120 per player includes court rental, pictures, facilitator, liability insurance. Additional cost for buddy shirts, materials, end of the season party. - -- - - 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Temecula Youth Basketball Champions League Is Temecula based. Temecula residents have participated in the past. Temecula residents specifically benefits from the program because of the proximity of the court location. Local volunteers have also learned how to peer mentor special needs players. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 25-40 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 25-50 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT- SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Our event focuses on a positive environment. It helps develop social skills for the special needs, while {peer volunteers continue to learn compassion and patience. Physical activity is very important for health,especially for the disadvantaged community. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 5,000 Amount contributed to the Project/Program by the Applicant $ Organization 1,000 Other grants or funding already awarded for Project/Program, if any $f D In -Kind match amount or volunteer credit hours estimated amount $ 560 hrs TOTAL REVENUE $ 6,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ 750 Facilities/Rent/Insurance f $ Supplies $ soo Marketing $ Services $ Food 1,000 Other cost to Join: $120x40 $ 4,800 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ is TOTAL EXPENSES TOTAL BUDGET $ $ 7,050 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. I If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3 Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF Organization: EXPENDITURE REPORT due on or before September 12, 2022 Name of Project/Program: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: - Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiarles if you do not have precise number): v 1 Date on E Name of Company Receipt/invoice on Receipt or Invoice MUST BE ON OR BETWEEN JULY 1, 2021 - JUNE 30, 2022 QZ 1 2 3 4 1 5 6 City of Temecula Amount Expenditure Description I Purpose DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: TOTAL FY 2022-2023 Amount of Grant Fund Awarded: $ Name of Project/Program:, Month & Year FIRST $6,000 check was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) EName of Company Eon Receipt or Invoice QZ OA 3 Date on Receipt/Invoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, 2024 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount Description Purpose W EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. Every Community Service Funding application is considered individually and on its own merit. Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. ■ The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: A PLACE FOR ALL PIECES MAILING ADDRESS: 27890 CLINTON KEITH RD, SUITE D 8150 MURRIETA, CA 92562 PRESIDENT / AUTHORIZED OFFICER: IVY KIRSHBERG MAT NAVE PHONE:( 714 ) 724-1010 EMAIL: Ikimhberg@yahoo.com SIGNATURE: _ DATE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY. -RIr.li �JAPl1F PRESIDENT �IfLC. 8/29/2022 iV10liiN W., Y111F. 1iri SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 DEPARTMENT OF THE TREASURY Employer Identification Number: Date: NOV` 46-2012269 u 2013 DLN : 17053098339043 A PLACE FOR ALL PIECES Contact Person: C/O JEFFREY KIRSHBERG MR. DAVIS ID# 31636 27775 BOTTLE BRUSH WAY Contact Telephone Number: MURRIETA, CA 92562 (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170(b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: February 12, 2013 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. Enclosure: Publication 4221-PC Sincerely, Director, Exempt Organizations Letter 947 (DO/CG) STATE OF CALIFORNIA + FRANCHISE TAX BOARD C SABOX 942T57 BJ1 SACRAM 4285 CA 94257-0540 Entity Status Letter Date: 8/29/2022 ESL ID: 8818358920 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 3546151 Entity Name: A PLACE FOR ALL PIECES 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Q HELPO MENU Home > Tax ExemptOrpnization Search > A Place For All Pieces < Back to 5ur-r. Results A Place For All Pieces E I N: 46-2012269 1 Murrieta, CA, United States Form 990-N (e-Postcard) 8 Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. Tax Year 2021 Form 990-N (e-Postcard) Tax Period: 2021 (01/01/2021 - 12/31/2021) EIN: 46-2012269 Legal Name (Doing Business as): A Place For All Pieces Mailing Address: 27890 Clinton Keith Rd Suite D151 Murrieta, CA 92562 United States Principal Officer's Name and Address: Ivy Kirshberg 27890 Clinton Keith Rd Suite D151 Murrieta, CA 92562 United States Gross receipts not greater than: $50,000 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 1b A PLACE FOR ALL PIECES (B: HALLOWEEN DANCE) N_w 11b W11) ail 11 FISCAL YEAR 2022 M 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 Amount Requested: $ PROJECT/PROGRAM INFORMATION MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: INCLUSIVE HALLOWEEN TEENIADULT DANCE EVENT Start Date: 10/28122 End Date: 10/28/22 Physical Address of Project/Program: THE CORPORATE ROOM INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: A PLACE FOR ALL PIECES Mailing Address: 27890 CLINTON KEITH RD, SUITE D 0151 MURRIETA, CA 92662 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant A PLACE FOR ALL PIECES Organization: _ Website: aplaceforallpleces.org Number of Paid Staff: 0 Geographic Area(s) the Organization Serves: Year Founded: 2013 Social Media: FACEBOOK, INSTAGRAM Number of Volunteers: 26+ TEMECULA VALLEY Geographic Area(s) the Proiect/Progrram Serves: TEMECULA VALLEY NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: IVY KIRSHBERG Title/Position: PRESIDENT Contact Person's Direct Telephone: _714 7241010 Contact Person's Email: Ikimhberg@yahoo.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes F&] Date of Incorporation as a Nonprofit: 21I2r2013 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 46-2012269 State Identification Number: 3546151 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: 17ttts_Ilapps.irs.gov/app/eosl 2. ❑ Attach State Entity Status Letter using this link: https://www.ftb.ca.clov/otiliiie/self Serve entity StatGIS letterlindex.asr) 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: llti l�rct.[fry:e.covlVBliticali❑nlWctalSe��rrll.a_:1 : '1i.1�:ihry 'r City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No © Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No E] Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee 0 Board of Directors ❑ F Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. A Place for All Pieces fosters a community of empowered children and adults. Our goal is to Increase the quality of life for people on the spectrum. By providing opportunities for social motivation, initiations, and peer to peer interaction. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No [K] Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT MONTH + YEAR NAME OF CITY GRANT AMOUNT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No [J Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT T MONTH + YEAR i RECEIVED NAME OF ENITY II FUNDING RECEIVED $ 5,000 HAI ADVANCED MATERIALS SPECIALISTS Q@ 12/2021 P W P W City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. A Place for All Pieces Teen Adult Halloween Event will provide much needed social skills, peer to peer support. Temecula Special Needs families with teens and adults are always In need of programs. This event promotes a positive and safe environment for everyone. With the help of High School volunteers in the Temecula Valley area, special needs families are given the opportunity to enjoy themselves without judgements. They are surrounded by families who are also in need of respite from the daily grind of taking care of someone with special needs. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED, ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. VENUE: $1600 DECORATIONS: $3500 FOOD: $1500 DJ: $300 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Our Halloween stance event Is our biggest event of the year. Temecula Special Needs families and Peer volunteers from Terecula schools have participated in the past. It Is not only geared to benefit tf a special needs families, bUI also the high school peers who have returned yearly to help develop a positive environment for everyone. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT I 50-75 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 25-50 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT- SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. ❑ur event focuses on a positive environment. It helps develop social skills for the special needs, while peer volunteers continue to learn compassion and patience. It is the most sought after event of the year, with attendance growing every year. The cost will he around $6,900 this year. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES J EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 6,000 Amount contributed to the Project/Program by the Applicant $ Organization 1,900 Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 45 hrs TOTAL REVENUE 1 $ 6,900 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment ! $ Facilities/Rent/Insurance $ 1,600 Supplies $ Marketing $ Services $ 300 Food 1,500 $ 3,500 Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, HOWEVER PLEASE INCLUDE. T $ $ 6,900 TOTAL EXPENSES $ 6,900 TOTAL BUDGET $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures_) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Managers Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: _ Name of Project/Program: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Name of Company I-cR E on Receipt or Invoice F 7 ¢a 2 1 3 1 Ez Date on ReceiptlInvoice MUST BE ON OR BETWEEN JULY 1, 2021 -JUNE 30, 2022 EXPENDITURE TOTAL Amount Expenditure Description Purpose DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000' no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receiptslinvoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Name of Project/Program: TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request S_ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) _ r d E L " E 4Z 2 3 Name of Company on Receipt or Invoice Date on Expenditure ReceiptlInvoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, Amount Description Purpose 2024 EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. * The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. 16 If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: A PLACE FOR ALL PIECES MAILING ADDRESS: 27890 CLINTON KEITH RD, SUITE D #160 MURRIETA, CA 92662 PRESIDENT / AUTHORIZED OFFICER: _IVY KIRSHBERG PHONE: ( 714 ) 724-1010 EMAIL: lkirshborg@yahoo.com SIGNATURE:, _ DATE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: 8/29/2022 PRESIDENT 1111t VO I"N I)i"N, yrfAP: PRGd I NANV T SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OR 45201 Date: A PLACE FOR ALL PIECES C/O KURT GRAVES 3118 WILSHIRE BLVD STE D SANTA MONICA, CA 90403 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 46-2012269 DLN: 17053098339043 Contact Person: MR. DAVIS ID# 31636 Contact Telephone Number: (877) 029-5500 Accounting Period Ending: December 31 Public Charity Status: 170 (b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: February 12, 2013 Contribution Deductibility: Yes Addendum Applies: No 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. Enclosure: Publication 4221-PC Sincerely, Director, Exempt Organizations Letter 947 (DO/CG) STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B PO BOX 942657 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/29/2022 ESL ID: 8818358920 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 3546151 Entity Name: A PLACE FOR ALL PIECES 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. © 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p-m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: f711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Q HELPO MENU Home > Tax Exempt Organixdtion Search > A Place For All Pieces < Back to Search Result A Place For All Pieces EIN: 46-2012269 1 Murrieta, CA, United States Form 990-N (e-Postcard) 8 Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. Tax Year 2021 Form 990-N (e-Postcard) Tax Period: 2021 (01/01/2021 - 12/31/2021) EIN: 46-2012269 Legal Name (Doing Business as): A Place For All Pieces Mailing Address: 27890 Clinton Keith Rd Suite D151 Murrieta, CA 92562 United States Principal Officer's Name and Address: Ivy Kirshberg 27890 Clinton Keith Rd Suite D151 M u rri eta, CA 92562 United States Gross receipts not greater than: $50,000 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 2 AIM FOR GOOD INC. ► W wirl)Vm'lI�FL- ►i111 FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION AIM for Good Project/Program Title: Physical Address of Project/Program: Start Date: 4/20 End Date: indefinite INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: AIM for Good, Inc. Mailing Address: 31493 Rancho Pueblo Rd. #205 Temecula, CA 92592 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant AIM for Good, Inc Organization: _ Website: www.AimForGood.org Number of Paid Staff: 0 Year Founded: 2020 Social Media: FB/Instagram Number of Volunteers: 15 Geographic Area(s) the Organization Serves: Temecula Valley Geographic Area(s) the Proiect/Program Serves: Temecula Valley NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Mark Anselmo Title/Position: President/Co-Founder Contact Person's Direct Telephone:9519726680 Contact Person's Email: markanselmo®gmail.c Of NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 4/17/20 No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 850914556 State Identification Number: 4584598 PRINTOUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTS) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: htt :1/a sirs. ov/a Leos/ 2. B Attach State Entity Status Letter using this link: htt s., /www.ftb.ca, ov/online/self serve entitystatus letterlindex.as � {{ � 3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed infc6W424marity found on this State Registry's Search Tool: htt :1/rct.do .ca. r►111erihcationtWeb/Search.as x?facili =Y CITYMI 'IAGEP'SOFFICE City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No❑ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No N Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors IN Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION I BRIEFLY DESCRIBE THE ORGANIZATION's MISSION/GOALS AND OBJECTIVES. Our goal is to give back to our community wherever the needs may be. Our mission to help local individuals and families in need, local non -profits and to help facilitate events that spread awareness of multiple causes. Our founder originally started a non-profit, Our Nicholas Foundation, in 2004 to help support the local Autism community when their youngest son was diagnosed. Over the years he has seen needs multiply in many areas including cancer, hunger, autism/special needs, family support and more and wanted a solution to help quickly with no delays...thus AIM for good was started. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION's CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA's AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No E Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT MONTH + YEARu NAME OF CITY GRANT AMOUNT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP 1- OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NON Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW, NAME OF ENITY City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTSANVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECTIPROGRAM AS DESCRIBED HERE E DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Simply local individuals, families and non -profits in need ... whether that's financial, public awareness or volunteer support. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Our goal is to find needs and immediate) fill them it's hunger needs this Y g s Fall/Winter with the inflation/recession challenges we face... challenges local non -profits face with decreased donations in a recessionary period... providing video marketing for those in need ... charity events or public community support.. -Autism art camps...we are flexible and will fill the need. We have purchased and will be upgrading video production equipments to promote those in need via online marketing, etc. and will help purchase items as needed locally to help whomever we can. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Our focus is the Temecula Valley. Locally for non -profits we have directly supported Michelle's Place, Community Mission of Hope, Autism & the Arts j Foundation and Jacob's House and plan to expand that further. 3b 3c ESTIMATED FROM THIS PROJECT/PROGRAM: PROGRAM BER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT Sky's the limit ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM 15 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Helping individuals, families and non -profits wherever possible locally. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Covid, Inflation and Recession will and does impact all non-profit contributions. We haven't actively fundraised as we didn't want to compete for local dollars as the local non -profits build their strategies going forward... 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Our goal is to help whomever we can locally without any red tape ... so this grant would help us kickstart that goal and funnel much needed support via financial, marketing/promoting of needs, direct partnerships and more. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM $UDGET (dQ not fill In shaded prqss) LINE ITEMS FOR PROJECT/PROGRAM ___TREVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50000 Community Services Grant (Not to exceed $S0,000) Amount contributed to the Project/Program by the Applicant $ Organization Other grants or funding already awarded for Project/Program, if any $ 10000 In -Kind match amount or volunteer credit hours estimated amount $ 0 TOTAL REVENUE $ 60000 LIST OF EXPENSES FOR PROJECT/PROGRAM r s/Equipment ities/Rent/Insurance Supplies Marketing Services Food Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET $60000 $5000 $55000 $60000 $60000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approvedlawarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 AIM for Good Inc AIM for Good Organization: _' Name of Project/Program: FY 2021-2022 Amount of 'N/A CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this ProgramlProject (approximate number of beneficiaries if you do not have precise number): Date on E' E Name of Company Receiptllnvoice iture u on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose Q z JULY 1, 2021 -,TUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE 1 R EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive andlor will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the reraining balance of award to demonstrate finds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: AIM for Good, Inc Name of ProjectlProgram: AIM for Good TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $6,000 awarded and received? Yes or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request S Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) Date on Expenditure E Name of Company Receipt/invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER u E on Receipt or Invoice MUST BE ON OR BETWEEN 92 March 20,2020-JUNE30, Amount 1 Descri tion Pur ose a z 2024 p p �_ rs I EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. Every Community Service Funding application is considered individually and on its own merit. Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. m The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: AIM for Good, Inc MAILING ADDRESS: 31493 Rancho Pueblo Rd. #205 Temecula, CA 92592 PHONE: (951 ) 9726680 EMAIL: markanselmo@gmail.com PRESIDENT / AUTHORIZED OFFICER: Mark Anselmo izirdi N�,P1F SIGNATURE: O—A:�, ` — DATE: 09/1 1 /22 IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: V f-J N f P - - SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Department of the Treasury Internal Revenue Service Date: 04/07/2021 Tax Exempt and Government Entities I RS P.O. Box 2508 Employer ID number: Cincinnati, OH 45201 85-0914556 Person to contact: Name: Customer Service ID number: 31954 Telephone: (877) 829-5500 AIM FOR GOOD INC Accounting period ending: 31493 RANCHO PUEBLO ROAD 205 December 31 TEMECU LA, CA 92592 Public charity status: 170(b)(1)(A)(vi) Form 990 1990-EZ / 990-N required: Yes Effective date of exemption: April 17, 2020 Contribution deductibility: Yes Addendum applies: No DLN: 26053414002361 Dear Applicant: We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts Linder Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Sincerely, a- - t4t0f� Stephen A. Martin Director, Exempt Organizations Rulings and Agreements Letter 947 (Rev. 2-2020) Catalog Number 35152P STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B PO BOX 942657 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/11/2022 ESL ID: 5184525432 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 4584598 Entity Name: AIM FOR GOOD, INC. ® 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 1711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Q HELPB MENU Home > Tax Exempt Qrganix ion r h > Aim For Good Inc. 39TR-V'-VTTTR11;MM Aim For Good Inc. EIN: 85-0914556 1 Temecula, CA, United States Other Names Determination Letter o A favorable determination letter is issued by the IRS if an organization meets the requirements for tax-exempt status under the Code section the organization applied. Final Letters Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Form 990-N (e-Postcard)-o Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. Tax Year 2021 Form 990-N (e-Postcard) Tax Period: 2021 (01/01/2021 - 12/31/2021) EIN: 95-0914556 Legal Name (Doing Business as): Aim For Good Inc Mailing Address: 31493 Rancho Pueblo Road Suite 205 Temecula, CA 92592 United States Principal Officer's Name and Address: Mark Anselmo 31493 Rancho Pueblo Road Suite 205 Temecula, CA 92592 United States Gross receipts not greater than: $50,000 Organization has terminated: No Website URL: www.AimForGood.org Page Last Reviewed or Updated. 20-November-2020 f* Share $ Print e Home > Tax Exempt Organization Search > Our Nicholas Foundation Inc < $ack to Search R se ults Our Nicholas Foundation Inc EIN: 20-3348800 1 Temecula, CA, United States Auto -Revocation list o HELPO MENU Organizations whose federal tax exempt status was automatically revoked for not filing a Form 990-series return or notice for three consecutive years. Important note: Just because an organization appears on this list, it does not mean the organization is currently revoked, as they may have been reinstated. Posted Date: 08-10-2015 Exemption Type: 501(c)(3) Exemption Reinstatement Date: Revocation Date: 05-15-2015 Revocation Posting Date: 08-10-2015 Page Last Reviewed or Updated; 20-November-2020 F f* Share I Print STATE OF CALIFORNIA FRANCHISE TAX BOARD ('F T B FO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/13/2022 ESL ID: 2107018787 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 2784676 Entity Name: OUR NICHOLAS FOUNDATION, INC. 1. The entity is in good standing with the Franchise Tax Board. 0 2. The entity is not in good standing with the Franchise Tax Board, 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m, to 5 p.m, weekdays, except state holidays 916-845-6500 from outside the United States FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 3 ANIMAL FRIENDS OF THE VALLEYS CITY OF TEMECULA FISCAL YEAR 2022.. 2023 COMMUNITY SERVICE FUNDING.. REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount FZ,1ecquqasted: $5o,000 IlvAximum ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Temecula Has Heart for the Animals Start Date: 0710122 End Date: 07/01/24 Physical Address of Project/Program: City of Temecula INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Animal Friends of the Valleys Mailing Address: 33571 Mission Trail Rd Wildomar, Ca. 92595 Attn: Beth Soltysiak ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Animal Friends of the Valleys Year Founded: 1987 Website: animalfriendsofthevalleys.com Social Media: animaKdendsoffheyalleys Number of Paid Staff: 84 Number of Volunteers: 3752 Geographic Area(s) the Organization Serves: Temecula, Murrieta, Wildomar, Lake Elsinore, Canyon Lake, Menifee and surroundina rural county areas Geographic Area(s) the P.rograrn Serves: Citizens residing in the City of Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Beth Solt sick Title/Position: Director of Development Contact Person's Direct Telephone: 951-805-6239_Contact Person's Email: beth(&Dafv,org City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes O Date of Incorporation as a Nonprofit: 1987____ No O IF NO, THE INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number:33-0276892 State Identification Number: 1611141 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: I. D Attach IRS Deductibility Status using this link: http://apps.irs.gov/app/eos/ 2. D Attach State Entity Status Letter using this link: https://www.ftb.ca,gov/online/self serve entity status letter/i dex.asp 3. D Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.doj.ca,govNerification/Web/Search.aspx?facility=Y City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 Self Serve Entity Status Letter Entity Search Result Results displayed below. Entities matching the search criteria Entity ID Entity Name city .-ka.1.4.1 ANIMAL FRIENDS OF THE VALLEYS, INC. WILDOMAR Back Copyright© 2022 State of Callfornia ill Internal Revenue Service P.O. Box 2508 Cincinnati, OH 45201 nn Date: [LIAR IS JU07 ANIMAL FRIENDS OF THE VALLEY INC PO BOX 1143 LAKE ELSINORE, CA 92531-1143 Dear Sir or Madam: Department of the Treasury Person to Contact: Roger Meyer ID# 31-07707 Toll Free Telephone Number: 877-829-5500 Employer Identification Number: 33-0276892 This is in response to your request of January 30, 2007, regarding your tax-exempt status. Our records indicate that a determination letter was issued in December 1988 that recognized you as exempt from Federal income tax, and reflect 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 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, Cindy estcolt Manager, Exempt Organizations Determinations Form 990 Return of Qrganization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) OMB No. 1545-0047 2020 ► Do not enter social security numbers on this form as it may be made public. Open to Public Department of the Treasury Internal Revanuo service ■ Go to www.frs. ovlForrn990 for instructions and the latest Information, Ins colon A For the 2020 calendar ear or tax year be innln 07-01 c Name of aMxalloaNIM L FRIENDS OF THE VALLEYS 2020. and ondln 06-30 2021 INC D Employer Identification number B check if applicable: ❑ Address change qfthut,619sas 33-0276892 ❑ Name change Number and street (or P.O. box if mail Is not delivered to street address) Roemfsulte E Telephone number ❑ In! tat return 33751 MISSION TRAIL 951 674-0618 ❑ Final retumllarminated City or town, state or province, country, and ZIP or foreign postal coda G Gross receipts ❑ Amended return WILDOMAR CA 92595-8430 S 6,486,943 ❑ Application pending F Name and address of principal offlcer: H(al is this a group retum (msuhordinates9 ❑ Yes ❑g No H(b) Are all subordinates Included? ❑ Yes ❑ No 1 Tax-exempt status: 0 501(o)s) 501(n) ( ) aPrl rre. 4947 a 1 or 527 If "No," attach a [!at. See Instructions J ftb$lie: ► WWWW . ANIMALFRIEND�SOFTHEVALiL-IEYS . COM H c ► Group exompWn number K Form ofomanlration- M C u..roticn I r-y 1 Trust I fyAssociation 1 1 other ► f- Year of formation: 1987 1 M State of (apfd domicile: CA Part 1 I Summary_ 1 Briefly describe the organization's mission or mostsignificant activities; DEDICATED TO PROMOTING HUMANE CARE OF ANIMALS THROUGH EDUCATION AND A HUMANE, PRO -ACTIVE ANIMAL SERVICES PROGRAM. COMMITTED TO PREVENTING m c THE SUFFERING OF ANIMALS AND TO ENDING PET OVERPOPULATION 4- 2 Check this box ► ❑ if the organization discontinued its operations or disposed of more than 25% of its net assets. 0 3 Number of voting members of the governing body (Part VI, line 1a) .. , ........ . . .. . .... 3 7 y4 Number of independent voting members of the governing body (Part VI, line 1 b) .... .. ........ . 4 7 5 122 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) ..... .. .. ..... 5 6 4,959 �-, 6 Total number of volunteers (estimate If necessary) ... . . .. ...... . ....... .. . .... 7a 0 Q 7a Total unrelated business revenue from Part Vlll, column (C), line 12 . ......... .. .. ...... 71lb 33 418 b Net unrelated business taxable income from Form 990-T Part i line 11 Prior Year Current Year 912,088 825,791 8 Contributions and grants (Part VIII, fine 111) . . . . . . ... . .. .. . . . . . . . . 4 , 720 024 9 Program service revenue (Part VIII, line 2g) ... ..... . . . ............ 5,412,806 _ 65,799 58 343 10 Investment income (Part Vlll, column (A), lines 3, 4, and 7d) .... .......... 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and Ile) . .. . . .. . . . 80,006 124. 116 5,877,917 6,421,136 12 Total revenue - add lines 8 through 11 musts ual Part Vlll, Column (A), line 12 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) . . .. . . . ...... 208,816 220,137 0 14 Benefits paid to or for members (Part IX, column (A), line 4) . . . . .. . .. .... . 3,481,504 3,602, 602, 564 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) ... .. 16a Professional fundraising fees (Part IX, column (A), line 1 le) .... ..... ..... . 0 a b Total fundraising expenses (Part IX, column (D), line 25) ► 224,282 17 Other expenses (Part IX, column (A), lines 11a-1Id, 11f-24e) .. • • . • • . • • 1 981,930 2,105,589 5,672,250 51928,290 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) .. ..... 205,667 492,846 19 Revenue less expenses. Subtract line 18 from line 12 $ Beginning of Current Year 8nd or year 5 598,692 6,453, 827 92 '20 Total assets (PartX, line 16) . . . . . . . . . . . . . . .. . . . .. . . . . .. . . 1m 21 Total liabilities (Part X, line 26) . . .. . .. . ........ . . . .. .. ...... 1,067,599 1,132,842 Aar: 22 Net assets or fund balances. Subtract line 21 from line 20 4 531093 5320 985 111 Sianature Block Under penalties of perjury, I declare [hat I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and eompiole: Declaration of preparer (other than officer) Is based on all information of which preparer has any knowledge. TAMMI BOYD 1 05-11-2022 Sign Signature of officer Date Mere TAMMI BOYD, PRESIDENT - Typo or print name and title Print/Type preparees name Preperees signature Date Check R if PTIN Paid KRISTINE M ANDERSON t7-08-2022 sWemployed P00226669 Preparer Firm'sname ► ANDERSON PROFESSIONAL SERVICES Firm'sEIN ► Use Only Flrm'saddress ► 17620 GRAND AVENUE Phone no. Lake Elsinore CA 92530-53914 951-678-2165 May the IRS discuss this return with the prepareir shown above? see Instructions . X Yes No For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2020) EEA APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $600 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No X Yes D IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No X Yes D IF YES, PROVIDE council MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: Maryann Edwards is the current JPA Board member that oversees the Animal Friends of the Valleys Board of Directors. There is a city representative on the JPA Board from each of the & cities we serve. MISSION STATEMENT OF ORGANIZATION I BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. I Animal Friends of the Valleys is dedicated to promoting humane care of animals through education and proactive animal service programs. We are committed to preventing the suffering of animals and to help end pet overpopulation in the communities we serve. AFV's vision is to be recognized as the leading shelter by providing a safe haven for all animals, while becoming a full -service animal care facility that offers quality and affordable care. Through community education and involvement, AFV will reach our vision to help end pet overpopulation and find a loving and forever home for all adoptable pets in our shelter. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 FUNDING SOURCES CITY OF TEMECULA-SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? NoD Yes D IF YES, PROVIDE BELOW NAME OF PROGRAM/PROJECT AMOUNT MONTH+ YEAR NAME OF CITY GRANT FUNDED By THE CITY GRANT OR SPONSORSHIP FUND NG RECEIVED OR SPONSORSHIP Community Service Grant Spay. /neuter grant $5000 09/2020 (ISpay/neuter grant 4-ommunity service grant $ $ OTHER OUTSIDE SOURCES -SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE: CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No YesX IF YES, PROVIDE INFORMATION IN TABLE BELOW, AMOUNT MONTH+YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $20,000 T (Rachel Ray COVID Relief Grant for all cities D5/2021 $15,000 (Matching grant for all local cities for spay/neuter fees. 07/2021 $$20,00 CDFA Spay/neuter grant 2022-2023 for all six cities 05/2022 City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. • Free Spay/neuter vouchers Days to the citizens of Temecula • Free Pet Micro- chipping day or days 2022-2023 for Temecula Residents • Low cost pet adoptions at various business locations throughout the city of Temecula for Temecula residents only. Must show proof of residency. Expanded senior living visits with trained shelter pets within the city if Temecula • expanded pet education and reading program to school age children at both Temecula City Libraries. • Community Pet Walk within the city of Temecula 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED, ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The funds from this award will be spent with great regard. Every dollar will be spent helping the animals and the the citizens that reside in Temecula. The Temecula reinvestment Community Service grant will be allocated for Temecula residents only. AFV's low -cast spay/neuter clinic offers pet sterilization for $60-$130 depending on size and sex of Dog. 0n average it costs $So per dog. For cats AFV charges $50-$60 dependent on sex of the cat. For the Temecula spay neuter vouchers we are allocating 25% of the funds to help curb spay/neuter fees for the residents of Temecula. The funds will help cover over 100 spay/neuter surgeries and will help stop on average an extra 570 from roaming the streets or ending up in the shelter. Last year we offered City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING, EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. 1FV serves all local cities in southwest Riverside County, with Temecula being the largest with the highest )opulation. Most of all of our events are hosted in the city of Temecula. Every year on February 23 World Spay lay, AFV hosts a Spay/Neuter free voucher day for the residents residing in each city. Last year, we hosted World ;pay Day at Mary S. Roberts Senior Center. Because of funding we had to cap off at 100 free vouchers. With this einvestment grant of $50,000, AFV can help more Temecula citizens alter their pets. Since COVID and the rate of nflation many pet owners are forgoing spay/neutering their pet and have had to relinquish litters of puppies and :ittens to the shelter. This grant will help the citizens of Temecula from unwanted litters and keep the number of trays down in the city. All those applying for a free voucher have to show proof of residency with a current driver tense and utility bill. AFV would also offer free micro -chipping at these events. Currently the average cost to ;pay a dog $100 and $80 to neuter at AFV's low cost spay/neuter clinic. AFV Micro -chips are $20. 85% of all nimals that become lost without a micro -chip will never find their way back home. It costs AFV $628 an hour to are, feed and house over 200 pets at the shelter a day. This funding would dramatically decrease the number of inwanted pet litters in the city of Temecula. Last year alone, from the city of Temecula, AFV took in 218 stray cats, 32 owner relinquished cats of those 172 were adopted, 30 returned to owners, 98 adopted by rescues. Stray emecula dogs were at 246, owner relinquished 334. 255 Temecula dogs were adopted, 176 returned to owners nd 65 were adopted by rescues. Continuing to increase spay/neuter surgeries would decrease these animals ever inding their way into the shelter. This also illustrates the importance of micro -chipping Temecula pets. urrently, AFV hosts many off -site adoption events at various businesses in Temecula to accommodate Temecula tizens from making the drive to Wildomar. Some of these Businesses are Pet Co, Paradise Chevrolet Cadillac, ello Temecula Subaru, Promenade Mall, Mexico Cafe and various other Temecula Businesses. The citizens of Temecula are still dealing with the effects from COVID especially senior citizens living in assisted living homes. AFV would like to increase our foster service animal program to visit the assisted living in Temecula proper. It has proven that animals especially dogs' offsets loneliness, increases mobility, and increases cognitive ability while interacting with a dog or cat. This holds true for the school age children in Temecula. Many children are feeling anxious with the world around them. AFV would like to reinstate Dog Daze reading program at both City of Temecula Libraries. These days would be coordinated with the city of Temecula. Every Wednesday AFV hosts Huey's reading program from 3-4:30 free to school age children. We would like to expand a version of this program to the Temecula Libraries. This program helps children learn the proper way to approach an animal, how to care and feed a pet. It also allows them to read to the animals without peer judgment and increases reading skills and public speaking while have a good time. stly, AFV would like to host a Temecula Pet Walk during both years of the grant funding to bring the community 3b E S T I M AT E D NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 1400 with all program: I. City of Temecula Community Service Funding- Reinvestment in Temecula GRANT APPLICATION Page 10 of PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT- SUMMARIZE ANSWERS 1 —3 ABOVE IN 50 WORDS OR LESS - An ima I Friends of the Valleys has been serving the cities of southwest Riverside County for over 35 years. In current reports from Animal Welfare Association 70% of households have. 1 nr 2 pets residing in the Kamp. It is vital to help those citizens in Temecula that need extra help offsetting the cast of spay/neutering their pet. AFV already offers low cost spay/neuter surgery but with times the way they are many need additional assistance. These programs are greatly needed in the city of Temecula and if awarded will be able to help hundreds of Temecula residents young and old alike. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. AFV was deemed at) essential business by the Governor of California, That meant we were to remain open to to the public while abiding to all COViD guidelines. Duringthe peak time of COVID we were open by appointment only and had to adhere social distancing and sanitizing protocols. During 2021 until 2022 AFV had to postpone all major community fundraising events. AFV hosts three signature events. Wines for Canines and kitties, FORE the Animals Golf Tournament, and Paws on the Promenade Spooktacular which are all held at venues in Temecula. AFV lost over $170,000 possibly more by not having these events. We are trying to mace -up For lost revenue. AFV had to reduce or suspend the afore mentioned programs we are suggesting in this funding application. During COVID we had many people adopt due to the ability to work remotely, however once people started to go back to work pet intake increased. Now with people forgoing spay/neuter surgeries because of financial hardships we are getting more litters of puppies and kittens than in the past few years. Inflation accompanied with COVID has put a strain on many Temecula residents. The demographists in Temecula vary greatly and AFV would like to accommodate all citizens and their pets. While it helps the citizens in Temecula it also helps AFV reduce the number of animals entering the shelter. AFV currently has an average 241 animals at the shelter looking for loving and forever homes. These are dogs, cats, rabbits, guinea pigs, small farm animals reptiles and various wildlife. Our mission is to find a loving home for all adoptable pets. We are pleased to report we are at the highest adoption rate in our 35 years. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECTIPROGRAM, (2) EM0EXISTING PROJECTIPROGRAM, _ANDIQR_(a)_C7 TNLE.EXISTING PR- DJEC'.TIRRO RAM 1) The funds from this 2022-2023 reinvestment Grant from the City of Temecula will allow Animal Friends of the Valleys to create a new Pet Walk event for the citizens in Temecula. This will bring in much needed funding to the shelter for other Temecula events while supporting Temecula citizens their pets and local Temecula businesses. It encourages the focus on animal welfare in the city of Temecula while helping Temecula businesses and welcomes community gathering for all ages including pets. Temecula events such as these will help Temecula residents become more aware of the community programs offered at or through AFV. The new reading and pet education program will be offered to all Temecula elementary school children at both Temecula libraries. This will encourage children to learn to love to read while reading to a live pet. Funding from this grant will allow AFV to be able to offer this program a few times a year while offering it free of charge to Temecula families. Reading is fundamental and a fun way to encourae-e children and narents to utill7P TemPrula`s hPautlful libraries. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 2) In the past few years AN had to suspend or eliminate existing programs that help serve the city of Temecula due to lack of funding. Our micro -chipping events had to be suspended due to the lack of funding and social distancing. Micro -chipping is imperative in all domestic pets so they can find their way home. Every July 4th there are hundreds of dogs that run away due to City fireworks in Temecula alone. The ones with micro -chips get reunited 90% faster than those without micro -chips, It is imperative to help those Temecula pets and their owners. I Free Spay/neuter voucher program for the city of Temecula will help all Temecula citizens help offset the cost of ' altering their pet and ending unwanted litters. Many families will forgo the extra cost of altering their pet due to the high cost of living and supporting their children. It is mandatory in Temecula to have your pet licensed and to receive licensing, a pet must be vaccinated and spayed or neutered. With the newly adopted city mandatory spay/neuter laws, this grant is priceless in helping Temecula members afford the cost to spay/neuter their pets. The new ordinance is modeled after a fix -it ticket allowing pet owners that have been citied to come into compliance by spay/neutering their pet to avoid fines. This grant will offset the number of Temecula pets surrendered because of the financial burden on the owners. This will help those owners who cannot afford the cost of surgery and ultimately not be fined. The vouchers are good for dogs, cats, and rabbits. These programs will help deter Temecula residents from relinquishing their pets due to financial hardships. By offsetting these costs, it will help the economy in Temecula as residents will be able to spend more on local groceries, apparel stores, and gas to name a few. AFV is continually exploring new ways to encourage every community member to be responsible pet owners and help reduce pet overpopulation. 3) AFV would also use this funding to expand on existing pet adoption events in the city of Temecula. Currently we have offsite adoptions to help bring shelter pets to the city of Temecula to be adopted by Temecula residents. AN would like to expand on pet adoptions in the city of Temecula at various local businesses. On average at every off -site pet adoption there are over 10 adoptions per event. That is 10 less mouths to feed for AFV. While bringing a new family member into 10 Temecula homes. AFV's goals to help animals find loving homes while reducing the number of animals in the shelter. We would encourage other Temecula businesses to offer adoption events at their location. This helps the animals the shelter and the Temecula business with added marketing and flow of traffic onto their business. There are many new assisted living apartments in the city of Temecula. This population has been affected the most by COVID. Those in assisted living were under strict quarantine guidelines. Even family members could not visit their loved ones even if the senior was ill, This increased anxiety levels and depression among the residents, Many therapists that worked at the assisted living homes were cancelled due to COVID. This ultimately hurt the residences physically and mentally. Before COVID AFV had trained foster pets visit the elderly for companionship and to ease loneliness. Once an animal greeted each resident they would become happier and would interact with the animal which would increase mobility. Seeing the dog would emote past memories of their own pet and cognitively they would remember past experiences. To our delight many of the assisted living homes are pet friendly and the restrictions from COVID are lessening. Pets help the elderly increase memory, widen mobility by throwing a toy and by bending if possible to pet the animal. All pets ease loneliness and depression. These foster pets show unconditional love and affection. This is a must needed service to the elderly of Temecula, City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula, • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation o the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this aapplication may be rejected as incomplete- 1/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. Animal Friends of the Valleys ORGANIZATION NAME: MAILING ADDRESS: 33751 Mission Trail Rd. Wildomar CA. 92595 PHONE 051) 805.6239 EMAIL: befli(@_afv.org PRESIDENT/ AUTHORIZED OFFICER: ��� SD I`t'vS t & K-'. n TIrLE(11 { SIGNATUR y DATE: 09/10/2022 MONTH, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PRINT MAME. TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECUiA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 elf FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # ASSISTANCE LEAGUE OF TEMECULA CITY OF TE1%fCCtlLII FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING M REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ bo7 000 Project/Program Title: 5 Points Physical Address of Project/Program: MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION 3/20/202Q 6/30/2023 Start Date: End Date: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable x Assistance League of Temecula Valley Mailing Address: 74120 Via Montezuma i emecula, CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Assistance League of Temecula Valley 1989 9 Year Founded: Website: assistanceleague.org/temecula-valley Number of Paid Staff: None Social Media: Facebook & Instagram Number of Volunteers: 200 Geographic Area(s) the Organization Serves: Temecula Geographic Area(s) the Pro ect/Pro ram Serves: Temecula _ NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Diane Sitar Title/Position: Grants Coordinator Contact Person's Direct Telephone: k'951) 526-6771 Contact Person's Email: altemeculaayahoo.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 6/15/1989 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0360419 State Identification Number: 1463456 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. n Attach IRS Deductibility Status using this link: h :/la sirs, ovla /eos/ 2. M Attach State Entity Status Letter using this link: https:/Iwww.ftb.ca.gov/onfine/self serve entity status ietterlindex.asp. 3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Taal: h1p:11rct.doi.ca.gaVNerilica[ionlVllehl5eerch.asnX?FaClllty�Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No E] Yes ❑ IF YES, BRIEFLY DESCRIBE. i Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES, Assistance League of Temecula Valley (ALTV) ® is celebrating 34 years of service in Southwest Riverside County, ALTV is an all -volunteer, 501(c)(3) nonprofit organization that transforms lives and strengthens our communities through philanthropic programs in Southwest Riverside County. Member volunteers are dedicated to identifying and serving the needs of Temecula, Murrieta, Menifee, Lake Elsinore, Wildomar and Romoland communities through philanthropic programs developed and administered by our members. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ® IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Operation Schocl Bell $ 6,sI0 April 2021 CDBG Operation School Bell $ 5,000 December 2020 CSF Operation School Bell $ 7,226 April 2022 CDBC� 5 Points $ 920 July 2022 Council member di •rr n r� CSF Operation School Bell $ .9,491 April 2020 CDBG Operatioii School Bell $ 5,o00 December 2021 CSF $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. MONTH + YEAR FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT -RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. All TV idontlfuos the needs of chilrren rind families in Temecula and develops piulaat;uopic progrrrm.n ro be adrninrstered independently as well vis in parnership with other non-prorits. ALTV's 5 Points Pro ram proVIdes varous basic needs in the area of clothing, food, heaith, literacy and supplies 007N,,iij is provided to iovv to moderate income families, fo-sterihorncicsz3 youth, as weii as emergency lothing to students in need. Food is provided for school prograrns and local food pantries rleaith services provide hygiene kits for foster/horneless and teddy bears to local hospitr.iIs to comfort children in crisis. �Ne al°,3o provide supplies to the schools (such as backpacks) school supplies, fidget (oys, etc) as needed +Nhcn LCAP school counselors identify specific needs. Please see rite attached list for more specific information regarding the service and supplies we have provides and expert to provide in the future 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAMMROJECT. Approximately $17,000 of the requested grant funds will reimburse At -TV for a variety of services and supplies that directly benefit those residing in Temecula from March 20, 2020 to the present. We have attached a list of those items to give examples of what we provide and will provide receipts with our Compliance Report. The remaining funds from this $50,000 grant request will be used to fund additional similar services and supplies between now and June 30, 2023. Going forward; it is our intention to purchase supplies from stores and vendors in the City of Temecula whenever possible. ALTV works closely with Temecula middle and high schools to provide supplies for the LCAP program, the special needs preschool program and foster youth as well as elementary school support. In addition, we work closely with Temecula transitional housing and the community pantry. TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. J EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Services provided and supplies purchased directly benefit Temecula residents. Services and supplies were, and will continue to be, distributed to residents through LCAP counselors, Rancho Darnacitas Empowerment Village, foster youth agencies; Community Mission of Hope, Temecula transitional housing, Non Minor Dependents, Temecula Valley Hospital, and Temecula schools for various basic needs. 1 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 2, 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 25 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. �rUC(.?eCls r-IYn ti'i= ClUlf1C'M,'i ':R de � �r'.iIC :.� and 7lwanals `that dl cctiy hcdi' C '�� 1 � r' r tit �:h Grr:,n �nr. talili�:s �n Z��grn r,Ulc,.-lar1Cal'??l lrr;rlt fi^iIS g1'a11t In cl`l:diJorl to ncoryle Imn, our Stol;_" `i'v!ll r�kjk'v AL1"/ i0 I1-,o'eas2 filat'?l'�ci S In 7022-2023 til Provide f(l( if; r� eed fl T%f"UlCU �l. All ALTV c`;vF,n1.j8 13 Sri•: � S '�7 I1C9 Qc?]I CC;f;"1"!-'t��ltl?S ,. _?r''1r_ tiir'jLlijil C)Jr;7t"il7[l'.I1�Jlsl(; �?�pgr_11t1a 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA J COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. ALTV has faced several challenges in its operations. When ALTV was forced to close its thrift shop under COVID mandates, it inhibited our ability to generate income from our thrift shop, which is cur primary source of revenue. ALTV has been in recovery mode since that time. We also faced challenges in providing services and distributing materials due to the mandates. ALTV collaborated with local LCAP school counselors, food pantries, and foster/homeless agencies to provide services and materials to the best of our ability during those challenging times. We were successful in our efforts to help the community. Inflation has also significantly increased the cost to operate our philanthropic programs. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Proceeds from this grant will allow ALTV to continue providing basic needs services and materials to children and families of Temecula. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50.000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 316,2` 0 Organization Other grants or funding already awarded for Project/Program, if any I $ In -Kind match amount or volunteer credit hours estimated amount _ $ 10,000 TOTAL REVENUE $ 86,250 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/Insurance $ Supplies $ 59,250 Marketing $ Services $ Food 1 1 27,000 Other $ Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ J HOWEVER PLEASE INCLUDE. TOTALEXPENSES $ TOTAL BUDGET $ j $ 86,250 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 Services and supplies provided between Marcie 20 2020 and resent: Christmas presents for Moms and children residing at Rancho Damacitas Empowerment Village * Emergency clothing for a foster child Supplies for the Exceptional Children's Christmas Program in Temecula Christmas presents for Temecula Transitional Housing - Non -Minor Dependents • Household items for Temecula Transitional Housing — Non -Minor Dependents • Backpacks for Community Mission of Hope • Food and hygiene supplies for Community Mission of Hope • Fidget toys & stress balls for Temecula school counselors to distribute as needed • Clothing for students at Temecula Elementary school • Movie tickets for HUGS Foster Family Agency (summer activities for foster youth) • Teddy Bears for Temecula Valley Hospital for children in crisis • Computer tablets for youth residing at Rancho Damacitas Empowerment Village • Student Body cards for foster/homeless youth at Great Oak High School • Famous Footwear gift cards for families residing at Rancho Damacitas Empowerment Village • Mini refrigerator & microwave for Great Oaks High School's ROOTS program (LCAP) ■ Old Navy gift cards for students at Temecula Middle Schools Examples of Support, Supplies and Food to be provided from present to June 30 2023: Support for LCAP Program (Local Control and Accountability Plan) at Temecula schools. • Program addressed the needs of foster/homeless youth, second language learners and youth living in poverty. • All middle and high schools in Temecula have an LCAP counselor on site. Support for all LCAP programs in Temecula schools (3 high schools and 6 middle schools) which provide the following services for foster/homeless youth: * School supplies • Food/healthy snacks ■ Student Body cards • Senior package (valued at $200 each) that include a choice of a yearbook, prom ticket, grad night ticket, etc. * Funds for special classes * Hygiene kits * Computer tablet or other necessary electronics • Emergency clothing * Incentives for learning * Support for extra programs * Stress relievers (fidget toys, stress balls, etc.) for counseling sessions Food voucher for Western Eagle Foundation Support for Temecula Elementary Schools: Food for Vail Elementary's "pantry closet" which is available to families with food insecurity. Other Temecula schools may have a similar program that we would support. Support for Special Needs Preschools. There are 11 Special Education Preschool (PreK) Classrooms in TVUSD, teaching over 200 students at Jackson Elementary and Alamos Elementary: * School supplies • Emergency clothing * Enrichment activities * Books for classroom libraries * Manipulatives for hands-on learning * STEM items (i.e. Magnetic Building Tiles, STEM kits, Butterfly/Ladybug habitats, etc.) • Social Emotional Learning (SEL) supports (i.e. Lakeshore Feelings and Emotions items, pretend play items, cooperative games, etc.) ■ Flexible Seating (floor seats, wobble cushions, balance balls, bean bags, etc.) • Sensory Manipulatives and supports • Gross Motor/Fine Motor equipment or supplies Support for Foster/Homeless Youth: Household items for young adults in Transitional Housing in Temecula through Foster Family Agencies Food vouchers ■ Educational support (special classes or counseling) • Christmas gifts Support for Rancho Damacitas Empowerment Village: • Food vouchers • Christmas gifts for Moms and children • Grocery/gas cards • Special classes or programs as requested by staff Support for Exceptional Children's Christmas Program. This program is designed for special needs children who get a visit with Santa and have activities in which they participate while waiting for their turn to see Santa. ALTV's "Assisteens" auxiliary (7th-12th graders) administer the program: • An appropriate toy or activity for children waiting to speak with Santa • Goodie bag for each child Book for each child Support for Community Mission of Hope: • Backpacks • Food as needed Support for Temecula Valley Hospital: • ALTV provides Teddy Bears on a monthly basis for children receiving care in the hospital ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: ■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. ■ The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Assistance League of Temecula Valley MAILING ADDRESS: 28720 Via Montezuma Temecula, CA 92590 PHONE: (951 ) 111-6771 EMAIL: _;sip -me i1ladVhtu1) coin PRESIDENT/AUTHORIZED OFFICER: Mary Murphy President jllrt � SIGNATURE: ! Ir f '•r ,,? 1 r+. /�' DATE: Au ust 17, 2022 IF DIFFERENT THAN ABOFVE; Diane Sitar APPICATION PREPARED BY: SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELP® MENU Home > Tax Exempt Qrganixation Search > Assistance League Of Temecula Valley Assistance League Of Temecula Valley EIN: 33-0360419 1 Temecula, CA, United States Publication 78 Data e Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990,990-EZ, 990-PF, 990-T) v Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2020 Form 990 Tax Year 2019 Form 990 Tax Year 2017 Form 990 Tax Year 2016 Form 990 STATE OF CALIFORNIA FRANCHISE TAX BOARD F"GB PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 7/29/2022 ESL ID: 4849707501 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1463456 Entity Name: ASSISTANCE LEAGUE OF TEMECULA VALLEY ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. X3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information • This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). ■ The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) efile GRAPHIC print - DO NOT PROCESS I As Filed Data - I DLN: 93493283011090 Q Form 0 Return of Organization Exempt From Income Tax OMB No. 1545-0047 V t►� 2019 Under section 501(c), 627, or 4947(a)(1) of the Internal Revenue Code (except private fou7iii ► Do not enter social security numbers on this form as it may be made public. 0,1—o cent of lbc Tr wnw ► Go to V WIVW, 4aV/al`arnt-r7 for instructions and the latest information. Imemnl Revenue S—ice A For the 2010 catendar vear. or tax Koar beginning 06.01-2,019 and ending 05.31-2020 B Check if applicable: C Name of ugarazaS ten D Employer identification number ASSISTANCE LEAGUE OF TEMECULA VALLEY ❑ Address change ❑ Name change 33-0360419 ❑ Initial - etm n Doing 4ual4tasa as ❑ FinalrMwNlel minnpl ❑ Amended return Numbor and streot (of P.O. box if rnad Is not deliviuvil to street e4rlrey7) Room(suile E Telephone number Q Application p",Iil 28720 VIA MCNIEIUMA (951) 694-8016 CAy or town, State or province, country, and ZIP or fu4ipn pt t," coda TEMECUTA, CA 92590 G Gross receipts$ 1,196,835 F Name and address of prindpal ofiieer: H(a) Is this a group return for 28720 VIA MONTEZUMA subordinates? ❑Yes RNo TEMECULA CA 9259D2510 H(b) Are all subordinates ❑Yes []No included? I Tax-exempt status: 21)O c 501( 3 ❑ 501 c ( ) 4 (insert no,) ❑ 4947(a)(1) or ❑ 527 If "No," attach a list. (see instructions) 3 Website: • www,te+rtecu3avaltey.asylstanealaapue.erp H(c) Group exemption number ► K Form of organization: I] Corporation ❑ Trust ❑ Association ❑ Other ► L Year of formation: 1989 1 M State of legal domicile: CA SUMM,3ry 1 Briefly describe the organization's mission or most significant activities: ASSISTANCE LEAGUE OF TEMECULA VALLEY IS A VOLUNTEER PHILANTHROPIC ORGANIZATION DEDICATED TO SERVING THE NEEDS OF m FAMILIES IN SOUTHWEST RIVERSIDE COUNTY. VOLUNTEERS ARE COMMITTED TO COMMUNITY SERVICE AND SPECIAL PROGRAMS TO HELP LOCAL. CHILDREN AND FAMILIES IN NEED. ti C Q s 0 0 2 Check this box ► ❑ if the organization discontinued its operations or disposed of more than 251/o of Its net asse 9. 4 3 Number of voting members of the governing body (Part VI, line la) . 3 12 y 4 Number of independent voting members of the governing body (Part VI, line lb) . . . . . 4 12 5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) . 5 0 Q 6 Total number of volunteers (estimate if necessary) . . . . 6 220 7a Total unrelated business revenue from Part Vlll, column (C), line 12 . 7a 0 b Net unrelated business taxable income from Form 990-T, line 39 . . . . . 7b Prior Year Current Year 8 Contributions and grants (Part VIII, line 1h) . . . 866,804 759,835 6,970 5,318 9 Program service revenue (Part VIII, line 2g) . . . 284 234 n, SO Investment income (Pert VIII, column (A), lines 3, 4, and 7d ) . 0 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and Ile) 12 Total revenue —add lines 8 through it (must equal Part VIII, column (A), line 12) 874,058 765,387 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3 ) . . . 413,579 321,838 0 14 Benefits paid to or for members (Pert IX, column (A), line 4) . . . . . 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 0 0 v' 16a Professional Fundraising fees (Part IX, column (A), line lie) . C. b Total fundraising expenses (Part IX, column (D), line 25) 0169,249 17 Other expenses (Part IX, column (A), lines 11a-11d, Ilf-24e) . . . . 443,295 408,940 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 856,874 730,778 17,164 34,609 19 Revenue less expenses. Subtract line 18 from line 12 . b t IBepinning of Current Year End of Year arc 71 20 Total assets (Part X, line 16) . . . E173,2831 860,753 m 59,534 12,395 a 21 Total liabilities (Part X, line 26) . . . . . . x411. 22 Net assets or fund balances. Subtract line 21 from line 20 813,7491 846,356 HIS Signature f6fatk Ulider penalties of perjury, I declare that I have examined this return, Including Accompanying sehedulos and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer(othgr than officer) is based on all information of which preparer has sign ••• Q10.1o. 5lynature of ofcar Date Here 11 E1 1 19E WilEIL pretxleat Type or print name and title Print/ I ype preparers name Preparer's signature Dare t z, Check El if p00449291 Paid self- Preparer Firrr's name ► LESLIE A DOHERTY CPA APC Firm's EIN ► 20-20B2661 Use Only I Firm's address ► 41680 KALMIA ST STE 115 Phone no- (951) 698-2260 MURRIETA, CA 92562 May the IRS discuss this return with the preparer shown above? (see instructions) . © Yes ❑ No For Paperwork Reduction Act Notice, see the separate instructions. Cat. No, 11282Y Form 990 (2019) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 5 BIKE TEMECULA VALLEY CORP CITY OF TEMECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 5,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Cycle For Hope Start Date: 08/10/22 End Date: I LN03122 Physical Address of Project/Program. 2736 Ynez Road, L-7 #205 Temecula, California 92591 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Bike Temecula Valley, Corp. Mailing Address: 31311 Canterbury Court Temecula, Ca. 92591 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Bike Temecula Vall , Corp. Year Founded: 2021 htt s //www.tvbikecoalition.com/ https://www.facebook.com/biketemeculavalley Website: P = Social Media: roalitinni Number of Paid Staff: Number of Volunteers: 51 Geographic Area(s) the Organization Serves: Primarily Temecula Geographic Area(s) the Project/Program Serves: Primarily Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Gary Oddi Contact Person's Direct Telephone: 951-970-8034 Title/Position: President of the Board of Directors Contact Person's Email: garyoddi@tvbikecoalition.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes x❑ Date of Incorporation as a Nonprofit: June 10, 2021 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 87-1364605 State Identification Number: 4755644 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: http://apf)s.irs.gov/a;]p/eos/ 2. ❑ Attach State Entity Status Letter using this link: https://www.ftb.ca.govlonline/self serve entity status letter/index.aso 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: h t : /r a , v/V rili anon/Web/Search.aspx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION j Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑x Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ❑x Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. -71 Bike Temecula Valley (BTV) Is an engaged Inclusive coalition of cyclists, dedlcated to advocating for a safe, fun, and accessible network of cycling infrastructure and treatments that promote human powered recreation and transportation. We proactively work to assure the safety of the cycling and human powered community. Protecting from auto v cycle collisions and other dangers of the road, through the installation of facilities and treatments. such as protected bike lanes, bike crossings, cycle tracks, class - I bike lanes, at. Also, be a leader in safe riding and driving practices, such as sharing the road, eye contact, hand signals, rolling stops. distracted or impaired driving or riding. Ultimately. develop a vision "0" culture for active transportation. Positively fostering the growth and development of cycling in the region through marketing, fund — raising, educating, and advising. Listen to the community and collectively share their voice regarding cycling to the city, county, and community at large. Make everything we do and advocate for available to all, consciously removing all obstacles. Such as, facilities made available for people with disabiiitias, low-income neighborhoods, et. And trails being reached easily from all neighborhoods and accessible to wheelchairs or mobility scooters, Advancing cycling as a pleasurable pursuit. It Is whatever brings joy to those participating with the coalition [hat is cycling related, for Instance; when your bike or other human powered vehicle brings happiness, including slow sociable riding experiences; endurance endorphin release rides, single track adrenaline eustress runs, pump track skills confidence building laps, nature rides, tow stress facilities use, aesthetically pleasing rides, et Constructively, pragmatically, tenaciously, and In n FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑x Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Cycle For Hope Event, Funds submitted $ 900 June, 2022 City Council CS Grant, to Community Mission of Hope (CMOH) not BTV Council Member Stewart $ 2500 City Council CS Grant, Mayor Protem Schwank Cycle For Hope Event, Funds submitted y P June, 2022 to CMOH not BTV BTV is currently requesting funds from City Council CS Grant from all 5 Council Members OounsA-Men*e an application, while one has declined our $ "2500" (Amount applied for. Funding 2022 -23 City Council CS proposal, and 3 have not yet responded. NOT re eiv d1- Grant OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO X❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Our major event this year will be the "Cycle for Hope" bike rides on October 2. This is a cycling event supported by BTV in collaboration with Community Mission of Hope / Rancho Damacitas. This event includes three rides, 50 - 25 - 15 milers, where participants will be given an opportunity to ride their bicycles through the neighborhoods of Temecula and on the roads of Temecula Valley Wine Country for a great cause_ Though these rides are simply rides, chip timing will be provided so riders can have access to their performance results. The event ultimately is to benefit The Community Mission of Hope / Rancho Damacitas to help end homelessness and hunger In our community. Secondarily BTV is dedicated to supporting events and programs that encourage healthy activities. The Cycle For Hope will demonstrate the benefits of an active community. In an event of this magnitude, volunteers are key to success. The support of volunteers from Temecula brings our community together to promote health, wellness, and a higher quality of life. 12 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. If granted the Funding, we would supplement the "Cycle For Hope" event budget. Within this budget we will be purchasing route signage, sign frame holders, volunteer high visibility vests and shirts, participant commemorative shirts, and bike racks, (as designated in the Program/Project Budget sheet provided in this Application). The largest cost from the Budget is support from California Highway Patrol and Temecula Police, Traffic Division for route safety, which is not covered in the CS Grant funding. Yet this extreme expense puts a strain on our budget expenditures, therefore increasing the need to fund the above listed expenditures. �1 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. The ultimate goal for all proceeds from this event will benefit the Community Mission of Hope and will be allocated to feed the hungry and help the homeless. The proceeds will be directly infused to The Community Mission of Hope's system that helps feed the hungry and support a better life for the homeless. These proceeds will provide direct assistance to those needful populations of Temecula. Residual benefits are: - Bringing community together at a healthy event to benefit our most vulnerable residents. - Including Temecula youth / students in the activity and in the volunteer force for community service. - Educating Temecula about the benefits of cycling. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 500+ FROM THIS PROJECT/PROGRAM: (Base on how many people CMOH can help with the roceeds-froali.jtclp.For Hopei 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 100+ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. Partnering with CMOH, BTV is excited to provide a healthy event for Temecula Residents. Cycle For Hope includes diverse volunteer opportunities, will trumpet Temecula's bicycle routes, and assures all proceeds are channeled to help end homelessness and feed the hungry. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 5,000 Amount contributed to the Project/Program by the Applicant $ Organization 0 Other grants or funding already awarded for Project/Program, if any $ 3400 (2021 - 22 City Council Community Service Grants, Stewart & Schwank allocated to Community Mission of Hope for Cycle For Hn _ In -Kind match amount or volunteer credit hours estimated amount $ 0 TOTAL REVENUE $ 8,400 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Bike Racks, sign holders Facilities/Rent/Insurance Insurance Flyer for City of Temecula & Riverside Count Volunteer high visibility Shirt I Vest, Supplies Course Signage and Markers, radios, Participant Marketing Socalcycling.com, Pierson Print Flyers & Posters Services Registration Service, BikeSignup.com Food Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. (Temecula PD & CHIP & Gemini Tir TOTAL EXPENSES TOTAL BUDGET $ EXPENSES $ 1000 $ 300 $ 4500 $ 800 $ 1750 250 $ 0 Ing) $17,000 $ 25,600 $ 25,600 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. ` If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Name of Project/Program. Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): - Date on _ Expenditure Name of Company Receipt/Inv, Eon Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose Q = JULY 1, 2021 - JUNE 30, 2022 ` DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE 1 2 3 4 I 5 6 Is EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these Instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit andlor require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the fuilowing Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount Is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: Organization: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Name of Project/Program: TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report Is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by tho City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yos If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) i Date on Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER E Name of Company Receiptllnvoice on Receipt or Invoice MUST BE ON OR BETWEEN rto E , March 20, 2020-JUNE 30. Amount Description Purpose Q z 2024 EXPENDITURE TOTAL�$ EXPENDITURE TOTAL i City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. ■ Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot, • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete- I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Bike Temecula Valley, Corp. MAILING ADDRESS: 31311 Canterbury Court Temecula, Ca. 92591 PRESIDENT / AUTHORIZED OFFICER: Gary A. Oddi PHONE;( 951 ) 970-8034 EMAIL: garyoddi@tvbikecoalition.com President, Board of Directors _..} 7 PRINT NAME SIGNATURE: • _ DATE: August 12, 2022 MONTH, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECU LA, CA 92590 Questions. Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Department of the Treasury Date: Internal Revenue Service 07/19/2022 Tax Exempt and Government Entities Employer ID number. I� P.O. Box 2508 87-1364605 Cincinnati, OH 45201 Person to contact: Name: Customer Service ID number: 31954 Telephone: (877) 829-5500 BIKE TEMECULA VALLEY CORD Accounting period ending: 27636 YNEZ ROAD L-7 205 December 31 TEMECULA, CA 92591 Public charity status: 509(a)(2) Form 9901990-EZ 1990-N required: Yes Effective date of exemption: June 1a-, -2-021' Contribution deductibility: Yes Addendum applies: No DLN: 26053582002322 Dear Applicant: We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form. 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt --status-will -be -automatically-revok If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Sincerely, Stephen A. Martin Director, Exempt Organizations Rulings and Agreements Letter 947 (Rev. 2-2020) Catalog Number 35152P r Secretary of State r Certificate of Status 44ppoft Kl I, SHIRLEY N. WEBER, PH.D., California Secretary of State, hereby certify: Entity Name: BIKE TEMECULA VALLEY, CORP. Entity No.: 4755644 Registration Date: 06/10/2021 Entity Type: Nonprofit Corporation - CA - Public Benefit Formed In: CALIFORNIA Status: Active The above referenced entity is active on the Secretary of State's records and is authorized to exercise all its powers, rights and privileges in California. This certificate relates to the status of the entity on the Secretary of State's records as of the date of this certificate and does not reflect documents that are pending review or other events that may impact status. No information is available from this office regarding the financial condition, status of licenses, if any, business activities or practices of the entity. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of June 27, 2022. SHIRLEY N. WEBER, PH.D. Secretary of State Certificate No.: 024913933 To verify the issuance of this Certificate, use the Certificate No, above with the Secretary of State Certification Verification Search available at bizfileOnline.sos.ca.gov. oil Bicycle Coalition Bike Temecula Valle Nbikecoalitionx Cycle For Hope Pro Ride Half Century o"$125 8:OOAM PDT 11:00PM PDT Price increases after September 1, 2022 at 7:59am PDT Sign Up EVENTS Cycle For Hope Intermediate Ride Quarter Century $85 8:30AM PDT 11:00PM PDT Registration ends October 2, 2022 at 8:29am PDT RIDE WEBSITE Additional ride Information can be found at https://www.bikesignup.com/Race/CA/Temecula/CycleForHope. PLACE Community Mission of Hope, 41760 Rider Way Temecula, CA US 92590 DESCRIPTION Cycle For Hope Local Ride 15 Miler $39 9:OOAM PDT 11:OOPM PDT Registration ends October 2, 2022 at 8:59am PDT Cycle For Hope is a cycling event to help end homelessness and hunger in our community. There will be three ride distances, 15, 25, and 50 miles through thf city of Temecula and The Temecula Valley Wine Country. Ride results will be provided by Gemini Timing. A commemorative T-shirt and goodie bag will be provided. The courses will take cyclists through Temecula's finest neighborhoods and trails and the 25 and 50 milers will ride through the beautiful Temecula Valley Wine Country. Post race celebration will be held at Refuge Brewery. RIDE CONTACT INFO If you have any questions about this ride, click the button below. BIKE TEMECULA VALLEY IS A S01C, NON-PROFIT ORGANIZATION. WE THANK OUR COMMUNITY PARTNERS AND WELCOME YOUR CONTRIBUTIONS TO CYCLING IN THE VALLEY. tveducators.org msjc MT. SAN )ACINTO COLLEGE 0 0B 0� �B TEMECULA, CA 11 901 COMMUNITY MISSION OF HOPE RANCHO DAMACITAS CHILDR(=N & FAMILY SIRVIUS FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # • 1 BIRTH CHOICE OF TEMECULA CITY OF TEMECUI.A FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING • REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 1 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50.000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Client Care Programs Start Date:Ongoing End Date: Ongoing Physical Address of Project/Program: 41750 Winchester Rd. Suite O, Temecula Ca. 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Birth Choice Centers Mailing Address:1jdge Gate Dr. Suite 220 I ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Birth Choice of Temecula _ Year Founded. _ 1989 Website; www_bifthchoicecenter%grg Social Media: _0-birthchoiceoftemecula Number of Paid Staff: 3 Number of Volunteers: 1.2 Geographic Area(s) the Organization Serves: Temecula Valley/Riverside County Geographic Area(s) the Proiect/Program Serves: Temecula Valle /Riv0!2!jnty NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Janette Chun Title/Position: CEO Contact Person's Direct Telephone: 951-234-6140 Contact Person's Email: contact@ bi rthch o ice, center NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 1989 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0302353 State Identification Number: CI800935 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: htto://ai3i)s.irs.gQv/82 /eos/ 2. ❑ Attach State Entity Status Letter using this link: https-/Iwww.ftb.ca.gov/online/self serve entity status letter/index.as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt :Ilrct.doi.ca. ovNeNficationA(Veb/Search.as x?facilit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES To support people facing pregnancy, parenting and reproductive health concerns. Birth Choice of Temecula's goal is to allow families a place to go to deal with unplanned pregnancy and parenting concerns. We also want to allow women and men a place to deal with reproductive loss through a support group program. It is our objective to offer education, mentorship and material needs support to families that are struggling with providing for their children and are desiring rentorship and parenting support. We never want a family to feel as if they cannot parent due to lack of goods and services. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Client Care Program $ 500 June 2021 Council Member Grant Client Care Program i $ 2000 June 2021 Council Member Grant Client Care Program $ 1000 July 2022 Council Member Grant I$ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ $ I$ $ 1 $ 1 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 11 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. I This funding will go to support our centers programs to include the following: Client Care Program and Fatherhood Program The Client Care and Fatherhood Programs offer pregnancy, parenting and life skills education, one on one mentoring, material assistance, grief and loss support and related services. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED, ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. For our 2023 Budget Year, our Client Care and Fatherhood Programs will use these funds to purchase the following goods, equipment and services: - Upgraded technology (i.e. computers as ours are 7 years old and need to be updated) - IT professionals to install said computers and monitor them - Goods such as: Hygiene Kits, Diapers, Wipes, Formula, Car Seats, Pak n Plays, Strollers, clothing, gas and food cards and various other parenting needs. - Brochures, paper goods and materials needed for these programs - Update some office furniture (Need a few new chairs) - Offset a portion of building lease (at least 35%) 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Our center services around 120 Temecula residents annually. They come for regular monthly visits and enjoy our services at no cost. Many other Temecula residents avail themselves of our pregnancy testing and ultrasound services as well as the services that we are requesting funding for. Being able to have baby items, mentors, courses and upgraded technology will allow them to receive maximum benefit so that Temecula farnilies feel strong so that we can assist with building safe and great communities. I 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 120 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM 12 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. Birth Choice Centers is a place of help that provides assistance to families who need help to provide for them and their children. Our programs provide them with the goods and services they need. Without such help, they would not be able to build thriving families. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. he CV-19 Pandemic was an incredible difficulty for us. Previously our center was operating 4 ays a week and we serviced close to 1600 appointments a year. We had 25 volunteers and 5 taff. Once the pandemic hit we went down to 3 staff and 2 volunteers as well as our donations rasticaIly reducing to the paint that we had to shut down 2 days of service each week. he needs of the families did not stop however and with 2 days of service and 3 staff we still ad 1,279 appointments that year, that meant that we had close to 10 appointments every day. was an incredible feat that was only possible because of our great love for our clients and a lot IF prayer. Now we are operating 3 days a week with 3 staff and have 12 volunteers. ;Our clientele continues to grow and the need is incredible, especially during this time of inflation land steep prices. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. For our 2023 budget year, it is our intention to expand our existing programs and projects. Our reality is that our programs are expanding without us trying to expand them. This grant will give us the ability to serve all residents without having to decrease supplies to make them last. These last 2 years we provided families with over 15k diapers, around 500 cans of formula and 600 bags of clothing as well as hundreds of other goods We are only in August of 2022 and we are already near bypassing that amount. This grant will allow us to not only upgrade our serious) outdated technologybut also provide for much needed goods for our families as our services are greatly expanding. These funds would also allow us to offset a portion of our building lease up to 35%. If the board wishes that the funds to offset leasing charges should be allocated differently, we would then adjust the apportionment to the boards preference. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM IiI REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $120,000 Organization Other grants or funding already awarded for Project/Program, if any $ 2000 EXPENSES In -Kind match amount or volunteer credit hours estimated amount $ 30,000 TOTAL REVENUE $ 202,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment i — $ 15,000 Facilities/Rent/Insurance 1111 $ 65,000 Supplies $ 40,000 I I 1 Marketing $ 5,500 Services $ 3,500 Food $ 20,000 Other F $ 5,500 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ 68 000 HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $ 223,500 TOTAL BUDGET $ $ 200,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS` FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Name of Project/Program: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on Expenditure E Name of Company Receipt/invoice .9 on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose JULY 1, 2021 - JUNE 30. 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE ¢z 1 2 3 4 5 1A EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant' FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: TOTAL FY 2022-2023 Amount of Grant Fund Awarded: $ Name of Project/Program: Month & Year FIRST $5,000 check was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes._ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request 5 Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number). Date on tName of Company Receipt/invoice E on Receipt or Invoice MUST BE ON OR BETWEEN :0 3 March 20, 2020 - JUNE 30, Q Z 2024 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount I Description Purpose 1 I$ 1 _ 2 $ 3 $ EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: ■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. ■ The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Birth Choice of Temecula MAILING ADDRESS: 1 Ridgegate Dr. Suite 220 Temecula, Ca. 92590 PRESIDENT / AUTHORIZED OFFICER: Janette Chun °RINT NAME SIGNATURE IF DIFFERENTTHAN ABOVE, APPICATION PREPARED BY: PHONE: (951) 240-3006 EMAIL: contact@birthchoice.center CEO TITLE DATE: 9/1 /2022 MON`N, DAY, YEAR PRINrNAiMf TIf E SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD F T 8 PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/18/2022 ESL ID: 2469572054 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 1800935 Entity Name: BIRTH CHOICE CENTERS, INC. 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. a3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Q HELPB MENU Home > Tax Exempl-ftanIzation Search > Birth Choice Centers Inc. Birth Choice Centers Inc. EIN: 33-0302353 1 Temecula, CA, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) e Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2019 Form 990 Tax Year 2018 Form 990 Tax Year 2016 Form 990 Form 990 OMB No. 1545-0047 Return of Organization Exempt From Income Tax 2020 -'•tlnder"ctft§01(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) dpor t,to Pu(allc ooparlmont of the Treasury ► Do not enter social security numtters an this form as it may be made public, Inleriler Revenue Service ► Go to wwwdrs.gov1ftrmM tar instructions and the latest Information. Insisectfon A For the 2020 calendar year, or tax year beginning , 2020, and ending , 20 B Check if applicable: C D Employer identification number Address change BIRTH CHOICE CENTERS, INC. 33-0302353 Name change 1 RIDGE GATE DR. #22D E Telephone number Initial return TEMECULA, CA 92590 951-699-9808 Final return/terminated Amended return G Gross receipts $ 822,629. F Name and address of principal officer: JANETTE CHUN H(a) Is This a group return for suboedlnalos? Yes Application pending["SAME No AS C ABOVE H(b) Are all subordinates included? Yes No If "No," attach a list. See instructions Tax-exempt status: }{ 501(c)(3) 501(e) ( )� (insert no.) 4947(a)(1) or 527 J Website: ► WWW. BIRTHCHOICECENTERS . ORG H(c) Group exemption number ► K Form of organizafion: }C Corporation Trust Association Other► L Year of formation; 1989 M State of legal domicile; CA Part I I Summaty 1 Briefly describe the organi2alion's mission or most significant activities -CRISIS PREGNANCY COUNSELING AND v PARENTAL SUPPORT INCLUDING CLOTHES FOOD AND OTHER MEANS, _______ ----- -- —-------------- ----- ___----•-------------_---- c o _�'—----------- 0 2 Check this box ► If the organization discontinued its operations or disposed of more than 25% of its net assets. a 3 Number of voting members of the governing body (Part VI, line 1a) ......................... ......... 3 9 ed 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 W) .......... ......... r 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a)........................... 5 13 z 6 Total number of volunteers (estimate if necessary) ................................................... 6 30 a 7a Total unrelated business revenue from Part VIII, column (C), line 12.. .. ........ . . . .......... ....... 7a 0. b Net unrelated business taxable income from Form 990-T, Part I, line 11. ............................... I 7b 0. Prior Year Current Year 8 Contributions and grants (Part VIII, line 1 h).......... ...... , ... . � ti•••• •••••••-••••--•- 573 969. 822 629. 9 Program service revenue (Part VIII, line 2g). . .................... . .. . ............... 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 l le) .............. 12 Total revenue — add lines 8 through 11 (must equal Part VIII, column (A), line 12) -- -. 573 969. 822,629. 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) .................... 122 028. 75,863. 14 Benefits paid to or for members (Part IX, column (A), line 4)........ . . ........ . . . ... . h 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)...-- 236 845. 169 618. ° 16a Professional fundraising fees (Part IX, column (A), line 11 e) .. . . . . . ........... . . . .. . b Total fundraising expenses (Part IX, column (D), line 25) ► 9 777. "' 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e)........................ 296 443. 297 198. 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) . - - - . - - - - . 655,316. 542 679. 19 Revenue less expenses. Subtract line 18 from line 12 ......... .... ............. . —81, 347 . Beginningof Current Year 279 950. End of Year 20 Total assets (Part X, line 16). . . ...... . ......... . ... ... .. ....... , ............ 118,546. 426,675. 21 Total liabilities (Part X, line 26).......... ....... . ........ ......... , , .. Net 17,620. 45,799. 100 926. 380, 876. 22 assets or fund balances. Subtract line 21 from line 20 . - -. .................... Part 11 1 Slgnature Block Under penalties of perjury, I declare that I I+ exantln this Mum, rKl d�lr accompanying stherhdas and slalonlenh, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other I + d 1f , of „filch limparor Nis any hsrowtadpa. Sign signatures ofoilrecr'Rmm► -- ifala Here DOUGLAS MACRAE TREASURER ype or print name and tirlo Print/Type preparer's name Preparer's sir dies Dale CheckX if PTIN Paid DOUGLAS C. MACRAE 1 tP00438711 Preparer Firm's name ► SHAFER & MACRAE CPAS Use Only Firm'saddress ► 43385 BUSINESS PARK DR STE 150 Firm's EIN ► 33-0884861 TEMECULA CA 92590 Phoneno, 951-296-0785 May the IRS discuss this return with the preparer shown above? See instructions- . . .. X Yes No BAA For Paperwork Reduction Act Notice, see the separate instructions- TEEA01011- 01/19/21 Form 990 (2020) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 7 BNAI CHIAM i A,. I K, k 1 �y `l FISCAL, YEAR {��r 2 - 202233 �+��� �+ �r� �r ` COMMUNITY SERVICE ICE FUNDING - REINVES T �1ii..i7 1 IN , EMEVYI...i"A PROGRAM APPLICATION (Please PrW or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2.022 PROJECT/PROGRAM INFORMATION Amount Requested $ 3 .L .0 k i ti MA)UMUM ALLOWABLE $50,OW PER ORGANIZATION � ' r �Drrin1�f12 �� PrajectlPrngraln Title: >"� [� • tivl V � � �� WI sw bate: End Date: Physical Address of ProjectlProgrsm: V 1Ca 1Y1 P_ A . UYCIQ. L Li INCLUd6 IF DIFFMENT T14AN GrGANIZA us KuL*4G ApcAE`:s If Grant is Awa(dad, Make Check Payable to: Com CLt on B nain ,I Che l Mailing Address: 2 -! ��\Jia 9r1netsc-t ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Q r e G [r JQ Y1 4) hAl l 0"M I (Near Founded: Website: r i �= , l' 1.) I ] a .t7 r1'1 Soaial Media: G lx*r k „� !.. ��4i i m r h can Number of Paid Staff -3 Number of Volurftem _ GeOgraphic Area(s) the Organization Serves: 7crn �wlel , [fly (1" 6A ,}1� � [ (� C lots f °�} I z i 11 b rL)d<— Geograptdc Areas) the Pro' _ Serves: l FrC'� ��1 rt : l�l U� fF1 e t-6A _^ NOTE r-UW--Q?d Y SERVICE FUNDdNG GRANT Pr=PAIA FUNom MUST mELXct_tj.,- U SERVE TEMECULA Contact Persods Dkect Telephone_ U 1 9l b-f 13% Go ntad Per%orf's Emaih bnA i _ 1Q rrl PIONWROFIT STATUS Is this organization incorporated as a nonprofit? Yes Q i]ate of Incorporation as a NonpraFR: o— 1 q l l No ❑ IF NO. THEN INEOWLE TO RErEfVE CITY FUNDIM6 Federal lclentrfication Number: � � � � � St*e Itlerrtification Number: R-5 PRINT PUT ACID ATTACH TO T' IS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLQM: 1, 2 Attach IRS Deductibility Status using this link: hft:Agg 22vlas>�e�1 2. Attach State Entity Status Letter using this link: Laos f .o flb sefve eqM status letterlsnclex.3s 3. d Attach fast page only of most recant IRS Form 990 or attach print out of detailed info about your charity Found on this State RegisWs Search Taol: lrrct- ca- NC'�iliG3tidrr/111k+biSf3adPS —Y Cary of Temewla Caren undy ,%Nke Funding - Reinvestment in T(-n-eeu'-a GRANT APPLICATION Page 5 of 13 APPLICATION AUTI#OR1.ZA1'10N Has IRc organization or any menftm of Me Sowd of Direaol-; of the orgw'xation been invoMed wrih any personal bminess Iransadions valued over $6W inducting any business transactions, negotiations, invest nts, or interests in real property with a Temecula City Gourd Member during the P2912 months? Nn ,Yes ❑ LF YES, BRIEFLY OESCR1t3E is a Te cula City Council Member a member VIM Bbitrd of Dftct0r3 Wig Off VA the organization? No Y?S ❑ tF YES, PROME COUNCIL irEMBER'S NAUC AND TITLE VWTHIN THE ORGANIZATION: Tics Applicabon has been authorized by the orgaNzationr'sL;: Executive Committee ❑ Board of Directors Members -at Lame ❑ MISSION STATrINEIE?ff OF ORGANIZATION BRtE=FLY DESCRIBE THE ORCANIZATION'S MISSIONAGOAL S AND OBJECTIVES- V1�f'gCAt;or Vic;+ cWAIr+� i5 \m2 pit( JCAr)dj �,>>1 ° +�- o zn L ,fir 1ti YU� e. C� S tide y � edo 6 +c bjQtrQ a *4 ���hYhillJ �U� CiJ IJ 16ml =f p") /� V, FINANCIAL STATEMENTS iI7C'�!I jiGr! ��7 UPON REQUEST, COPIES OF THE ORGANiZATIOMS CURRENT BUDGETIFINANCLAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DE NMSTRATE SOUND FIMANCIAL MANAGEMENT- DO NOT SUBMIT NOW. City & Temccula Cwywnun4y %"vote h-unaln,7 - Ki9ww=Z&M"L Wr I WIMlk14 f-MIAN I /V -r-Uc'^TIC+r+I rey. 0 ..r 10 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQ STING) ANY OTHER SOURCES OF FUNDI NO FROM THE CITY FOR ANY PROGRAM? NO 94 Yes ❑ IFYES. PROMDE BELOW, MAW OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTIJ + YEAR FUNDING RECEIVED I NAME OF C" GRANT OR 5FON50RSHIP _ I I � OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR TIME-SAMEIN THIS APPLICATION? No [ Yes [] IF YES. PROVIDE INF047MA11ON INTABLE BELOW. AMOUNT RECEIVED NAME Cif EfIf1Y &"TN +YEAR FUNDING RECEIVED M of Temecula Comnturity St11ViCt Funding - Relm+enwt in Temewle CiRANT APPLICATION Page 7 of 13 GRANT PR0,ffCT/PR0GRW DESCREMOY P PORTANT-RECEIPTMMVUfCESISRVOUIREDTOEESUBMITTEDTOTHEMYTOVAUOATETHEORGANIZATIONSPENTGRANT FUNDING AMRDED RY THE CITY TOSUPPORT THE PROXCPPROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM TI-iE TEMEGULA GRANT FUNDING WILL SUPPORT. �or�� : on x i ► ► 1 On K5 +d �, aV<:AA e, 7illoeL l ,:� rpjjd07 -.> on -f!� �� E 5 �, r ��� tl��vv� � i c1 C v oit Il dPSk5 �0 I�I� t' k i s u (}eki d i)vr c�nnvI Awl v� v y � �U �I a SSova., S pde r a vi 0 n 2 DESCRIBE HOW THE ORGANISATION WILL SPEND THE GRANT FUNDING, IF AWARDED, ALSO, INCLUDE A LIST OF 00005, EQUPWMENT, ANDIOR SERVICES THIS ORGAN9ZATION HAS PURCHMED OR PLANS TO PURCHASE VIKM AYORDED FUNDS TO SUPPORT THIS PROGRAMIPROJECT. -lo 1'Y? aln;cftn scq il e. PYOJ 1��jC�1r'1�.Y45r Eli►@�j�^G�j }met! aeeP s sckFe- C�00Y. J ,J .�1 Ge the n t- &) 'ry'),lf Cot-�A- -'� � � Imo*, �i � �`� � �,} FS ►'o(2 C� ct�l"�; �OpipIlIxej loci decor fiOr 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAMIPRQIECT IF A~DED CTIY FUNDING_ EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFIT y TEMECULA RESIDENTS. and (-5 �w on l� Sync go�U�. SyL��! i c> K. 4D j5 rj �v j I�V q Ilk�r�c�i ��c��l n"" erl t- � f off a fT 6067i 3D ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FRAM THIS PROJECTIPROGRAM 3C ESTIMATED NUMBER OF VOLUNTEERS INVOLVM IN THIS PR0JC-CT"0C-pRAFA 30 , � o City of TamaG:la Camwnly Service Funding - Reinveatnert in Temsada GRANT APPLICATION Page B of 13 PROJECTIPROGRAM DESCRIPTION t'O,'VnA lUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1- 3 ABOVE IN 50 WORDS OR LESS. here iS o17Ij a Pw CUm fyluk-ri i�„ or voy)*1 510 'ie, d bu I t a S a ,�'/)a I� -rIvrPtv 11Ja(e fri 'J� ' fi t' /�`r�e?CUIC rPSI alb s. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATIOWS ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. 6 C'c) r�C�Gf��nn p3'Y)'v 'hrrr lo. Pp d C WIr.f U-s sbon 7"'? elderly peopfb yjo-� abkc- �n,? Asp tag Pkit d,( wn a.s incorne, . 3coee, fvOi reopo01f1 C)jy- 1'r� (-5 1 c� " )qa f oTv r f was ' y'ron IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL= (7) NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECTIPROGRAM, AND/OR (3) CONTINUE EXISTING PROJECTIPROGRAM. aS Y r 11C.c� Ianr� j � f �j -c � ro s �n r4 r(a), tie,ors �l ��+� ���'`�!'rS� G�',1�'� le- �jol.)!'� L s) �'lor � �� ��� ' ,Pl or t 5 q �' P Cf uL '' /7e P r r7 Q f0 I A r`'-9 �'j C M� u uy of Temecula Community Service FundMg - Ri .nvestmentin iernrr_ula GRANT APPLICATION Page 9 of 13 PROJK7/PROGRAM BUDGET tdo not fill in shaded areas) LINE rFEMS FOR PRWECT/PROGRAiM — REVENUES D7MEMSFS LIST REVENUES/1NOOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Senricm Grant (Not to exceed W,000) 3 Amount contributed to the PrVJiect/Progmm by the Applicant $ Organization Other grants or funding already awarded for Project/Program, if any $ - �I In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $2 0 Z7iJ LIST OF UPENSES FOR MMECF/PROGRAM Tools/Equipment $ Facilitias/Rentlinsurance Supplies $ 6 Marketing $ Services $ Food V Other Staffing Expense THIS 15 INELIGIBLE TO BE FUNDED BY idM GRANT; HOWEVER PLEASE INCLUDE_ $ TOTAL EXPENSO 4 TOTAL BUDGET $ . $ Kati Cn of Temecula Community Service Fundog • kemveurrerrt in Temecula GRANT APPLICATION Pape 10 of 13 f — ACKNZ OWLEUGEN ENTISIGIIATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements_ • Every Community Service Funding application is considered individually and on its own merit. Awards will be given bo organizations and activities that directly benefit the residents of Temecula_ • Funding is nolt Imirnediately available to the recipient, and requires an award letter signature upon approval_ Please allow time for checks to be processed_ • The awarding of Community Service Funding does not oonstltube an automatic annual allocation. • The recognition for Community Service funding should accrue by the City of Temecula. • Cornmundty Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately, • Community Service Funding grants wiH not be awarded or arrvounced within the f;0 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this applicadon's due date or this appliicrtion may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: On&I I DI MAILIK ADDRf:SS: 21.15 1 D c l 'l [,f.Snl PHOf#E: 5I 42-7-7 ,- -73 t1Vri 5( EAMI:bm T chgl M I g1nail, um PRESIDENT / AUTHORIZED OFFICEFL r 1�u-S b' 1(/,(") p' sidew t SIGNATU RL _ j/� 9561{•�",-' DATE-1 +'I IF DIFFERENT THAN ABOVE, APPICATIDIH PREPARED BY: ir'^+!h H A M F SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Corn m inity Service Funding Attn: City Manager's Mce 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey,lBrown@TerrleculaCA.gov (951) 694.6413 B",Lowrey@Temem[aCA.gov (951) 69L�3959 City of Temecula Comnu'ity &errioe Funding , Reinve9brre4t in Tem v::o GRANT APPLICATION Page 13 of 13 STATE OF CALtF40MA ~ FFLW4CWRETAXFXVJD F" B PO BOX % 2957 SACRAMENTO CA 94257A540 Entity Status Letter ESL ID: &M554520 Why You RaONved This LeWr According to our records, the following entity information is true wW a wnde a5 of The dale oflhis letter, ErMy ID_ 0722510 Enft Name: CONGREGATION FINAi C HAIM OF MURRIETA HOT SWfNGS 1. The entity is in good standing wet the FfaWNM Tax hoard_ 2. ThO amity i5 root in good standing with the Franchise Taos Board_ ® 3. The entity is curerdly exempt loom tax under Revenue and Taxation Code (R&TQ Sedion 23701 d- 4- VA do not have ounent Wommlion aboiA The entlty- 5. The entity was administratiwety di5solvedlcxncelled on throuo the FmncWe Tax Board AdndnlstrallNe Dfss,WuWn proem, kepostard informmMon + This infomiatfon does not necessa* refkd ThO cniiiy's current legal or administrative status with any other agency of the stale of California or other governmental agency (w body. • if the erffdy% powers, rights, and pfMbges were suspended or forleRed at any time in the past or if the errllity did business in California at a time when It was not qualffied or not registered to do business in Catfomia, this inforrnxtiori does not rated the status or voidabiiiily of contracts made by The entity in Callfonlia during the perW Tile erlft was suspended or forfeded (R&TC SecbDm 23304.1. Z3304.5, 23305a. 23305-1), The entity Canute of reviver may have a Erne !-amnion or mwy limit fha furKdons the n,,Aved annoy can periomr, or both (RUG Section 233Q5b). Cormert With Us Web, ftkC4Lgmr Phone: 800-852.5711 from 7 d.rrt.1* 5 psm, weekdays, except state holidays Qlf �500 hum outside the United States California Relay Service: 711 or t3-735-2M (For pwsons with hearfirtla or speech i npaimmmrts) F1`13 42MA WED (REY 12-2019) NF-LP8 MENU = ffQ= > Tax pA OTganixation Search > Congregation Snai Chaim Of Murrieta Hot Springs Congregation Bnai Chaim Of Murrieta Hot Springs EIN: 95-30941901 Murrieta, CA, United States Publication 78 Data o organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On PubUcatiarr 78 Data List: Yes Deductibility Code: PC Po_qe lost ReWewedor Updated 10-N0vembar-2= � r", Shiro $ Mrrt W Lim, 956 MA DCLAM, I .. . i; -,j . - '. -, I 1 11 1 :f- I Registrant Details (as Wjcim N� (XN(WJXj.NI'I0N BMeU CHAIM OF UUMELA H(Yr SM1sc:3 fRS MM� VAtbe r Tn- Rdigicv; Rcgistry Status: Exempt - Religious Renewal Dw/Exp. Date: NUMLOur; EX(IMWI b..%w. ]Record Tyv.,-, (7hanoty Xtjj.-b-aU?,n Firattift Dow INAC of LA* IU'ft-W4&LEMA7 Mia-ding Address (MY, N-W Z* %ft WRIM CA 425O Corr Fifing I ,,s & espondence 2010 Raffic APP %NoI.%bpd An-nual Renewal Data No AnimeW R&wwal Dam Related R-P-.�!qistratjons & Event Reports No Related Records 6"PaPffo.j0jrA &W31MM VA FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # BOY SCOUTS OF AMERICAY CA IE COUNCIL 045 TAHQUITZ DISTRICT CrrYOFTENECULA FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING • REINVMWTMENT IN TEMECULA PROGRAM APPLICATION (Pisa so Pant or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 129 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000.00 MAXIMUM ALLOWABLE: $50.000 PER ORGANIZATION Scouting In Temecula Project/Program Title: Start Date: 9-12-22 End Date: 8-30-24 Physical Address of Project/Program: Same as mailing address INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Boy Scouts Of America, Tahquitz District Mailing Address: 2351 W. Lugonla Ave. Suite F Redlands, Ca.92374 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Tahqultz District, Boy Scouts of America Organization: Year Founded.. 1910 Website: clecbsa.org Social Media: facebvok.comltahquitz.district Number of Paid Staff: 1 Number of Volunteers: 230 Geographic Area(s) the QLaaakgion Serves: Riverside and San Bernardino Countines Geographic Area(s) the Prolecypr2gram Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVE v USED TO SERVE TEMECULA. Contact Name: Tim Long Title/Position: District Executive Contact Person's Direct Telephone:951-453-3666 Contact Person's Email: tim.long@scouting.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 1910 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number. 95-1744350 State Identification Number. 7689144562 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTS) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: htt :Ila sirs, ovla Leos/ 2. ❑ Attach State Entity Status Letter using this link: htt sLwww.ftb.ca. ov/amine/self serve entit s atus ;etterlindex.as 3. ❑ Attach first page only of most recent IRS Form 990 pr attach print out of detailed info about your charity found on this State Registry's Search Tool: t n .ca. avN�rilica EonMlehlSearch as x7facl I =� City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $600 including any business transactions, negotlatlons, investments, or interests in real property with a Temecula Cfty Council Member during the past 12 months? No N Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No M Yes ❑ IF YES, PROVIDE COUNCIL MEMBERS NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee 0 Board of Directors ❑ Members -at -Lange ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The mission of the Boy Scouts of America is the porepare young people to make ethical and moral choices over their lifetimes by instilling in them the values of the Scout Oath and Law. The goal of Scouting is to encourage the physical, intellectual, social, emotional and spiritual developments of young people so that they take a constructive place in society as responsible citizens, and as members of their local, national and international communities. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPNS AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ■ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Day Camp/Outdoor-Adventure -7500 f i $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No E Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED G. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Boy Scouts of America is active and looking to grow membership within the timeframe of this grant not only in the number of Temecula residents, but in our international relationships. We are looking to accomplish this by bringing BSA Scouts and/or groups from Temecula's sister city in Japan to Temecula, as we aim to expand out diversity and inclusion goals as an organization. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Boy Scouts of America is looking to help cover the costs of membership for Scouts and their families in Temecula as well as cover the costs of bringing Scouts from our sister city in Japan, to Temecula, to enhance the City's existing relationship. This may include shipping costs for materials sent, covering the cost of food and host family supplies, etc. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING, EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. This grant will specifically enable Temecula residents to participate in the Scouting program in a much less -personal finances way. Our goal is to use these funds to cover registration costs for Scouts. Secondarily, this grant will fund the transporation costs and food costs for Scouts from Japan bringing international tourism revenue through site -seeing and local businesses and shops in the city. 3b 3c ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 50-100 ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 30_40 City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Boy Scouts of America is looking to increase our membership numbers within the City of Temecula by covering costs associated with joining or remaining in the program. Scouting teaches Temecula residents the value of community and we'd like to expand that internationally through diversity and inclusion to our sister city in Japan. LCOPPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC ECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA MMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. The COVID-19 pandemic had a significant Impact on our program in Temecula. Boy Scouts saw a double-digit percentage reduction in membership and participation across the board. With the increased costs associated with simply providing for a family, Temecula residents are expressing challenges in covering costs of the program and being able to keep their child in the program that they know makes a positive and tangible difference. 1.9 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) 9,XPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PRO,IECTIPROGRAM. These funds will help the Boy Scouts of America continue and expand out engagement with the residents of Temecula by providing a program that gives back to the community through Eagle Scout projects, and a variety of other community service/impact opportunities. These funds will additionally enable our program to provide Temecula's sister city in Japan the opportunity to visit the city of Temecula, learn more about it and bring international awareness and knowledge of all Temecula has to offer back to Japan. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not flll In shaded arem) LINE ITEMS FOR PROJECT/PROGRAM FREVENUES- LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 4,000.00 Organization Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 5,000.00 TOTAL REVENUE $ 59,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food Other Staffing Expense EXPENSES $15,000.00 $4,500.00 $5,000.00 $3,000.00 $1,500.00 $5,000.00 $30,000.00 THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $20,000.00 TOTAL EXPENSES $84,000.00 TOTAL BUDGET $59,000.00 $84,000.00 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-+2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Carnmunity Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, ail grant funds received must have been expended anytime on or between July 1, 2021. and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received Frorn the City were spent If the funds were not spent in accordance with the a p p rovedlawe rd ad application, the 0rgaalzation will be required to retum the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper hack -up documentation including the completed table below with accompanying receiptslinvoices, most be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of recetptslinvoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office - CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Tahquitz District, Boy Scouting In Temecula Scouts--Cf-Amer 1.0 —Name of ProJact/Program: FY 2021-2022 Amount of '2500 CSF Grant Fund Awarded: _ Month & Year CSF Grant Received from City: 06/2022 Number of Beneficiaries Living In 92590, 92591, 92592 that Directly Benefftted 50 from this PfogramfProject (approximate number of benanoiaries If you do not have precise number): Name of Company Date on __ Ex nditure on Recelpt or Invoice MUSTBE OIN OR BVETWEEN Amount Description Purpose JULY t, 2021 -DUNE 30, Z022 DESCRIBE THE EXPENDITURE I PURPOSE OF EXPENDITURE z r � - — - T��J>."A3"par� 6r $ c4 S�"+s(r"P�lres 2 A)A-5 P. rho. rh�� �, 2-o-jz $ zap. 64u'w-e« >� 3 6on4-k e Tor zo11. 4 $ AA-4 cea, (S "erde' U C'* Dar e."op. ALT$h{.,r �7uii5WPKf t �iE � eue rrt a c.�.y.•�i e t EXPENDITURE TOTAL $ S�`I 11 26 EXPENDITURE TOTAL MUST BE EQUAL TO OR GREATER) THAN TOTAL AWARD AMOUNT, Cfty of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 M,oftqPTFQd= 0jp 5fo2 6371 Haven Avis Sb 3-213 Randw Cucamonga, CA 91737-OW US (909) NS-7671 www.ThelEJAz THE IMAgEMpORium BILL.TO BOY SCOUTS OF AMERICA California Inland Empire Council 1230 Indian Cl. Redlands, CA 92374 P.MNUMBER SAIM NEP Per Edits Ham pa Cu MMApp" 351 6.0981197 2.140.44T 2M Cab Soaat Day Camp Rod wlBlack toga Prka Youth. 49s. 133m, 105L - Adult: 39st 14m, 71., 4XI CUOM 200 6.7822 1,366.44T 2M Cub Swut Day Camp Kaye" wMa k Logo PdM Ad —A 1183, Mn- 58L. 5ft. 22 2YJ 6 34 4 4xt Dbowwt - - - f-874.22-874.22T 'r & Promotional Discount M- $tD3--I1tp-21 2 s0.7 6 SUBTOTAL 2.622.66 TAX (7.75%) 203.26 TOTAL 2,825.92 AP RDVE J ENTERED ay: DATEG glzZ 7111etox akwebl INVvICE Involos Number, 270541 POW NASD. DIC. W42115 LNM DRIVE WALDO. VO 53093 sev.l..o wr2m -§Fnaws avow rrr/= w mxa awmma 31M oomw OMPNOON 9wn3-ZH* 40610 rnrprnwulArml�► ST7EirQ C1fCW5AC=Aff ostq Paid In-FzU_ 9111 CA INLAND EMPIRE CCUNCIL BSA i Ship CA INLAND EMPIRE COUNCIL BSA To: 58155 [DYLLBROOK OR T4: MOM DOWNS IDYLLW=,CA 92549 531651DYLLBROOKOR IRS M STATES IDYLLWILO. CA 92549 UNITED STATES Trrm: ad aeo Na Your Raftw Ca 3rNp V♦_i ICOM cc blun1bif 'Cud9iRCL11Q nvw. Qaudr lam IN" Aiiwi WMONPFW,IT test TAROEr RW4)CK&gT CALL TO WTUPoe1NFii! m- 911-aw Oirdtr 0i1[ U" 9uanttoc !fitIPrlea TQwPrlcoArlU MD EACH me an OVAD lit SAM in 190A0 2.0 aw we"ty: v^w.naepeehowm.ory Mono: (920) 52"OW Fg7C: (92Q} 627.6t142 Amountsubject to Amount Exempt Subtolal: Sales Tax from Sales Tax IrW610 Discount, Q.W 3.297.0D Total Sales Tax. 3,297.00 ILM 0.00 Taut 3,207.00 nf 9 An t rtim a•an e irefox about"blw Invoice Number: 270542 J u,a.,�r w.yH unSanwvr r+vacf involm Re _ao ' Srdp pea. Pips I NJa= V7/2M enrl0r_ � + cwtlimw ffl ..- Cl> tm W4285 LAKE ONVE awm WALDOr WI 53093 CUa r41ERe OuL ow Shipment Hutn�er 709.790.2m C90.4ACC0UW oA8 Paid 4nft# ti1B CA INLAND EMPIRE COUNCIL BSA S11)p CA INLAND EMPIRE COUNCIL BSA To: 53145 IDYLLSROOK OR TCK MIKE DOWNS IDYLLWIM CA 92549 1095 MONTECITO DR UNITED STATES CORONA, CA 92879 UNITED STATES Temu Ert Doo ko. Your Rtf►nnce 6hlp yiy CRWIT CNID oe i SfIIi�iQ I7s.afrrlollvn far atv LM gimuSI41 t�11tm0a I.4301k1IC9 W41 alto: Ww naep"11"e.org Afflo rd Subject to Amount Exempt Sales Tax from Sales Tax 0,00 219.00 Phone: (02016234040 pw 1920)623-0042 Subtatak Involce Discount; Total Sal" Tac: Total; 219.00 0.00 0.00 210.00 ,f G+rJ 11'1MH 0.49A A 11 Monday, September 12, 2022 at 15.51:14 Pacific Daylight Time Subject: FW: Your BoothPop Order Confirmation (#10057) Date: Monday, September 12, 2022 at 12:34:23 PM Pacific Daylight Time From: Matt Bear To: Tim Long Attachments: Image001.png, image002.png Matt Bear I Scout Executive, CEO BOY SCOUTS OF AMERICA Callfornia Inland Empire Council 2351 W Lugonla Ave. Ste F Redlands, CA 92374 P 909.793.2463 x302 1 C 909.544.9796 - - - - - ��.-a-n-x-x•!1'►s��li=[ez inn•11_it�'L','�Slr:.i•1'[�Ili4!IC=#l'L�l-1:i�3LR�•��� ter »y CAMP RMRRSOM CALWIGHIA INLAND IV•I•N ,DV%Q" i CONFIAENMAUry NOVICE This message is lnten*d to ba 09+4"Od only by UM listod mdPent(a). It may contain Inb7 mtlon that is privileged. conlWandal ondPorexampt from dlsdosum underappircobte law. Any dissemination, dls6fbution or copying of this massege is st►tcflyplroR�ltad withouf nry(lrlpr pam7lSSi0I7. If you 3ltl not the fntarrdad R?C}�ifan� or if yvu tie VB n)COIIRRd Ahls oommunkatxNf In e►ror, please notify me Immediataly byreturn e-may end pennananlly remove the ontinel message and any oopias bum yDarowputor and all back-up systams, From: BoothPop <service@boothpop.com> Sent: Thursday, June 30, 2022 3:28 PM To: Matt Bear <Matt.Bear@scouting.org> Subject: Your BoothPop Order Confirmation (#10057) Thanks for Your Order Your order ID is #10057. A summary of your order is shown below. To view the status of your orders(ick bm• Shipping Address Billing Address Page 2 of 2 Matt Bear John ®ear Callfomia Inland Empire Council, Boy Scouts of America 2033 E BROOKSIDE DR 2351 W Lugoinle Ave. Ste F Ontario, CA, California 91761 Redlands, California 92374 United States United States 9090449796 DON"9796 Your Order Contains... 10114 east Custom Full Color Event Canopy Tents (Add Backwall? No Thanksl, Add sidewalls? No Thanksl. Select Production 7irm Standard Production-7 CAN10F 2 $900.000SD $1,800.00U5D Buslaeas Days, Are Your Files Print -Ready? Yes, I desWed the files myself., Carrying Case Optlons., Black Nylon Beg, Desired In - Hand Date? Jul 15th 2022) Boothpop L CopyraglttD 2017 Boothpop STOP. THINK, CLICK. Subtotal: $1,800.00 USD Shipping: $0.00 USD Tax: $139.50 USD Grand Total: $1.939.50 USD Payment Method: Credit Card Page 2 of 2 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member Is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. i/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Tahquitz District, Boy Scouts of America MAILING ADDRESS: 2351 W. Lugonla Ave, Ste F Redlands, Ca. 92374 PHONE: 951 1 ` 53-3666 EMAIL: tim.long@scouting.org PRESIDENT AUTHORIZED OFFICER: Tim Long, District Executive SIGNATURE DATE: 09/1 L/LOLL IF DIFFERENT THAN Ail3O APPICATION PREPARED BY: SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 20221 TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 i3etsy.L.ovrrey@TelliectilaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 13 of 13 ralRs jniern ! Rovohus sprVicv 0264e4 CINCINNATI ON 45999-0038 SOY SCOUTS OF AMERICA STEPHANIE PHILLIPS 1325 W WALNUT HILL LN IRVING TX 75038-3008 In reply refer tot 02 48219434 Jan. 21, 2020 I.TR 4167C 0 22-1576300 000000 00 130010850 BODC s TE OY Scouts of Ameft Callfornle Inland Empire Coundl 045 B5 EIN N 95-1744350 Eerployer identification numbers 22-1976300 Group exemption numbers 1761 Dear Taxpayers This is in response to your request dated Jan. 09. 2020, for Information about your tax-exempt status. Our records indicate we issued a determination letter to you in November 1965, and you're currently exempt under Internal Revenue Code (IRC) Section 501(c)(3). We also recognized the subordinates on the list you submitted as eXearpt frow federal Income tax under IRC Section 501(c)(3). For federal incope tax purposes, donors can deduct contributions they make to you as provided in IRC Section 170. You're also qualified to receive tax deductible bequests, legacies, devises, transfers, or gifts under IRC Sections 2059, 2106 and 2522. Please refer to wtrw.irs.gov/charities for information about filing requirements. Specifically, IRC Section 60331(j) provides that, 11 you don't file a required return Or notice for three consecutive years, Your exempt status will be automatically revoked on the filing due date of the third required return or notice. In addition, each subordinate organization is subject to automatic revocation if it doean+t'file a required return oe Rat'ics for thr•tt' consecutive years. Subordinate organizations can file required°returns or notices individually or as part of a group return. For tax forest instructions, and publications, visit www.irs.gov or call 1-800-TAX-FORM (1-800-829-3676). If you have questions, call 1-877-829-5500 between 8 none and 5 p.m., local time, Monday through Friday (Alaska and Hawaii follow Pacific Time I . STATE OF CALIFORNIA FRANCHISE TAX BOARD FTB PO BOX942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 10/12/2022 ESL ID: 1908321967 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 0094468 Entity Name: CALIFORNIA INLAND EMPIRE COUNCIL, INC., BOY SCOUTS OF AMERICA ® 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. a3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States 1990 Return of Organization Exempt From Income Tax OMB �No. 1545-0047 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) / 0, Do not enter social security numbers on this form as it may be made public. .1..101 ruttnent ol'the fl Sll y ► Go to www.1rs.rgov/Farni990, for instructions and the latest information. mind Revenue Sen,icc For the 2019 calendar year, or tax year beginning I heck if applicable: C Name of organization BOY SCOUTS OF AMERICA Address change CALIFORNIA INLAND EMPIRE COUNCIL 045 Name change Initial return Doing business as Final return/terminarxl Amended ietui n Number and street (ur P.O. bux if mall is nc Application pending 1230 INDIANA COURT City or town, state or province, country, and ZIP or REDLANDS, CA 92374 F Name and address of principal MATT MYERS 1230 INDIANA COURT REDLANDS,CA 92374 Tax-exempt status: 0 501(c)(3) ❑ 501(c) ( ) (insert no Website; ► WWW.BSA-CIEC.ORG and endlnn 12-31-2019 street D Employer identification number 95-1744350 E Telephone number (909) 793-2463 G Gross receipts $ 5,2.87,572 H(a) Is this a group return for subordinates? ❑ Yes 0 No H(b) Are all subordinates included? ❑ Yes ❑No ❑ 4947(a)(1) or ❑ 527 If "No," attach a list. (see instructions) H(c) Group exemption number ► :orm of organization: W Corporation ❑ Trust ❑ Association ❑ Other ► L Year of formation: 1972 1 M State of legal domicile: CA 1 Briefly describe the organization's mission or most significant activities: To prepare younQ people to make ethical and moral choices over their lifetimes by iri in them the values of the scout oath and law. 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 la) . 3 28 4 Number of independent voting members of the governing body (Part Vl, line lb) . 4 27 5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) . 5 51 6 Total number of volunteers (estimate if necessary) 6 7,500 7a Total unrelated business revenue from Part VIII, column (C), line 12 . 7a 0 b Net unrelated business taxable income from Form 990-T, line 39 . 7b Prior Year Current Year 8 Contributions and grants (Part VIII, line lh) . 882,430 1,209,552 9 Program service revenue (Part VIII, line 2g) . 826,140 1,182,412 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) . 1,151,801 289,333 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and Ile) 996,616 1,229,474 12 Total revenue —add lines 8 through 11 (must equal Part VIII, column (A), line 12) 3,856,987 3,910,776 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 20,776 30,274 14 Benefits paid to or for members (Part IX, column (A), line 4) 0 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 1,366,133 1,340,520 16a Professional fundraising fees (Part IX, column (A), line Ile) 0 t b Total fundralsing expenses (Part IX, column (D), line 25) ►344,942 17 Other expenses (Part IX, column (A), lines lla-lld, llf-24e) 1,254,888 1,531,487 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 2,641,797 2,902,281 19 Revenue less expenses. Subtract line 18 from line 12 . 1,215,190 1,008,495 N Beginning of Current Year End of Year .v 20 Total assets (PartX, line 16) . . 3,801,789 4,841,080 n g 21 Total liabilities (Part X, line 26) . . 612,414 742,180 22 Net assets or fund balances, Subtract line 21 from line 20 3,189,375 4,098,900 ii M Si nature Block der penalties of perjury, I decla•e that I have examined this return, including accompanying schedules and statements, and to the best of my Dwledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has knowledge. it FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # a I BOYS & GIRLS CLUB OF SOUTHWEST COUNTY f 4 kj I K01-11" FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Before & After School Day Camp Project/Program Title: Programs Start Date: 1/1/22 End Date: 6/30/23 Physical Address of Project/Program: 31465 Via Cordoba, Temecula, CA 92592 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Boys & Girls Clubs of Southwest County Mailing Address: PO Box 892349 Temecula, CA 92589 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Boys & Girls Club of Organization: Southwest County Website: www.becswc.org Number of Paid Staff: 31 Geographic Area(s) the Organization Serves: Year Founded: 1990 Social Media: @becswc Number of Volunteers, 100 Temecula, Murrieta, Lake Elsinore Geographic Area(s) the Proiect/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Carly Bennett -Valle Title/Position: CEO/CFO Contact Person's Direct Telephone:951-699-1526 Contact Person's Email: carlyv@becswc.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit. 1996 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0475756 State Identification Number: 1671809 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FWIjAg �&i! s: 1. K Attach IRS Deductibility Status using this link: http://apps.irs.aov/anti/eos/ sEp 12 2022 2. 0 Attach State Entity Status Letter using this link: htips://www.ftb.ca.govionline/self serve entity status letter/index.ask C, . nr 1 =n�t_t;'SorrKI. 3. ® Attach first page only of most recent IRS Form 990 or attach print out of detaile�tPfol4your charity found on this State Registry's Search Tool: http://rct.do'.ca.gov/Verification/Web/Search.asox?far.illty=Y City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temocula City Council Member during the past 12 months? No ■Lj` Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No q Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The mission of the Boys & Girls Club of Southwest County is to inspire, enable, and support all youth to realize their full potential as successful, responsible, and impactful members of the community. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City or Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes E IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP �Y FUNDING RECEIVED F OR SPONSORSHIP Before & After School Program $7226 Awarded CDBG 22-23 Great Futures Breakfast $1080 7/2022 CM CSF 21-22 Great Futures Breakfast $1080 7/2022 CM CSF 21-22 Before & After School Program $6969 4/2022 CDBG 21-22 Ultimate STEM $5000 CSF 21-22 CDBG 20-21 CSF 20-21 2/2022 8/2021 4/2021 Before & After School Program $5491 Ultimate STEM $5000 is l OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ❑ Yes N IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT RECEIVED NAME OF ENITY $ 1125 1Walrrlart $ 5000 SCE $ 10000 f TJX Foundation MONTH + YEAR I FUNDING RECEIVED 12/2020 12/2020 1 /2021 $ 1500 $ 20000 $ 3333 $ 3567 lWalmart OJJDP TJX Foundation Nano Bank RCTC 3/2021 12/2021 1/2022 6/2022 $ 18780 Ongoing City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Boys & Girls Club of Southwest County (BGCSWC) provides year-round academic support, sports, arts, STEM, career readiness, and leadership programs through our Before & After -School and Day Camp Programs. Our programs consist of high quality integrated academic, behavioral, and social -emotional learning practices that help address issues faced by our youth today. BGCSWC enriches the lives of young people and provides a safe haven in which they can learn and grow. We are committed to ensuring that Club members stay inschool, build healthy relationships, have a strong sense of self, and that they are prepared for adulthood 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The BCGSWC will utilize grant funds to support programming efforts for the Before & After School and Day Camp programs for youth ages 6-17. Funds awarded will be used to purchase program and food supplies, equipment (including safety equipment), cover some transportation expenses from transporting youth to/from school, and other necessary expenses (including insurance costs) required to run our high quality, safety focused programs year-round. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Grant funding for our programs will benefit youth members ages 6-17 who are Temecula residents. The grant funding will provide needed supplies, equipment, and other necessary expenses required to run safe, quality Before and After School and Day Camp Programs for Temecula's youth at our Pechanga Great Oak Clubhouse. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT $O FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 5 _J City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. BGCSWC will provide Before/After School and Day Camp Programming year-round to youth ages 6-17. Youth will participate in high quality, safety focused youth development programs daily. Funds awarded will be used for supplies, equipment, transportation, food, marketing and other necessary costs required to run these programs. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. During the pandemic, we temporarily closed 2 of our 3 clubhouses.With the support of our community, we were able to keep our doors open at our Pechanga Great Oak Clubhouse in Temecula. We adjusted and adapted a new Learning Hub Program where youth could come to the Club, use our wiFi and participate in their virtual classes during the day. Our staff assisted each child to make sure they could log in and stayed on task each school day, then helped with homework after class.The organization's annual revenue in 2020 decreased 60% or $900,000 from 2019, and in November of 2020 the Board of Directors made the tough decision to lay-off the President & CEO and Director of Marketing & Special Events to help decrease expenses.We have also faced capacity restrictions due to social distancing practices over the last 2 vears. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Awarded funds will allow BGCSWC to continue existing programming. Our Before & After School and Day Camp Programs are the main umbrella that make up our programming structure. Through both of these programs youth are provided the opportunity to learn and grow in a safe, fun environment with the support of professionally trained mentors. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill In shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 233,630 Organization Other grants or funding already awarded for Project/Program, if any $ 38,900 CDBG; CSF; RCTC; TJX FOUNDATION; UNITED WAY; NANO BANK In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 322,530 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment INCLUDING SAFETY EQUIPMENT Facilities/Rent/Insurance " lI�IV�J!\/�IYVC - VV-Nr-MML LIABILITY/PROPERTYM/ORKERS COMP Supplies INCLUDING PROGRAM Marketing Services Food Other INCLUDING UTILITIES; TRANSPORTATION Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; _HOWEVER PLEASE INCLUDE. EXPENSES $8,520 1 $30,180 i1 $11,000 $1, 000 $4, 000 30,000 $237,830 TOTAL EXPENSES $322,530 TOTAL BUDGET $322,530 $322,530 ; City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Boys & Girls Club of Southwest County MAILING ADDRESS: PO Box 892349 Temecula, CA 92589 PHONE: (951, 699-1526 x109 EMAIL: carlyv@becswc.org PRESIDENT/AUTHORIZED OFFICER: Carly Bennett -Valle PRI,V F L-7 SIGNATURE: jf�7)-_ IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: DATE: 9/11 /22 CEO/CFO TIM-F !v"ofi l,, No, YFAR rL_ SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELPO MENU Home > Tax Exempt 0 ganization Search > Boys & Girls Club Of Southwest County < Back to Search Results Boys & Girls Club Of Southwest County EIN: 33-0475756 1 Murrieta, CA, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2019 Form 990 Tax Year 2018 Form 990 Tax Year 2017 Form 990 Tax Year 2016 Form 990 STATE OF CALIFORNIA FRANCHISE TAX BOARD FTB PO BOX 942957 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/12/2022 ESL ID: 5296811263 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1671809 Entity Name: BOYS & GIRLS CLUBS OF SOUTHWEST COUNTY X❑ 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) EXTENDED TO NOVEMBER 15, 2021 Return of Organization Exempt From Income Tax OMB No. 1545-0047 Form 99D Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 21320 Department of the Treasury ■ Do not enter social security numbers on this form as it may be made public. pen to Pub] lc Ininnal Revenuesevrce Go to www.irs. ov/Form990 for instructions and the latest information. Inspection A For the 2020 calendar year, or tax year beginning and ending 8 chock n C Name of organization D Employer identification number appllrnbfe: ®Gik"e BOYS & GIRLS CLUB OF SOUTHWEST COUNTY []mange Doing business as 3 3- 0 4 7 5 7 5 6 �Initlal rsturn Number and street (or P.O. box if mail is not delivered to street address) Roam/suite E Telephone number Dictum/ 25090 JEFFERSON AVE SUITE A 951-699-1526 termfn- aled City or town, state or province, country, and ZIP or foreign postal code G Grosso, mjo+ T $ 1 , 0 9 8 , 2 4 6 . Amended MURR I ETA CA 9 2 5 6 2 return H(a) Is this a group return Otronlina- F Name and address of principal officer: AMANTE P�,ie1rg P P for subordinates? .,-.., DYes ®No 25090 JEFFERSON AVE STE A, MURRIETA, CA 925 H(b) Are all subordinates included70Yes ONo Tax -axe m t status: W 501(c)(3) Q 501 c) }■ Insert no.) 4947(a)(1) or 527 If "No," attach a list. See instructions J Website, ■ WWW . BGCSWC . ORG H c Group exem Lion number K Form of orolnixation: LX1 Corporation I I Trust I I Association 1 7 other■ I L Year of formation: I QQn M et of Is al domicile: CA 1 Briefly describe the organization's mission or most significant activities: THE MISSION OF THE BOYS & GIRLS to CLUB OF SOUTHWEST COUNTY IS TO INSPIRE, ENABLE, AND SUPPORT ALL 2 Check this box ■ !. 1 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 1 a) 3 22 ,e 4 Number of independent voting members of the governing body (Part VI, line 1 b) ,. ,,...., 4 22 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) 5 6 Total number of volunteers (estimate if necessary) ,.. 6 a7 a Total unrelated business revenue from Part VIII, column (C), line 12 7a 0. b Net unrelated business taxable income from Form 990-T, Part I, line 11................................ .... 7b 0. Prior Year Current Year d 8 Contributions and grants (Part VIII, line 1 h) 686,867. 9 Program service revenue (Part VIII, line 2g) ....773,433. 225 , , 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) 0. 7 , 5 21 . 15 9 , 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) .... 12 Total revenue - add lines 8 through 11 (must equal Part VIII, column A , line 121 , , , 683,527. 13 Grants and similar amounts paid (Part IX, column (A), lines 1.3) 0. 14 Benefits paid to or for members (Part IX, column (A), line 4) -67 in 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5.10) 1 , , 9 2 2 . , r 16a Professional fundraising fees (Part IX, column (A), line 11 e) .., _ 0. b Total fundraising expenses (Part IX, column (D), line 25) ■ 16 7 , 3 3 6 . W 17 Other expenses (Part IX, column (A), lines 11 a-11 d, 11 f-24e) 7 18 Total expenses. Add lines 13.17 (must equal Part IX, column (A), line 25) ...... 1,952, --f712,449. 19 Revenue less ex erases. Subtract line 18 from line 12................. ............... ....... .„__.._ -1 3 , $ 2 . — 32 , 9 22 . N Beginning of Current Year End of Year �; R 20 Total assets (Part X, line 16) 2,140,262. Sa Sa 21 Total liabilities (Part X, line 26) 126,060. 2 3 0 7M. 985,2W 22 Net assets or fund balances. Subtract line 21 from line 20 . ..... ...ZP. w. .... Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than olliter) is based on all information of which preparef has any knowledge. —10 Sign Iglu ure o officer Date Here \ STEVE AMANTE, TREASURER ype or print name and title Print/Type preparer's name Preparer's signature a e Check PTIN Paid 3REGORY J. PRUDHOMME , CPA if r ern to ed 0 0 2 3 4 5 2 5 Preparer Firm's name b, PRUDHOMME ASSOCIATES CPAs^ , INC. Firm's EIN Use Only Firm's address ■ 43460 RIDGE PARK DRIVE, SUITE TEMECULA , CA 92590 Phone no. ( 9 51) 6 7 6— 3131 May the IRS discuss this return with the preparer shown above? See instructions X 1 Yes I 7 N, 032001 12-23-20 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2020) SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 10 CADENZA STRING ORCHESTRA CITY OF TTwMEC[)LA► FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 I PROJECT/PROGRAM INFORMATION Amount Requested: $ ,wj al) MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Y&,An I��iS�Oan el f+� FU14 p Start Date Physical Address of Project) rogram: _a1g1 1011/2012 End Date: 51,3112&'Z fog INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING If Grant is Awarded, Make Check Payable to: OIJOI ��IrI(k (90 Mailing Address: ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant rr __ Organization: TTtri ord�Iym Year Founded: 2��g Website A CG YI S7iI r ICY S Social Media: _ f0c_&b&V[<', _hidaCj�Gt1l� Number of Paid Staff:J Number of Volunteers: Geographic Area(s) the Organization Serves: �tlVet ids GUA Geographic Area(s) the Proiect/Program Serves: efil eL(l NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE E_XCL�U$IVELY USED TO SERVE TEMECULA. Contact Name: 1 oZ cQGlI r) Title/Position: Tr' 5( fer 0. Contact Person's Direct Telephone: �`1oWkontact Person's Email: 2-C-CO IiQ4 �• NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes [Date of Incorporation as a Nonprofit: - A •24a No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 93 �O State Identification Number: _c q tg6Jr0q PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. [Attach IRS Deductibility Status using this link: I7tt ./icif12ti +I-, oovlapL/eos/ 2. Attach State Entity Status Letter using this link: itttfls IIwwW Ill) C&A.'JOV/r,rilinelself serve elitity statLIS letter/index-asp 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: �7.rtt3 I�rC! dci.ca.croylVerifips;tir:��IW Y�I;r:�rr..l7.aspx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, inve7Yes[] Is' or interests in real property with a Temecula City Council Member during the past 12 months? IN IF YES, BRIEFLY DESCRIBE: Is a 7Yes ula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ❑ Members -at -Large I MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES I 10, rudel lxu�)(d ed-vt0honl arvt f(9 ut1fI h Gall 7 FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No /Yes ❑ IF YES, PROVIDE BELOW, NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP 8 OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No ❑ Yes IF YES, PROVIDE INFORMATION IN TABLE BELOW AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ - )and 6061- hs istrxu City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT 1� /b 4 /rcuc /& /xz* a 100i ►'rru�L far V 7Lh a nrura��i kc 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. — 1.cC� punt 4Y n� ,,4 y 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS win % U C c • r� �' a, i ��r tea C-#Ip 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 30 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: X City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. �l (v19all a �t ► 11.a1 f�1 u G V f �1 a I� ,u�E�LI • � tit flan/ &ljW*c/ Gov �$ ' f-eir ��h�c�cPA• l��P�, . /Atp �4-0 OW aakl la�, 49- 6enhaf, 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. IIlCGi '� 0 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. W d loam >f f0 AcZ-1nalitc, tex-Aw v kticlvo n r c- City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $/a �� Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ VVD Organization Other grants or funding already awarded for Project/Program, if any $ In -Kind match amount or volunteer credit hours estimated amount $ / ' m TOTAL REVENUE $ /tj� 6VD LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ $ 5� Facilities/Rent/Insurance Supplies $ it 6M Marketing $ /I6M Services $ .150v $ Food Other $ 1i5� Staffing Expense THIS 15 INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ HOWEVER PLEASE INCLUDE. _ TOTAL EXPENSES TOTAL BUDGET $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 i - PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT *IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit andlor require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be regUired to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Name of Project/Program: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92690, 92691, 92692 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on Expenditure E Name of Company Receipt/invoice Eon Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose a = JULY 1, 2021 - JUNE 30. 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE i I 2 I 3 4 5 0 EXPENDITURE TOTAL .P EXPENDITURE TOTAL MUST BE EQUAL TO { (OR GREATER) THAN TOTAL AWARD AMOUNT i1 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 b the Cit of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds From the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $6,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $6,000. A) Follow #1,A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $1 DK). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to Organization: City of Temecula, 41000 Main St., Temecula, CA 92690, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Name of Project/Prog TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $. was received from City: 1. Is this Expenditure Report is to provide documentation for first $6,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92690, 92691, 92692 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) E Name of Company az on Receipt or Invoice I 2 3 Date on ReceiptlInvoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30. 2024 EXPENDITURE TOTAL Expenditure MUST SUPPORT PROJECTIPROGRAM IN APPLICATION & AWARD LETTER Amount Description Purpose W I EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot, • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best o^f our knowledge and belief. �j 1 ORGANIZATION NAME: Lalrn1 . Av iJ►G�ii L ISfr MAILING ADDRESS: C'erf 01c mu 7 EMAIL: PRESIDENT / AUTHORIZED OFFICER: PHONE: (&) --c-)400m.3 SIGNATURE: DATE: o IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 I,c&n City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD FTB PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/7/2022 ESL ID: 1281837848 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 4196509 Entity Name: CADENZA STRING ORCHESTRA 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ® 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information • This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5. 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: WAY 2 0 2019 CADENZA STRING ORCHESTRA C/O SANDIWA DEL ROSARIO 31927 CORTE POLLENSA TEMECULA, CA 92592-0000 Dear Applicant: DEPARTMENT O? THE TREASURY' Employer Identification Number: 83-4606030 DLN: 26053530002529 Contact Person: CUSTOMER SERVICE ID# 31954 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: May 31 Public Charity Status: 170(b) (1) (A) (vi) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: September 20, 2018 Contribution Deductibility: Yes Addendum Applies: No We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522, This letter could help resolve questions on your exempt status. Please keep,it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public Charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Lette-- 947 HOME ABOUT MEDIA CAREERS REGULATIONS RESOURCES PROGRAMS CONTACT Registrant Details Entity type: Corporate Class as registered wlth the Secretary of State or based on founding & reglstratlon documents, Mailing Address Filings & Correspondence Annual Renewal Data Related Registrations & Event Reports The related records shown below depend on the record type being viewed: • Charity Registrations relate to Professional Fundralsing Events which relate to Professional Fundralser Registrations. • Raffle Reglstratlons relate to Raffle Reports. • Click on the RCT Registration No to navigate to the related record. FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 11 CANINE SUPPORT TEAMS INC. CITY OF TE ECUTA FISCAL, YEAR 2022 M 2023 COMMUNITY SERVICE FUNDING M REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MOND", SEPTEMBER 12, 2022 Amount Requested: $ Project/Program Title PROJECT/PROGRAM INFORMATION I 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION PAWZ for Wounded Veterans Program Physical Address of Project/Program: Start Date: 01 1 3 End Date: 12/31/23 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Canine Support Teams, Inc. Mailing Address: 24480 Jenny Ln, Murrieta, CA 92562 I ORGANIZATION AND GEOGRAPHIC AREA SERVED I Name of Applicant Organization: Canine Support Teams Inc. Year Founded: 1989 F: @caninesupportteamsl I: @k9supportteams/ Website: caninesu ortteams.or Social Media: Ts QKgSuponrtTeams Number of Paid Staff: Number of Volunteers: 40+ Geographic Area(s) the Organization Serves: Southern California 84%, AZ, CO, HI, ID, NV, OR, TX, and WA Geographic Area(s) the Project/Program Serves: Southern California 87% and HI, NV, OR, TX, WV NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Judy Hernandez Title/Position: Client Service/Donor Relations/Admin. Contact Person's Direct Telephone: _951 301-3625 Relations/Administration Contact Person's Email: cstmain@caninesupportteams.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 1991 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0434821 State Identification Number: 1484828 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: htto://aQps,irs.gov/aPPleos/ 2. ❑ Attach State Entity Status Letter using this link: httos://www.ftb.ca.gov/online/self serve entity status letterlindex.as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http_1/rct.dQi.ca,aavNedfica$ionM 1Search.aspx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or fficer of the organization? No® Yes ❑ IF YES, PROVIDE COUNCIL MEMBERS NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Mission: To provide specially trained dogs to persons with disabilities to support their personal, social, and occupational independence. Canine Support Team's (CST) goal is to place 30 dogs annually with individuals who have various disabilities including, but not limited to, multiple sclerosis, cerebral palsy, cystic fibrosis, traumatic brain injury (TBI), spinal cord injury, post -traumatic stress disorder (PTSD), and limited mobility. By delivering expertly trained service dogs, we seek to provide disabled individuals with enhanced mobility, independence, and companionship. CST accomplishes this by individually training each dog to assist with: walking with and beside a wheelchair or walker, retrieving dropped items, turning lights on and off, opening and closing doors, pressing elevator buttons, pulling off socks and sweaters, and barking to alert for help in emergencies, and serving as an ice -breaker in public situations. For eligible veteran clients, CST provides the service dog at no cost to the recipients. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT, DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes X❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT FUNDED BYTHE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP PAWZ for Wounded Veterans $ 5,491.75 September 2020 City of Temecula OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ❑ Yes R IF YES, PROVIDE INFORMATION IN TABLE BELOW, AMOUNT RECEIVED NAME OF ENITY MONTH + YEAR FUNDING RECEIVED $ 15,000 California Relief Grant Program March 2021 $ 2,800 Fredrick and Lorine Taylor Foundation September 2020 $ 15,000 Mary Jo & Hank Greenberg Animal Welfare Foundation November 2020 $ 10,000 Inland Empire Community Foundation October 2020 $ 5,000 Linda I. Smith Foundation November 2020 $3,500 Sidney Stern Memorial Trust May 2021 $5,000 The Armrod Charitable Foundation May 2021 $ 525,827 Wounded Warriors Service Dog Program (US Treasury) January 2022 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE I DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. CST launched the PAWZ for Wounded Veterans Program to address the increasing number of men and women who, after serving our country in the United States military, require a service dog (SD). At no cost to the recipients, CST trains service dogs to support disabled veterans who are seeking enhanced mobility, independence, and companionship. Whether their disability is obvious or invisible, CST is committed to helping veterans reclaim their independence. At around 8 weeks, SDs are placed with Volunteer Puppy Raisers (VPR), who work directly with CST trainers to socialize the puppies through outings and experiences (e.g-, navigating restaurants and shopping centers, using public transportation, processing through TSA, handling crowded events, etc.) VPRs participate in CST -led trainings twice per month. At 18 months, dogs enter Advanced Training (AT) with our Inmate Trainers (IT) through our Prison Pup Program. SDs learn the specific tasks necessary to support a disabled client. ITs meet weekly for training sessions with CST's professional trainers. After AT, dogs are matched with disabled veterans and start the t 0-day Team Training at CST's facility. Upon completion, the dog and veteran receive the Assistance Dogs International (ADI) Public Access Certification. For the "working life" of their SDs, clients are encouraged to contact CST for supplemental training and required to complete a CST Veterinary Health Certificate and to recertify with ADI. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The funds provided by this grant will help CST to provide two additional Temecula veterans with a service dog. It costs an estimated $25,000 to prepare a dog for a life of service. The bulk of CST's expenses are related to the physical care and training of our service dogs. The money awarded will pay for the training, training equipment (e.g., leashes, collars, harnesses, vests, and training tools), canine care equipment (e.g., grooming equipment, crates, microchips, housing), dog food, supplies for the advanced training program (e.g., training treats, consumable tools, equipment), kennel supplies (e.g., food dishes, storage containers, specialized cleaning supplies), and veterinary care and prescriptions (e.g., monthly flea, tick, and heartworm pills, general health, and emergency illnesses). 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. According to the CDC, one in four adults in the U.S. has a disability, including impairments with vision, hearing, mobility, and cognition. These individuals face many challenges, particularly relating to their access to quality jobs, education, and other social functions. Yet, with the assistance of expertly trained service dogs, disabled individuals have been able return to the activities that enrich their lives. For instance, one recent study concluded that "vets with service dogs reported a 22 percent higher rate of life satisfaction, as well as similarly increased rates of mental health, resilience, and ability to participate in social activities." This same study also found that veterans with service dogs "indicated having fewer post -traumatic stress disorder (PTSD) symptoms and lower levels of depression." (rebootcamp.militarytimes.com) The City of Temecula has more than 8,000 veterans, of which more than 6,000 are under the age of 64. With the generous funding from this grant, CST will be able to provide two additional veterans from Temecula with a professionally trained service dog to help support their personal, social, and occupational independence. Furthermore, CST currently has 7 other veteran clients who reside in Temecula, who we will be able to continue to provide supplemental training and re -certify with ADI. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 1 9 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 1 10 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. At no cost to the recipient, CST's PAWZ program trains dogs to support disabled veterans who are seeking enhanced mobility, -independence, -and -companionship. —This -grant will-help-OST-provide-two-Temecula-veterans-with-a service-d costs an estimated $25,000 to prepare a dog for a life of service. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Due to California COVID state mandates, which precluded CST from meeting with clients, conducting the prison training program, and holding our Team Training intensives, our number of placements declined for 2020, Beginning in July 2020, we were able to resume training in a limited capacity (1:1 team trainings) and were pleased to place eight dogs with veterans in such a short time. In 2021, ten dogs were placed with veterans. Again, COVID restrictions hampered our ability to conduct much of our advanced training, especially within the prison. Today, we are back to our pre-COVID placement levels with an anticipated 30 dogs being placed with veterans this year. It should be noted, that while we were under COVID restrictions, CST did take a number of steps to ensure the safety and well-being of our clients, pups, and staff. Most notable, CST initiated supplemental, specialized virtual training, including: (1) helping clients with PTSD mitigate symptoms being exacerbated by their isolation using their service dog; (2) offering new methods for navigating stores and for exercising with social distancing; and (3) providing solutions, especially for those suffering from compromised immune systems, for caring for their dog and themselves. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The approximate cost to raise and train a dog for a life of service is $25,000. Over the next year, CST will identify two eligible veterans from within Temecula who would benefit from the partnership of a service dog. With the generous funds provided by the City of Temecula, CST will be able to provide these two individuals with an expertly trained service dog at no cost to the individual. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM j REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount $ $ 525,827 $ TOTAL REVENUE $575,827 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies $ 47,040 $ 57,680 $ 8,080 Marketing $68,800 Services $ 60,320 Food Other $18,690 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET $218,250 $478,940 $ $478,940 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS` FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to -substantiate how funds received -from the City were Spent: - If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Name of Project/Program: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on £ Name of Company Receipt/Invoice E on Receipt or Invoice MUST BE ON OR BETWEEN Amount JULY 1, 2021 - JUNE 30, 2022 QZ Lt I 3 4 5 6 EXPENDITURE TOTAL diture Description DESCRIBE THE EXPENDITURE Purpose PURPOSE OF EXPENDITURE EXPENDITURE TOTAL MUST BE EQUAL TO (nR r,RFATFRI THAN TnTAI AWARrI AAAnI IMT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions, If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024, In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up domimentatinn innliidin0 the tahle below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to Organization: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Name of Project/Program- TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number] E Name of Company Eon Receipt or Invoice Q Z 2 Date on Receipt/Invoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, 2024 EXPENDITURE TOTAL Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount I Description I Purpose EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval, Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Canine Support Teams, Inc. MAILING ADDRESS: 24480 Jenny Ln, Murrieta, CA 92562 951-301-3625 PHONE: ( ) EMAIL- cstmain@caninesupportteams,org PRESIDENT / AUTHORIZED OFFICER: _ C O- fuk QQQ jAQ,1nQf L _ PRINT NAME TITLE SIGNATURE• PTE: a-x MONTH, DAY, YEAR IF DIFFEREN THAN ABOVE, APPICATION PREPARED BY: Nye 5 -t &figu— PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELPO MENU Home > Tax Exempt Organiza#ion Search > Canine Support Teams Inc. aI: s I : M Canine Support Teams Inc, E I N: 33-0434821 1 M u rri eta, CA, United States Other Names Publication 78 Data Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2019 Form 990 Tax Year 2018 Form 990 Tax Year 2017 Form 990 Tax Year 2016 Form 990 Page Last Reviewed or Updated: 20-November-2020 r# Share $ Print STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/4/2022 ESL ID: 8084017744 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1484828 Entity Name: CANINE SUPPORT TEAMS, INC. X❑ 1. The entity is in good standing with the Franchise Tax Board. El2. The entity is not in good standing with the Franchise Tax Board. X❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) ** PUBLIC DISCLOSURE COPY ** Return of Organization Exempt From Income Tax Form 990 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Depart1110- Do not enter social security numbers on this form as it may be made public. tatarnatmenf of U. Bury 110� Go to www.irs.gov/FormOgO for instructions and the latest information. A For the 2020 calendar yanr, or tax year beginning B ctsw* if C Name of organization ,volcabW j IMMW CANINE SUPPORT TEAMS INC. [-6r am*! wu a Doing business as iavun Number and street (or P.O. box if mail Is not delivered to street address) [�],r= P.O. BOX 891767 termin- ated City or town, state or province, country, and ZIP or foreign postal code [�A"""'�°''LN!me ECULA CA 92589-1767 I JI�P II �:k�inito�� and address of principal officer: CAROL ROQUEMORE Pend`' AS C ABOVE Tax-exempt status: 501 e 3 5U 1 c ■ inswt on, 4947 J Website: Ill WWW.CANINESUPPORTTEAMS.ORG K Farm} of or anizallon: LXj Cnrparalion Trust Association El Other 0- Part l I Sui rtmaty and 2020 Open to Public Inspection D Employer identification number 33-0434821 Room/suite E Telephone number 951)-301-3625 G Glosslwolp%s 784 460. H(a) Is this a group return for subordinates? I J Yes X1 No H(b) Are all suhordlnates includod? [::] Yes [::] No r 527 If "No," attach a list. See instructions 19 9 01 M State of local domicile' CA 1 Briefly describe the organization's mission or most significant activities: CANINE SUPPORT TEAMS ( CST) IS A 0 G CALIFORNIA BASED NON—PROFIT ORGANIZATION THAT PROVIDES SPECIALLY c2 Check this box 0 if the organization discontinued its operations or disposed of more than 25% of its net assets. c3 Number of voting members of the governing body (Part VI, line 1 a) g 8 0 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 6 am-- w 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) .............. 5 14 14 6 Total number of volunteers (estimate if necessary) ,- a7 a Total unrelated business revenue from Part VIII, column (C), line 12 7a 0. b Not unrelated business taxahle income from Form 990-f Part I line 11 7b 0 . Prior Year Current Year 650,543. 781,283. 0 8 Contributions and grants (Part VII I, line 1 h) m9 Program service revenue (Part VIII, line 2g) 3,602. 2,950. 10 .......... ,_ ._..................................... Investment income (Part VIII, column (A), lines 3 4, and 7d) ,,,,,, „ 752. 227. 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 1 Oc, and 11 e) ............ 8 641. —5, 334. 12 Total revenue - add lines 8 thr h 11 must equal part Vill column (A). line 121 663, 538. 779,126. 13 Grants and similar amounts paid (Part IX, column (A), lines 1.3) _ . , .--• _ 0. 0. 14 Benefits paid to or for members (Part IX, column (A), line 4) ..-- - . 0. 0. 385,795. 360,815. 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 2 16a Professional fundraising fees (Part IX, column (A), line 1le) ,.,,, ., „ 0 . 0. n b Total fundraising expenses (Part IX, column (D), line 25) 68 991 . 17 Other expenses (Part IX, column (A), lines 11a-1Id, 1 lf-24e) ------------ -- 304 631. 397,514 . 690 426. 758,329. 18 Total expenses. Add lines 13-17 (Must equal Part IX, column (A), line 25) 19 .--, -. • ., Revenue less expenses. Subtract line 18 from line 12 ............. .. ........... ... ..... .. — 2 6 8 8 8 . 20,797. Beginialno of Current Year End of Year 20 Total assets (Part X, line 16) . _. .... 341,292. 605,226 . 10,000. 253,137 . a 21 Total liabilities (Part X, line 26) .................. .... 22 Not assets or fund balances. Subtract fine 21 from line 20 331,292. 352,089 . rdr4 IN I -agdglakulu 01FJU1i Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is Irue, currect, and complete. Declaration of Rreparar outer than officer is Mae on all information of which prqaftr has any knowledge. Sign Signalum of officer Dare Here CAROL RO UEMORE, VICE PRESIDENT/CEO lype or print narnc and title PrintiType preparer's name Preparer's signature 13aio ec Pl'IN Paid OVEPREET BUTTAR CPA OVEPREET BUTTAR CPI1/10/2]ilm e 01329403 Preparer Firin's name MERCAD I EN , P.C. line's N 2 2 — 3 2 71712 Use Only Firm's address P. 0. BOX 7648 PRINCETON, NJ 08543-7648 1PIwn-!ro.609--689-9700 May the iRS discuss this return with the prepare?, shown above? See irtstnrctions X1 Yes 032001 12-23-20 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2020) SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION 12 CAUSE FUR PAWS INC CITY OF TEMECUI[A FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 10,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Cause Fur Paws Helping animals Project/Program Title: with diabetes Start Date: 01 /01 /209�d Date: 12/1 /2022 36522 Via er e Physical Address of Project/Program:Terniecitla r;l 9259 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Cause Fur Paws, Inc Mailing Address: 47200 De Portola Temecula, Ca 92592 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Cause Fur Paws, Inc Website: www.causefurpaws.org Number of Paid Staff: 0 Year Founded: 2011 Social Media: https://Www.facebook.com/causeforpawstemect Number of Volunteers: 3 Geographic Area(s) the Organization Serves: Riverside County Geographic Area(s) the Proiect/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Valerie Andrews Title/Position: President Contact Person's Direct Telephone: 951 775-7275 Contact Person's Email: vall @causeefurpaws.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 2011 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 27-5415050 State Identification Number: 3354176 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: http://apps,irs.gov/app/��eos/ 2. ❑ Attach State Entity Status Letter using this link: https://www.ftb.ca.gov/online/self serve entity status letter/index.asD 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: httQ//rcl.doi.ca.govfVrificationNVeb/Search.asnx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ® Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. To provide donated funds to veterinarians and animal hospitals that directly benefits the immediate physical well-being of animal diabetes. These funds wili help finance costs for medicine, veterinarian services and hospitalization expenses, due to the effects of diabetes on the animals and/or prevent euthanasia due to inability to meet the costs of medical care. Upon appiication, approval and fund availability, Cause for Paws will disperse funds to pay the bill received from the veterinarian or animal hospital with eligibility criteria met and availability of funds. To provide appropriate referrals for health or behavioral care for Animals with Diabetes. To provide education and to inform the public about Diabetes in animals FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW, City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 I FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. f NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR NAME OF CITY GRANT + FUNDED BY THE CITY GRANTOR SPONSORSHIP I FUNDING RECEIVED OR SPONSORSHIP I OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Our program is to get the word out by local publications, social media outreach and direct emaili that this organization can help with the costs associated to animal diabetes. They don't need to -euthanize their pets we can help_ We have been helping for over 11 years. -We also hold a fund raiser at Oak Mountain Winery on August 21st to raise money, have a dog carnival for the dogs to enjoy and educate the people about canine diabetes, treatments and funding. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. i ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. We will use this money to reach out to all of the local Temecula Veterinarians, animal hospitals,pet stores and animal supply stores to let them know we will help any needy pet owners with the costs of diabetes control to include insulin, needles, glucose testing and test kits as well as precription food as long as the funds last. Helping our local pet owners. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Any animals in Temecula with diabetes will benefit with our support in paying for insulin and need special diets,vet bills and testing. The people will benefit by not only the finaciai support but the community being educated what to look for in their pets and get them help before they get very sick or loose their eyesight. The education will reach the whole community with out outreach 1 in 500 dogs suffer from diabetes. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 114 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. It has been our goal to be_able _to_reach more_people to educate them on canine —I diabetes and let them know we are here to help financially with the treatment of their pets. We are also experienced with our own diabetic dog symptoms and treatments and help give comfort and suggestions for everyday care and giving shots to animals. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. During covid we were not able to do any fundraising ( it is still not easy to raise funds and get donations). The Veterinarian situation is still not good as many retired so people have long waits to get an appointment for their pets. We are able to help in referring vets that specialize in diabetes and eye issues which is common with diabetic dogs. With people having to pay higher prices for everything they don't have the fund it takes for Insulin and needles and therefore are forced to Euthanize their furry friends.That is where we come in and can pay for the services the animals need with your help. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The funds will enable us to continue helping the animals and will give us the money to promote what we do and gain support to continue growing and helping the community, We have been self supporting for over 11 years but we want to reach everyone and not have to turn anyone down for lack of funds. We will have the fund to put together phamphl with information about canine diabetes and distribute to all local animal hospitals, Vet offices, petco etc. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant(Not to exceed $50�000)- 10, 000 Amount contributed to the Project/Program by the Applicant $ Organization 1500 Other grants or funding already awarded for Project/Program, if any $ I In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 11500.00 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment (- $ Facilities/Rent/Insurance $ 500 Supplies $ 500 Marketing $1500 Services $ Food 1000 $ Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $ 3500.00 TOTAL BUDGET $ $ 3500.00 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUSFISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may -jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization. _ Name of Project/Program: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): E d Date on Expenditure e Name of Company Receipt/invoice Description Purpose Q Y z' on Receipt or Invoice MUST BE ON OR BETWEEN Amount I DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1, 2021 - JUNE 30. 2022 5 $ I 6 $ EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation, Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount -of -funds-to-the-City-.To-substantiate-that-grant funds-from-the--City-are-spent-appropriatelyi-proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: _ Name of Project/Program:,. , TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report Is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92691, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) - a) Date on Expenditure t W Name of Company Receiptlinvoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION &AWARD LETTER E on Receipt or Invoice MUST BE ON OR BETWEEN Q Z March 20, 2020 - JUNE 30, 2024 Amount Description Purpose 1 011 Ea J -I.. --L$ I EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot, • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME:.l12�� MAILING ADDRESS: t PHONE: EMAIL PRESIDENT / AUTHORIZED OFFICER:11`r.T['t�%�, PRINT NAME SIGNATURE: )J41t�Q. IF DIFFERENTTHAN ABOVE, APPICATION PREPARED BY: DATE: 7 1:;�.I q Q,— SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA Tpp FRANCHISE TAX BOARD FIR PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 7/2/2022 ESL ID: 2469901519 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 3354176 Entity Name: CAUSE FUR PAWS, INC. 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: QEPZ52o11 CAUSE FUR PAWS INC -- C-/O-VALERI-EANDREWS 47200 DE PORTOLA TEMECULA, CA 92592 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 27-5415050 DLN: 17053227305011 Contact Person: YVONNE-LIGGET-T ID9 31296 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 509 (a) (2) Form 990 Required: Yes Effective Date of Exemption: January 25, 2011 Contribution Deductibility: Yes Addendum Applies: No 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. Enclosure: Publication 4221-PC Sincerely, Lois G. Lerner Director, Exempt Organizations Letter 947 (DO/CG) W 2021 - 990-N (e-Postcard) ACCEPTANCE LETTER Form 990-N (e-Postcard) Online Filing Congratulations! Your 2021 tax return has been accepted by the IRS. Thank you for preparing your exempt tax return, IRS Form 990-N, with ExpressTaxExempt. Your return information is listed below and we hope you had a pleasant experience e-filing with ExpressTaxExempt. FORM INFORMATION TAX YEAR: 2021 IRS SUBMISSION ID: 32101820220322000136 TAXPAYER INFORMATION NAME: Cause Fur PAws Inc DBA NAME: Cause Fur Paws ADDRESS: 47200 De Portola Rd STATE/COUNTRY: California PHONE: (951) 767-2116 RETURN ID: 4B00032229517-4 E-FILE TIME STAMP: 2/1/2022 2:03:58 PM TAX ID: 27-5415050 CITY: Temecula ZIP: 92592 EMAIL: vandrews@oakmountainwinery.com PLEASE PRINT A COPY OF THIS LETTER FOR YOUR RECORDS Thank you again for your business. If you have any questions or need any assistance, please contact our customer support via live online chat, email at support@expresstaxexempt.com, or by phone at 704-839-2321. We're here to help! Sincerely, ExpressTaxExempt Support Team (704)839-2321 support@expresstaxexempt.com Span Enterprises • (704) 839-2321 • 2685 Celanese Road Suite 103 • Rock Hill, SC - 29732 Rie-gustrant Details Organization Name: CAUSE FUR PAWS, INC. IRS FEIN: 275415050 Entity Type: Public Benefit SOS/FTB Corporate/Organization Number: 3354176 Registry Status: Delinquent Renewal Due/Exp. Date: 5/15/2018 RCI' Registration Number: CT0251190 Issue Date: 7/17/2017 Record Type: Charity Registration Effective Date: 7/17/2017 Date of Last Renewal: DBA: Ma hog Address Strect: 47200 DE PORTOLA Street Line 2: City, State Zip: TEMECULA CA 92592 F;4rVi v gs & Corriespond ence , sing Reports Letter Missing Reports Letter Incom Incomplete RRF-I Letter Founding Documents Founding Documents ConCrttifltign of Registration j,,etter Confirmation of Registration Letter Form RRF-1 2020 s —tDs I ir 1-Q uency Letter Ist Delinquency Letter ,Founding Document Click on Document Type at the Icfl to open PDF 2-].J FarM REE-1 Click on DOCrlmCnt Type at the left to open PDF 2016 E4rir1 RELI Click on Document Type at the left to open PDF 2M Form RU-11 Click on Document Type at the left to open PDF 2414 ForM RRF=1 Click on Document Type at the left to open PDF 2012 Form RRF-1 Click on Document Type at the left to open PDF 12011 Form RRF-I Click on Document Type at the left to open PDF +1 ' . mL a s: R e ' -,e w a 1`a D "„ a Status of Filing: Accepted Accounting Period Begin Date: 1 /l,/201 1 Accounting Period End Date: 12/3 1 "201 I Filing Received Date: 8;21/20I7 Form RRF-1 RejectAneomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff; !status of Filing: � Accepted Accounting Period Begin Date: l'1/2012 Accounting Period End Date: 12/31/2012 Filing Received Date: 3/21"2017 Form RRF-1 Reject/Incomplete Reason; Form CT-TR-I Reject/Incomplete Reaso IRS Form 990 Reject/lneomplete Reasoi Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reasc IRS form 990 Reject/Incomplete Reasoi Notes From Registry Staff: Status of Filing: Accounting Period Begin Date. - Accounting Period End Date: Filing Received Date: Form RRF-1 RejectAncomplete Reason: Form CT-TR-1 Reject/Incomplete Reasn IRS Form 990 RejectAncomplete Reaso► Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date. - Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reaso IRS Form 990 Reject/Incomplete Reason Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/fneomplete Reason: Form CT-TR-I Reject/Incomplete Reaso IRS Form 990 Reject/Incomplete Reason Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-I Reject/Incomplete Reason: Form CT TR-1 Reject/Incomplete Reasoi IRS Form 990 RejecOncomplete Reason Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reaso► IRS Form 990 Reject/Incomplete Reason; Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-I Reject/Incomplete Reason: Form CT-"rR-1 Reject/Incomplete Reasor IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Incomplete Accounting Period Begin Date: 1 /1 /2020 Accounting Period End Date: 12/3 1;20)0 Filing Received Date. 8; l8i"2021 Form RRF-I Reject/Incomplete Reason: Form CT TR-I RejecOncomplete Reason: IRS Form 991) Reject/Incomplete Reason: Notes From Registry Staff: Related Registrations & Even ept �. No Related Records FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 13 CULTIVATING INCLUSION INC. CITY OF TEMECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 7,500.00 Project/Program Title: cultivating Inclusion Inc. MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Start Date: 02-02-2015 End Date: ongoing Physical Address of Project/Program 39775 Alta Murrieta Dr., Murrieta, CA 92563 - "no mail should be sent to physical address. INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Cultivating Inclusion Go Mary Ann Tams •• Mailing Address: 31430 Loma Linda Rd., Temecula, CA 92592-1604 **all correspondence needs to go to this address, ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Cultivating Inclusion Inc. Website: http:11www.cultivatingindusionfarm.com Number of Paid Staff. zero Year Founded: 2015 Social Media: Facebook, Instagram Number of Volunteers: 15 to 20 Geographic Area(s) the Organization Serves: southwest Riverside County Geographic Area(s) the Proiect/Program Serves: Southwest Riverside county NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Mary Ann Tams Title/Position: Garden Director Contact Person's Direct Telephone: 951-296-7756 Contact Person's Email: Cultivatinginclusion2@yahoo.aom NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 06-26.2018 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: e2-06o9510 State Identification Number: =� "7 �3 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTEl) AS FOLLOWS: 1. XAttach IRS Deductibility Status using this link: littp:ltclpl)s.irs.gov/app/co 1 2. l)�Attach State Entity Status Letter using this link: htt s:1/ A.ftb.ca.gov/onfine/seif serve entity status lettedindex.as 3. J9 Attach first page only of most recent IRS Form 990 # attach print out of detailed info about your charity found on this State Registry's Search Tool: ht ://rc .do'.ca. ovNeriri do /W 1 rc s x?f ilit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No �Z Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Cultivating Inclusion is a one of a kind project that provides vocational training opportunities for youth and adults with special needs throughout our valley. We provide a job site location for day programs, two of which, Care -Rite Vocational Services and TMI Vocational Services are located in the City of Temecula. We work side by side with special needs adults as they learn how to prepare, plant, nurture and ultimately harvest produce. The feeling of satisfaction and accomplisment is palatable upon their faces- Not only do our special needs adult visitors learn the rudiments of gardening, they know that the produce they have cared for goes to local food banks. We have been able to bring nearly 1,200 Ibs of citurss and produce to St. Vincent de Paul (St. Catherine's Catholic Church chapter) and Western Eagle Foundation this year alone Together we learn to work as a team and socialize with a bit of fun in between through snacks, games and crafts. All of the above is brought together by a wonderful group of volunteers who believe that our special needs adults involved in Cultivating Inclusion are a necessary and vital part of our community. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No kZ Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP City of Temecula AMOUNT t MONTH + YEAR FUNDING RECEIVED 01-2022 NAME OF CITY GRANT OR SPONSORSHIP $ 5,000.00 $ Community Sery Reinvesting in Temecula Grant $ $ i $ $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No ❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW AMOUNT MONTH + YEAR NAME OF ENITY RECEIVED FUNDING RECEIVED Heritgae Hills Event Ctr. $ 1,000.00 01-2020 $ Inland Empire Community 9-2020 660.00 Foundation $ 5,000.00 Lendistry - State of CA Grant Coalition - California Relief Program 02-2021 $ 1,420,00 Rodgers Seed Money 01-2021 $ 3,500.00 Vines Christian Fellowship 03-2021 $ 1,450.00 Network for Good 06-2022 Q 300.00 Vines Christian Fellowship 06-2022 06-2022 $ 217.00 The Habit - Fundraiser percentage of sales City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Cultivating Inclusion farm is spedficatly designed for special needs adults. We literally give our special needs adult visitors the tools to care for and nurture produce In a community garden setting. We welcome adults who are part of State of California licensed day programs and students in the Adult Transition Programs in Temecula Valley USD. Together we harvest a variety of produce which in turn is donated to local food banks, i.e. St Vincent de Paul, Western Eagle Foundation and Community Mission of Hope. In this positive outdoor environment our patient volunteers work side by side with our farmhands, and when we take a break together, socializing skills are honed and enjoyed. The unique combination of co-workers is real and friendships are formed, united in a great cause to provide fresh produce to our neighbors in need- 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Keeping our landscape clear of weeds and vermin is of primary concern. Because when both of these pests are present our produce is threatened and the beauty is blighted on the property. As this is very vital, keeping our farm neat and healthy, we require both weed abatement and pest control services. In addition, we supply our special needs adults with water, healthy Snacks, arcs and crafts, copy services for different information and adult coloring books, For promotional purposes funds are spent on flyers for events, business and post cards, Not to mention signage so that our garden is one that can be located easily. We recently had a theft of our previous heavy aluminum sign at the farm which was a $700.00 purchase. The tools and replacements that are required of gardening is also one in which monies are spent. Along with the buying starter plants, shrubs and trees to shade our garden and provide beauty. Soils of all variety to enrich our indigenous soil are required and this too is an expense. All in all —any resources received will be put to goad use and will very much help our farm grow 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Temecula residents who attend either a day program like Care Rite, TMI or ATP programs in TVUSD benefit from the Cultivating Inclusion farm experience Once our special needs adults walk through our garden gate they are greeted with a smile and hello. This is sometimes not always the case when they enter locations, but at the farm all are welcome and appreciated by their presence. We become friends and co-workers, bringing life to our soil and harvesting the produce, it is a sense of accomplishment that is palpable and necessary feeling for everyone to experience. 3b ESTIMATED NUMBER OF PEOPLE FROM THIS PROJECT PROGRAM FROM TEMECULA EXPECTED TO BENEFIT I 350 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: I 15to20 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. We are a community garden set up to teach our special needs adults about growing produce. Fresh produce that we in turn donate to fellow neighbors in need of fresh food who welcome afresh alternative In this growing process we we show our special needs adults they have purpose- 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATIONS ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Covid 19 specifically affected our non profit due to the fact that our adults in both day programs and ATP classes with TVUSD were not meeting in person. Therefore, like the rest of the word, they had to resort to communicating with those outside of their home via zoom. In 2020, though the Cultivating Inclusion farm was being maintained we were not being visited by our special needs communities because of the restrictions. When w321 came around, we greeted sporadically special needs adults whose day programs limited to being open three days a week. We would also host special events around holidays, wherein folks picked out pumpkins, made pine cone ornaments and valentines with sunflower seeds. In June of 2021, we were able once again to greet our day programs and we were thrilled to have them back we had missed them and our mission of working together to grow produce for our neighbors in need. Since the pandemic is ongo�nq even now, I notice that plants, delivery or soils, seeds and snacks that we provide have all increased in price, More often than not, nur dear volunteers will donate snacks and craft supplies to an effort to decrease having Cultivating Inclusion funds used for this reason- 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. In addition to promotional items, supplies and general repairs, we would like to make the Cultivating inclusion farm accessible for those special needs adults who have mobility issues. It has been suggested that perhaps our center lane of the farm, meaning from front fence to the back fence a strip of concrete to enable all of our special needs adults can have a garder,.ng experience_ Lasl ye It we had a girt named Jessica who was part of an ATP program had an electric track chair but she became mire in some weller soil and we almost could not get her out, And Jessica really loved coming to the farm so she did return but we were more diligent about where she could travel to avoid getting stuck again. This request for mobility has come from leachers and parents of special needs adults. I could not in good conscience omit this need as being very important. For this above reason Cultivating Inclusion is asking for the additional $2,500.00 for the sole purpose of providing a centenualk for all our special needs adults. As in 2021 we requested $5,000.00 and happily gratefully received it in January 2022, but this year we are requesting the additional monies for the above purpose.. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 7.500,00 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 6.000.00 Organization -- Other grants or funding already awarded for Project/Program, if any $ 3.500.00 In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 16,00000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ 300.00 Facilities/Rent/Insurance" $ 834,00 Supplies $ 700,00 Marketing $ 1,500.00 Services $ 0. Food $1,e66.00 Other Accessibility $ 2,500M $ 0 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ $7,500.00 TOTAL EXPENSES TOTAL BUDGET $ $ 5,000.00 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. I If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: — Cultivating Inclusion Inc. Name of Project/Program; Cultivating Inclusion FY 2021-2022 Amount of $ CSF Grant Fund Awarded: $5,000.00 Month & Year CSF Grant Received from City: 01-2022 Number of Beneficiaries Living In 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not 1,200 have precise number): Previously submltled and approved before see attached confirmation dated 08-27-202Y. E Date on _ Expenditure Name of Company Receipt/Invotce Description Purpose on Receipt or Invoice MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1, 2021 - JUNE 30, 2022 1 $ 2 $ 3 $ EXPENDITURE TOTAL MUST BE EQUAL TO EXPENDITURE TOTAL $ (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2021.2022 by the City of Temecula, then this information is not due until Monday, September 12, 2022 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding_ City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application,4be organization will be required to refund the amount of Funds. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back -tap documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Monday, September 12, 2022_ EXPENDITURE REPORT due on or before Monday, September 12, 2022 1. Provide the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted 1200 From this program (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3, Attach Receipts/Invoices (in the same order as listed In this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Cultivating Inclusion Inc. Amount of Grant Fund Awarded: $ 5,000.00 Name of Company E on Receipt/invoice az'I 1 Home Depot I 2 Home Depot 3 Date (Mo/DayNr) on Receipt/lnvoice Must be dated on or between July 1, 2021 - June 30, 2022 11 /09/21 01 /26/22 Home Depot 02/15/22 Amount of Expenditure $ 38.44 $ 52.20 4 Home Depot 103/14/22 J $ 17.36 Louie's Nursery10/13/21 1 $ 77.94 Louie's Nursery 11 /09/21 ' $277.50 7 Louie's Nursery� 02/ �/22 EXPENDITURE TOTAL Note: Expenditure Total must be equal to (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City $ 39.98 Name of Project/Program: Cultivating Inclusion Inc. Month + Year Grant Received from City: 01 /2022 Describe... Explain ... (1) what the expenditure was I how the expenditure (2) purpose of the expenditure specifically benefitted Temecula residents MUST support Project/Program If namesladdresses of Temecula description on Application + Award Letter beneficiaries are available, Alensu attach. -- 1 cu foot citrus fertilizer "use Keeping our grove thriving cols lertifizer specTcauy to enrich sail in our grove. for food banks and clients rosemary, lettuce, cabbage starter plants Winter crops for food banks~ to ensure a winter crop and cllsnte learn io nurture plants steer manure for winter crop plants, Winter crops for food banks amending soil is key to productivity and clients learn the rare of veg. Petunia easy way plant 4 pack To make our farm pretty for to beautify the garden. clients and visitors Native blackberry bushes, for spring crop of berries for clients to harvest. 8 yards of organic planting mix soil to ensure the health of soil for prodrloe. 2 Flats of sirawherry plants so that a sweet treat is available for food banks. $ `;4� 9:"I / p i1 of 3 To ensure a variety of produce Is given to food hanks. Needed to keep our crop healthy for food banks/clients Healthy options for clients to harvest for food bank needy. City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2021-2022 by the City of Temecula, then this information is not due until Monday, September 12, 2022 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/oi require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application,.the organization will be required to refund the amount of funds, To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Monday, September 12, 2022. EXPENDITURE REPORT due on or before Monday, September 12, 2022 1. Provide the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted 1200 from this program (approximate number of beneficiaries if you don't have a precise number): _ 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Cultivating Inclusion Inc. Amount of Grant Fund Awarded: $ 5,000.00 Date (MolDaylYr) Name of Company E Recelpt/lnvoice on Receiptlinvoice Amount .Ion u E 2 Must be dated on or between July 1, 2021 - of Expenditure p Z June 30, 2022 2 Orozco Gen Maint. 1 08/30/2021 $ 385.00 3 Orozco Gen Maint. 09/28/202 1 $ 385.00 4 LOrozco Gen Maint. I O/26/202 5 Orozco Gen Maint. 1 1 /30/202 1 $ 385.00 6 Orozco Gen Maint. 1 2/28/2021 1 $ 385.00 7 Orozco Gen Maint. 0 1 /31 /2022 1 $ 385.00 Name of Project/Program: Cultivating Inclusion Inc. Month + Year Grant Received from city: 01 /2022 Describe... Explain ... (1) what the expenditure was how the expenditure 1 (2) purpose of the expenditure specifically benefitted Temecula residents MUST support Project/Program If namesladdresses of Temecula description on Application + Award Lefterl beneficiaries are available, i Initial cost of weed clean up in order M ry TC4C�eililtt foLqur for our farm to be neat in appearance. clients and visitors in appearance. Keeping our farm clean so that it is neat More accessible for our and accessible for our visitors and clients. clianw and Wallora in appearance, Keeping our farm clean so that is neat and More accessible for our accessible for our visitors and clients. clients and visitors. Repair and replacement of Produce to nurture for clients irrigation drip system to keep farm green. and food for food banks. Keeping our farm free of weeds so that I More accessible and easy it has a neat and pleasant appearance. for clients to harvest produce. Keeping our farm free of weeds so that More accessible and easy it has a neat and pleasant appeafance, for clients to harvest produce. Keeping our farm free of weeds so,het More accessible and easy It has a neat and pleasant appearance. for clients to harvest produce. EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ 2:7,0e'00 f pg 2 (or greater than) the "Amount of Grant Fund of 3 Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 FISCAL YEAR (FY) 021-2022 COMP41ANCE REPORT If your organization is awarded a Community Service Funding Grant In FY 2021r2022 by the City of Temecula, then this Information Is not due until Mdnday, September 12, 2022 If your organization Is awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, --all-grant-funds reoelved-must-be-expended-anytkne-on-or-between-July-1 2021-and-Jung-30,-2022- In addition, - all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up Information to substantiate how funds reoetved from the City were spent. t% If the funds are not spent in accordance with the approved purpose staled on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying recelpts/invoices, must be submitted to the City on or before due date: Monday, September 12, 2022. EXPENDITURE REPORT due on or before Monday, September 12, 2022 1 1. Provide the number of beneficiaries living in 92590, 92591 and 92592 that directly, benefitted from this program (approximate number of beneficiaries if you don't have a precise number): IQLOO 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receiptslinm voices (in the sae order as listed in this table) 4. Send to: City of Temecula, 41000 Main St, Temecula, CA 92590, Attn: City Managers Office - CSF Organization: Cultivating InCIUSIOn Inc. Name of ProjecWrogram:L,f1;Lh&.t3:7ulCIUS! Amount of Grant Fund Awarded: $ Month + Year Grant Received from City.() � -- Data (Mo/DayNt) Name of Company on Recelpt/lnvolcs on Recelptllnvolce Must be dated on or $ between July 1. 2021 - June 30, 2022 "IN 7 .0401H 3-1S-; Describe... Explain ... Amount Of Expenditure (1) what the expenditure was (2) purpose of the expenditure MUST MUST support Project Program description on Application + Award Lettet how the expenditure specifically benefitted residents M namecfaddnasas of Temecula beneAdarlss art available. $ -- �� 3 • Ham, cfo�i Frr drs ^40.n "P -, -I" kw �_ ,.rc- ni A naw a* fdr wivt Prro- EXPENDITURE TOTAL ` �O. (� Note, Ex nditure roiai must be equal$ 4 to (or greater than) the-AarlqurIf of Grant Fund I Awarded' (above) provided by the City r W CJfr.-0tls ait"ndC tbwd tom- l) le, . City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2021-2022 by the City of Temecula, then this information is not due until Monday, September 12, 2022 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may -jeopardize -any -future -funding.. City -of Temecula -reserves-the-right to -conduct an -aud it -and/or require -additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application4he organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Monday, September 12, 2022. EXPENDITURE REPORT due on or before Monday, September 12, 2022 1. Provide the number of benefioieries living in 92590, 92591 and 92592 that directly benefitted 1200 from this program (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Cultivating Inclusion Inc. Amount of Grant Fund Awarded: $ 5,000.00 Name of Company E on Receipt/lnvoice t� u E az' 1 Orozco Gen Maint Date (Mo/DayNr) on Receiptlinvoice Amount Must be dated on or between July 1, 2021 - of Expenditure June 30, 2022 03/01 /2022 $ 385.00 r[uUUI rr rCSL- TlujI AZ - 3 Rodent Pest Tech 0911 gI2021 1� $ 230.00 4 Rodent Pest Tech 11 /19/2021 $ 230.00 5 Rodent Pest Tech f 12/20/2091 $ 230.00 6 Rodent Pest Tech 102/19/2022 $ 230.00 7 Rodent Pest Tech 1 03/22/2022* $ 230.00 Name of Project/Program: Cultivating Inclusion Inc. Month + Year Grant Received from City: 01 /2022 Describe... (1) what the expenditure was (2) purpose of the expenditure MUST support Project/Program description on Appilcation + Award Let Keeping our farm free of weeds so thal it has a neat accessible appearance. Rid the farm of vermin and pests to ensure a safe environment, Rid the faun of vermin and pests to ensure a safe environment. Rid the farm of vermin and pests to ensure a safe environment. Rid the farm of vermin and pests _ to ensure a safe environment. Rid the farm of vermin and pests to ensure a safe environment. Rid the farm of vermin and pests to ensure a safe environment. EXPENDITURE TOTAL 'pd on 3/1112022 Note: Expenditure Total must be equal to $ 111,8109 3 of 3 (or greater than) the "Amount of Grant Fund Total $54t4rW for 3 pgs Awarded" (above) provided by the City a 19 City of Temecula Community Service Funding Grant APPLICATION Explain ... how the expenditure specifically benefitted Temecula residents If namesladdresses or Temecula beneficiaries are available, please attach. Helps keep our farm safe for visitors and more food for food banks, clients and more food for food hanks. Helps keep our farm safe for clients and more food for food banks. Helps keep our farm safe for clients and more food for food banks. Helps keep our farm safe for 4*ntn oral morn rood for frxxl banks, Helps keep our farm safe for clients end more food for food banks. Helps keep our farm safe for clients end more food for food bunks, Page 6 of 7 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the Funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. I. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance Of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization:- Cultivating Inclusion Inc. Name of Project/Program: Cultivating Inclusion Inc. TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: 5_ was received from City: _ 1. Is this Expenditure Report is to provide documentation for first $5,004 awarded and racelved? Yes or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) m l Date on Expenditure E t Name of Company Receipt/invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION &AWARD LETTER o E on Receipt or Invoice MUST BE ON OR BETWEEN a z' 1 Merch 20, 2020-JUNE 30, Amount Description Purpose 2024 2 $ 3 $ EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Cultivating Inclusion Inc. MAILING ADDRESS: Cultivating Inclusion c/o Mary Ann Tams 951 296-7756 31430 Loma Linda Rd., PHONE: (_) Temecula, CA 92592-1604 Cultivatinginclusion2@yahoo.com EMAIL: M PRESIDENT /AUTHORIZED OFFICER: Mary Ann Tams, Garden Director A �� ,1 �� ,� PRINF NAIME 11`LE I Y I l�t�i' y t �I f. v T-� August 2, 2022 SIGNATURE: DATE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PRINT NAME MONTH, DAY. VIA! SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date- J U 2 6 2018 CULTIVATING INCLUSION INC 39901 ALPINE UNION DR UNIT C __MURRIETA,CA 92563-0000 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 82-4809510 DLN: 26053569009448 Contact Person: CUSTOMER SERVICE ID# 31954 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 509 (a) (2) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: March 9, 2018 Contribution Deductibility: Yes Addendum Applies: No we're Pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section.501(c)(3). Donors can deduct contributions they make to you under IRC'Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (FOrM 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 -z- CULTIVATING INCLUSION INC Sincerely, Director, Exempt Organizations Rulings and Agreements Letter 947 STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B t PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 7/31 /2022 ESL ID: 3166835146 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 4127453 Entity Name: CULTIVATING INCLUSION INC. 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. X❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). • The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m, weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Q HELPS] MENU Home > Tax Exempt( rganixation Search > Cultivating Inclusion Inc. < Back to 5earcUesults Cultivating Inclusion Inc. EIN: 82-4809510 1 Temecula, CA, United States Other Names Determination Letter e A favorable determination letter is issued by the IRS if an organization meets the requirements for tax-exempt status under the Code section the organization applied. Final Letters Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Form 990-N (e-Postcard) a Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. Tax Year 2021 Form 990-N (e-Postcard) Tax Period: 2021 (01/01/2021 - 12/31/2021) EIN: 82-4809510 Legal Name (Doing Business as): Cultivating Inclusion Inc Mailing Address: 31430 Loma Linda Road Temecula, CA 92592 United States Principal Officer's Name and Address: Mary A Tams 31430 Loma Linda Road Temecula, CA 92592 United States Gross receipts not greater than: $50,000 Organization has terminated: No Website URL: http://www.cultivatinginclusionfarm.com Tax Year 2020 Form 990-N (e-Postcard) Tax Year 2019 Form 990-N (e-Postcard) Tax Year 2018 Form 990-N (e-Postcard) Po Lost Reviewed or Updated: 20-November-2020 r* Share Print L. 0'e C � i.-i! 4. . zif Organization Name; CUr1:11VATING INCLUSION INC., IRS FEIN: 824809510 Entity Type: Public F3ci,etit SOS/FTB Corporate/Organization Number: 4127453 Registry Status: Current Renewal Due/Exp. Date: 5/ 15/2023 RCT Registration Number: CT026-1665 Issue Date: 10/14/20t9 R"ortl Iype: Charily Re-isuation Effective Date: 10/14/2019 Date of Last Renewal: 6/6/2022 DBA: Mailing Address 'Street; 31430 LOMA LINDA RD Street Line 2: City, State zip: ITNIECULA CA 92592 ("f--47Q Confirm ltljon LiLjjggi tt' tl n Click on Document I')�pe at the Icft to open PDF 1' un g D� 117] Cl1lS —� ���-�-- Click on Documcnl Type ai the left lu open I't)1- � - Form CT-TR-i 2021 CT-550 Fornl f IBC' _1,_.1ticoIllplete 2018 Form RRf-1 2019-An1INI I "")I -Ill CT-TR-1 2020 I prat RRf I 2020 wjLR Fit - L 2021 Renewal Fill 1L 2020 _� ~ it Status of Filing: ;accepted Accounting Period Begin Dale: Ut/201 n Accounting Period End Date: i2 1/2018 Filing Received Dale: 10,29/2o19 Form R11117-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason: IRS Form 991) Reject/Incomplete Reason: Hates From Registry Staff: Status of Filing: E-•Accepted Accounting Period Begin Date: 1/1/20[9 Accounling Period End Date: 12;:31/2019 Filing Received Date: 1 /2T2020 Form RRF-1 Reject/Incomplete Reason: Form C F-TR-1 Reject/Incomplete Reason; IFUR Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: 7,11/2019 Accounting Period End Date: 7/1/2020 Filing Received Date. 7/27,2020 Form RRF-I Reject/Incomplete Reason: Form CT-TR-1 Reject/[ncomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: 1/1/2020 Accounting Period End Date: 12/3 P2020 Filing Received Date: I I.M12021 Form RRF-I Reject/Incomplete Reason: Resubmission/Correction Accepted Form CT-TRA RejectAncomplete Reason: Resubmission/Correction Accepted IRS Form 990 Reject/[ncomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin hate: Accounting Period land Dale: Filing Received Date: Form RRF-1 Reject/incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Accepted 1 /1 /2021 12/ 3 1 /2021 5/27/2022 Res ubinission/Correction Accepted ReSUbmissiwL/CwTectlon Accepted No Related Records FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 14 DORLAND MOUNTAIN ARTS COLONY INC. CITY OF TEMECUI.A FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 I PROJECT/PROGRAM INFORMATION Amount Requested: $ MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Art for Temecula Start Date: 1/1/2023 End Date: 12/31/2023 Physical Address of Project/Program: Dorland Mountain Arts 36701 Highway 79 Temecula CA 92592 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable Dorland Mountain Arts to: Mailing Address: PO Box 6 Temecula CA 92593 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Dorland Mountain Arts Year Founded: 1979_ Website: m Social Media: Number of Paid Staff: 2 Number of Volunteers: 95 Geographic Area(s) the Organization Serves: Temecula valley Geographic Area(s) the Project/Program Serves: Temecula Valley NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Janice Cipriani- Willis Title/Position: Executive Director Contact Person's Direct Telephone: 951-302-3837 Contact Person's Email: info@dodorlandartscolony.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 1984 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 95-3786125 State Identification Number: PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this.link: http://ar)os.irs.clovlapo%osl 2. ❑ Attach State Entity Status Letter using this link: htt s:!/www.ftb.ca, ov/online/self serve entity status letter/index-as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: httta:Ilrct.doi.ca.govNerification/Web/Search.apx?facih'fy=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No x❑ Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. voflana s mission Is io provloe a unique, Inclusive WorKing retreat Tor visual artists, Writers, and musicians inspiring creativity in a secluded natural setting. Dorland serves the regional community with arts events, educational and healing workshops and projects for children and adults. In conjunction with The Nature Conservancy, Dorland is mandated to protect the ecology of the undeveloped portion of its 300 acres. As such, Dorland staff and volunteers maintain trails and a small lake on the property, and make every effort to identify and preserve indigenous flora and fauna, and remove non -indigenous species. On May 3, 2004, the Eagle Mountain fire destroyed every single one of Dorland's structures. Convening immediately after the fire, the Board of Directors, devoted past resident artists, and individual supporters moved forward to rebuild. A licensed arborist guided the project, delicately removing fire -damaged trees to preserve the remaining indigenous oaks and surrounding native plants. Importantly, the Board of Directors used this loss as an opportunity to begin more sustainable building and construction practices. Since 2014, Dorland has added four more cottages, a Community Arts Center, ADA compliance (including two ADA parking spaces) and a pavilion and deck for community events. The now -thriving Associate Artists Program benefits Dorland's local and regional artists by providing artists, writers, musicians and supporters of the arts with essential space to meet, discuss: create, plan and impiement activities that support Dorland FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. I City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No Z Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No Q Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. the Associate Artist Program serves our local area of Temecula Valley. The program is run soley by volunteers. 550 local members participate in the program by organizing public activities that support Dorland, the regional arts community, and each other Dorland.'s cultural events in the Temecula Valjey attract an. average of 1615 attendees/ year, promoting the arts in our region. In conjunction with the City of Temecula, Dorland supports local artists with exhibits at the Merc Gallery, the Temecula Valley Museum, an online gallery and other local venues. The recent addition of Dorland's Community Arts Studio building with its outdoor Pavilion further gives Dorland the opportunity to provide expanded public arts events, exhibits, and educational and healing workshops for community children, youth, and adults. Programs that directly serve Temecula Valley residents: ASSOCIATE ARTISTS PROGRAM: Coffee on the Deck - Discussions about art, sharing, demos and critiques. 2 x per month COMMUNITY ARTS CENTER. 6 Art Exhibits per year open for public viewing and receptions WORKSHOPS: Sunday Scribblers - Free. This is a writing workshop and critique focusing on poetry and prose every Sunday. It includes guest speakers. Table Manners Theater - Free. Open to the public to participate in reading original and new plays and screenplays 6x per year 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Funding will support the operation of the Community Art where Dorland runs its community programs. Grant support would enhance the amenities by funding the installation of a utility sink and new flooring. New Flooring Art in the Community Studio/Gallery -$1500 Utility Sink Art in Studio/Gallery -$500 Facilities/Rent/Insurance for Community Studio/Gallery - $1,839 Supplies - $430 Marketing - $289 TOTAL- $4558 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Dorland hosts many events open to Temecula residents in The Community Arts Center located on our beautiful mountain campus. This three room building, deck and pavilion area allows us a space to invite local residents to participate in programs, workshops and special projects. The main room of this building provides a gathering place for workshops, programs and meetings. In addition, there is a library room and studio used for programs and available for special projects. Tge deck and covered pavilion provide outdoor space for community meetings, workshops and programs. Dorland Mountain Arts strives to provide a safe and welcoming space for the community to come together, learn about new ideas and skills and meet other creative folks. By offering free and very low cost programs to Temecula residents we are providing an opportunity for creative exchange, learning and sharing. Having a quality space with varied amenities enhances the experience for Temecula residents and allows for more programs in the future. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 800-1000 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 1 10 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. Dorland Mountain Arts is committed to providing quality programs and experiences to the Temecula community. —Upgrading our program space will -help us continue to provide creative sharing and learning opportunities. The Community Art Center is vital to our mission and indispensable in offering a quality experience to the residents of Temecula Valley. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. I_ 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM- City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 4,558 Amount contributed to the Project/Program by the Applicant $ Organization 5,500 Other grants or funding already awarded for Project/Program, if any $ In -Kind match amount or volunteer credit hours estimated amount $ 7,704 TOTAL REVENUE $ 17,762 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/Insurance $ 1,839 Supplies $ 430 Marketing $ 289 Services $ 2,000 Food Other flooring and sink $ 2,000 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, - HOWEVER PLEASE INCLUDE. $ 3,500 TOTALEXPENSES $ TOTAL BUDGET J $ 17,762 1 $ 10,058 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, ail grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1 _ Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Name of Project/Program: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on Expenditure E Name of Company 2 Receipt/Invoice M on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose a3 JULY 1, 2021 - JUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE 1 $ 2 3 4 5 $ 6 $ EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said -amount-of-funds-to-the-City To -substantiate -that -grant -funds -from -the -City -are -spent -appropriately, proper -.pro documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Name of Project/Program: TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92692 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number)_ E Name of Company E on Receipt or Invoice Q Z 1 2 3 Date on Expenditure Receipt/Invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, Amount Description Purpose 2024 Q W R EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. ■ If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Dorland Main Arts MAILING ADDRESS: PO Box 6 Temecula CA 92593 PHONE:( 951 ) 302-3837 EMAIL: infoRDorlandArts.org PRESIDENT / AUTHORIZED OFFICER: 4 Nawsha Narrisnin _ SIGNATURE: r�U - r DATE: 9/10/2022 IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 !nternal Revenue Service District Director DORLAND 4OUNTAIN ARTS COLONY, INC. Da te: NOV 0 1 1984 Dorland N,cuntain Colony, Inc. 36701 Highway 79 Temecula, CA 92390 Dear Applicant: DepartrnehL Jr the TreasL,,, y Our Letter Dated: December 29, 1982 Person to Contact M. Tomback Contact Telephone Number. t 213 ) 688-488 5 This modifies our letter of the above date in which we stated that you would be treated as an organization which is not a private foundation until the expiration of your advance ruling period. 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 Internal Revenue Code, because you are an`organization of the type described in section Sn�(all1�* Your exempt status under section 501(c)(3) of the code is still in effect. Grantors and contributors may rely on this determination until the Internal Revenue Service publishes notice to the contrary. However, a grantor or a 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 that resulted in your loss of section 504!T1f�,L* _ status, or acquired knowledge that the Internal Revenue Service had given potice that you would be removed from classification as a section 509laR W organization. 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. Sincerely iotlrn. District Directar 'axed 170(b)(1)(A)(vi) P.O. Sox 2350, Los Angeles, Calif. 90053 Letter 1o50 (00) (7-771 STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/12/2022 ESL ID: 7857079728 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1104809 Entity Name: DORLAND MOUNTAIN ARTS COLONY INC 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d, ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States s�!i �• California Secretary of State Electronic Certified Copy I, SHIRLEY N. WEBER, Ph.D., Secretary of State of the State of California, hereby certify that the attached transcript of 2 pages is a full, true and correct copy of the original record in the custody of the California Secretary of State's office. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California on this day of January 15, 2022 SHIRLEY N. WEBER, Ph.D. Secretary of State Verification Number: P82RJ34 Entity (File) Number: C1104809 To verify the issuance of this Certificate, use the Verification Number above with the Secretary of State Electronic Verification Search available at bizfile. sos. ca. gov rn' California Secretary of State MINN Electronic Filing Secretary of State r State of California Corporation - Statement of Information Entity Name: DORLAND MOUNTAIN ARTS COLONY, INC. Entity (File) Number: File Date: Entity Type: Jurisdiction: Document ID: Detailed Filing Information 1. Entity Name: 2. Business Addresses: a. Street Address of Principal Office in California: b. Mailing Address: 3. Officers: a. Chief Executive Officer: C1104809 01 /13/2022 Corporation CALIFORNIA H110480 DORLAND MOUNTAIN ARTS COLONY, INC. 36701 Highway 79 South Temecula, California 92592 United States of America PO Box 6 Temecula, California 92593 United States of America Curtis Horton 1869 Pasadena Glen Rd Pasadena, California 91107 United States of America b. Secretary: Noreen Ring 1935 Vista Del Norte Fallbrook, California 92028 United States of America Use bizMe.sos.ca.gov for online filings, searches, business records, and resources. v M N 00 a (D oo E� LP Z C a) O N U � CY N >o 0 M N " � N M o U � E a N a� UD 0 00 IT 0 C N E rJ O W t�.r,n Ile r� California Secretary of State Electronic Filing Officers (Cont'd): C. Chief Financial Officer: 4. Agent for Service of Process: Natasha HdIIISUn 24 Almy St Newport, Rhode Island 02840 United States of America Curtis Horton 1869 Pasadena Glen Rd Pasadena, California 91107 United States of America By signing this document, I certify that the information is true and correct and that I am authorized by California law to sign. Electronic Signature: Janice Cipriani Use bizfile.sos.ca.gov for online filings, searches, business records, and resources. 0 0 Nr 0 2 C N E 7 U O r1W Form 990 OMn No, 1545-0047 Return of Organization Exempt From Income Tax 2020 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) DapfuImool of Iho Tnlin ry ► Do not enter social security numbers on this form as it may be made public. Open to Public Intmnat Revenue Service ► Go to wwwJrs. ov1Form990for instructions and the latest information. Inspection A For the 2020 calendar year, or tax year beginning .2020. and ending 20 B Check if applicable: C Employer identification number ,Address change DORLAND MOUNTAIN ARTS COLONY 95-3786125 Name change P.O. BOX 6 E Telephone number Inliiai�e ;rn TEMECULA, CA 92593-0006 - 951 : 302-3 337 Final returNtermir'aled bb Amended return, G Cross recmials Y Appheation pendiny F Name and address of principal off,cer: WO'Is�Mis a group return for subordinate Tax-exempt status: J Website: ► W K Form of organization: SAME AS C ABOVE 501(cy3) 501(c) ( )� (Insertno.) )ORLANDARTSCOLONY,ORG Corporation I I Trust I I Ass or: ialion Other H(b) Are all subordinates mcruded? If ' No, , attach a list_ Sea. insuuctions Grcup exemption number 142 830. Yet: No Y<F No I Year or formation: 1982 I M Slate of legal domicile: CA Part l I 5ummaill 1 Briefly describe the organization's mission or most significant actnrilies:THE MISSION OF DORLAND MOUNTAIN ARTS_ COL_ONY__IS TO PROVIAE A jQVETWORK_ING AN_D_PE_RFORMANCE_R_E_TR_EAT�FOSTERING --_'_---_ _ r A COMMUNITY CONNECTION TO_THE_CREATIVE PROCESS IN A SECLUDED_ _CR_E_ATI_V_ITY_, _All] _ _ __- 0 2 _NA_T_U_RA_L__SE_T_TING_._____-_-_--__________-_-_-_-__--__--_-_--_--____--_-__--_----_ Check this box ► f if the organization discontinued its operations or disposed of more than 25% of its net assets. — _ --- ta 3 Number of voting members of the governing body (Part VI, line la). ..... 3 7 °a N 4 Number of independent voting members of the governing body (Part VI, line lb) - - - q 5 Total number of individuals employed in calendar year 2020 (Part V. line 2a). -. 5 2 6 Total number of volunteers (estimate if necessary). - 3 a 7a Total unrelated business revenue from Part VIII, column (C), line 12 7a a. b Net unrelated business taxable income from Form 990-T, Part I, line 11 ..... 7b 0, Prior Year Current Year 8 Contributions and grants (Part VIII, line lh)......... .... 174 803. 57,364. 9 Program service revenue (Part VIII, line 2g) .. 79,267. 74,586. 10 Investment income (Part VIII, column (A), lines 3, 4, and M) 1,450. 642. cc 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9C. I0f:..an _dilie] 13,066. 10,238. 12 Total revenue -- add Imes 8 through 11 (must equal Part Vlll- co mn (A), line 12) 268, 586. 142, 830. 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3).. - - . 14 Benefits paid to or for members (Part IX, column (A), line 4) .... .. . w 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 21, 669, 25,993. 16a Professional fundraising fees (Part IX, column (A), line Ile) wb Total Fundraising expenses (Part IX, column i line 25) ► 1,662. 17 Other expenses (Part IX, column (A), lines IIa-lid, 11f-24e)-- .. ..- ... 18 Total expenses. Add lines 13-17 (must equal Part )X, column (A), line 25) 19 Revenue less expenses. Subtract line 18 from line 12 86 561. 105 170. 108 230. 131 163. 160 356. 11 667. 88 4" 0p 1LL 20 Total assets (Part X, line 16).- 21 Total liabilities (Part X, line 26) 22 Net assets or fund balances. Subtract line 21 from line 20 Beginning of Current Year End of Year 903, 212. 920 211. 11,158.1 16,490. 892,054.1 903 721. Part If Signature Bloc urvfw penalties of poqury, I drrefare that I have eaamufed the return, mcludufy all:4v"anying scheduies and sialemerC, and to Bee best of my knnwledge and belief, it is free, cerrect, and complete. Declaration of preparl (other than officer) is based on all Womil W whMil prepare, has any knuMedge. t� Sign - arrgrwreraa11.oreCer vase Here CURTIS HORTON PRESIDENT. Yt7u or print narne and hl e Printilype preparers came Nreparcr's signature Dale Checx Lj If PT•N Paid LESLIE A. DOHERTY CPA LESLIE A. DOHERTY CPA self-employed P00449291 Preparer Firm snarne ► LESLIE A DOHERTY CPA APC Use Only nm'saddress ► 41880 KALMIA ST STE 115 FinnsEIN► 20-2082661 MURRIETA, CA 92562 Phoncno. (951) 698-2260 May the IRS discuss this return with the preparer shown above? See instructions JXYes No I For Paperwork Reduction Act Notice, see the separate instructions. rF=ALlo1L o!nnra' Form 990 (2020) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 1!5 FINE ARTS THEATER NETWORK CPI`Y OF TEM.IOCULA. FISCAL. YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVEST'MENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEF"ORE:-MONDAY-, SEPT-EMBER 12, 2022--- PROJECT/PROGRAM INFORMATION ) Amount Requested: $ 50,000.00 _ MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Pump up the Volume Project/Program Title. _ Start Date: 12/1122 End Date: 5/31 /23 Physical Address of Project/Program: 42051 Main Street, Temecula CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Fine Arts Network Mailing Address: 41391 Kalmia St #200 Murrieta, CA 92562 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Fine Arts Network Theater Organization: _ Company Year Founded: 1994 Website: www.fantheater.com Number of Paid Staff: 3 (part time) Social Media: FB, Instagram Number of Volunteers: 100's annually Geographic Area(s) the Organization Serves: SW Riverside County, Temecula Valley Geographic Area(s) the Project/Program Serves: Old Town Temecula Community Theater NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name- Beverly Stephenson Title/Position: founder/director Contact Person's Direct Telephone:951-314-2401 Contact Person's Email: faerietalewriter@gmail, NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes E Date of Incorporation as a Nonprofit: 10/7/94 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0624570 State Identification Number: 1872912 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. N Attach IRS Deductibility Status using this link: httpJ/al)ps.irs.gov/apeleros/ 2. K Attach State Entity Status Letter using this link: https://www.ftb,ca.g-Q-v/online/self serve enfty status letter/index.as 3. N Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: littn�//rct.do'.ca. ❑v/VerificatiordWeb/`Search.as x?facilll =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No Q_Yes -❑_IF_YES,-BRIEFLY_ DESCRIBE: — Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No pj Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee ❑ Board of Directors M Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. To build the self-esteem of all individuals through broad based, hands-on exposure in the performing arts. To channel the creativity of young and old in a positive and artistic direction. To utilize the sucess and self-esteem attained through participation as a preventative measure against negative peer pressure and anti -social behaviors. To involve the community, from youths to seniors in the sharing of their talents both on stage and off as leaders and mentors. To provide instruction in all genres of performing arts and stagecraft. To produce and perform quality local productions for the benefit of the participants and the spectators. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION's CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes M IF YES, PROVIDE BELOW NAME OF PROGRAM/PROJECT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Theater LIVE after Covid $2500 October 2020 Community Servic $ $ $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ■ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW AMOUNT MONTH + YEAR NAME OF ENITY RECEIVED _ _ FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECTIPROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. When the Old Town Theater _opened, The —Theater _Foundation -provided 36 wireless mic units. We, (Theater -foundation, Fine Arts Network, TVP) the resident companies have refurbished these mics multiple times over the past 17 years. We, now, only have 10 working units. We, Fine Arts Network, proposes to purchase an additional 24 units so we once again have enough mics to stage full musicals, concerts and plays. The program specifically is to keep the OTTCT at the cutting edge of performance venues by providing a quality visual and sound experience. The program would free us from the burden of renting mics from amide-aaencies.-at_a_heftv price while maintainina a auality sound experience. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The grant will provide for the purchase of 24 body mic kits which includes the elements, battery pack, transmitter and case to house all 24 units. (see attached) 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS, The Old Town Temecula Community Theater (OTTCT) has been praised as a "jewel box" of a theater. From its inception we have provided great sound. That element is in danger of disappearing due to the 17 year old and nearly obsolete equipment we have refurbished on several occasions. Local residents comprise over 50% of our audience. Temecula residents are proud to boast of the fine theater we have. If the sound quality is poor, the entire experience of live theater is undermined and becomes a negative experience for all. When first conceived, great attention was paid to the acoustics of the theater. After all the time and money spent on building and creating a fine reputation, we desire to maintain the 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 1 O,000+ annua FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: I200+ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CON71NUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. -Pump up the Volume will maintain quality sound and quality theatrical experience at the OTTCT by purchasing new state of the art equipment. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. The pandemic stripped us of our reserves and any ability we might have had to purchase this equipment directly. At the most recent board meeting we were earmarking funds to purchase new mic units over the next 3 years. We hoped to purchase 5-10 units (based on costs) immediately. Based on the estimate we just received, we would be hard pressed to afford 5 units currently ourselves. It would then take us 5 years in order to build to a full rack of 24 mics, hoping that we would not lose all of the older 10 units before we could replace them. The pandemic has created a situation, where we feel we are at ground zero, starting all over again building audiences, networking with performers and training our young theatrical enthusiasts. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The above mentioned funds will complement and ultimately replace seriously dated equipment that verges on being obsolete. It will allow new and existing programs/productions to maintain the high caliber of sound come to be expected of performances at OTTCT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from -this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 17,000 I Organization Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 67,000 LIST OF EXPENSES FOR PROJECT/PROGRAM 24 body mics with elements, casing, Tools/Equipment transmitters etc. see attached $ 67,000 Facilities/Rent/Insurance $ Supplies $ Marketing $ Services $ Food $ Other $ Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $ TOTAL BUDGET $67,000 $67,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, —all=grant=funds=must=be=substantiated-Mth-proper-back=up=dseumentation: Failure-to=provid"roper=docum-e-ntatl6n may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 1. Provide the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted 4,000 locals from this program (approximate number of beneficiaries if you don't have a precise number): annually 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Fine Arts Network Theater Co. Amount of Grant Fund Awarded: $ 2500.00 Theater LIVE Name of Project/Program: after Covid Month + Year Grant Received from City: DEC 2020 Date (Mo/Day/Yr) Describe... Explain ... Name of Company on Receipt/invoice Amount (1) what the expenditure was how the expenditure E - on Receipt/Invoice of (2) purpose of the expenditure specifically benefitted E Must be dated on or between July 1, 2020 - Expenditure MUST support Project/Prcgram description on Application + Award Letter Temecula residents Q z June 30, 2021 1 It benefitted residents Collection Made By City: /1/2020 - 9/30/2020 $ 300.00 1. Social Media by keeping them 10/1/2020-12/31/20 0 S �00.90 2. To keep FAN alive and formed of social informed opportunities that were Brittany relevant during closure. To safe and available. It _ Campbell promote Go Fund Me and provided and outlet for fundraising efforts during safe gathering and 1/1/2021- 3/31/2021 UU $ 300. closure on Social Media provided hope andcomfort through artistic 4/1/2024 - 6/30/2021 $ 300.0o presentations 2 Got Print.com January 13, 2021 1. Season program $2,427.94 2. To provide advertising and promotion materials EXPENDITURE TOTAL 3627.94 Note: Expenditure Total must be equal to (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City. City of Temecula Community Service Funding Grant In anticipation of opening we prepared a advertising style magazine piece to provide information about the City, the Theater and upcoming shows and what to FY 2021/2022 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with RLo er back -Up documentation. Failure to provide proper documentation may jeopardize any future funding. City oiTem'ecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office— CSF JEXPENDITURE REPORT due on or before September 12, 2022 Fine Arts Network Theater Pump up the Volume Organization: Name of Project/Program: Omvanv 91 FY 2021-2022 Amount of $ CSF Grant Fund Awarded: '�' Month & Year CSF Grant Received from City: October 2020 I Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on E Name of Company Receipt/invoice E on Receipt or Invoice MUST BE ON OR BETWEEN QZ JULY 1, 2021 - JUNE 30, 2022 2 3 4 5 6 —.I-- I EXPENDITURE TOTAL _ Expenditure Amount Description Purpose DESCRIBE THE EXPENDITURE I PURPOSE OF EXPENDITURE EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in - - accordance with the approved/awarded applicaticn, thee organization may not -receive and/or will -be -required -to -return -said amount -of -funds -to -the -City. To- substantiate--that-grant-funds from-the-City--are-spent--appropriately, proper -back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1,A above first, B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Fine Arts Network Theater Name of Project/Program: Pump up the Volume Company p TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: _ _ was received from City: . 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) E Name of Company Eon Receipt or Invoice 4Z Date on Receipt/Invoice MUST BE ON OR BETWEEN March 20. 2020 - JUNE 30, 2024 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount Description Purpose I 3 EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations an__d activities that__directly_benefit the reWents_of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. 7 Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. C The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Fine Arts Network Theater Company MAILING ADDRESS: 41391 Kalmia St.#200 Murrieta, CA 92562 PRESIDENT/ AUTHORIZED OFFICER: Joe Arreola PHONE: (951 )314-2401 EMAIL: fantheaterco@gmail.com President SIGNATURE: LJrG _ _ DATE: "/9/22 MONIT'H, DAY. YEAR IFDIFFERENT THAN AB ",Beverly Stephenson founder/director APPICATION PREPARED BY: I T ; . "'. SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions. Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA,gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA �jj FRANCHISE TAX BOARD FTB PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/12/2022 ESL ID: 5629859781 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1872912 Entity Name: FINE ARTS NETWORK 0 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) Q HELPB MENU Home > Tax Exempt Organization Search > Fine Arts Network < Back to Search Results Fine -Arts- Network EIN: 33-0624570 1 Murrieta, CA, United States Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2019 Form 990 Tax Year 2018 Form 990 Tax Year 2017 Form 990 Tax Year 2016 Form 990EZ Tax Year 2015 Form 990EZ INTERNAL REVENUE SERVICE DISTRICT DIRECTOR 2 CUPANIA CIRCLE MONTEREY PARK, CA 91755-7406 Date: OCT FINE ARTS NETWORK C/O-VIRGINIA K. COSTILQYT 28410 FRONT STREET, SUITE 104 TEMECULA, CA 92590 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 33-0624570 Case Number: 954230016 Contact Person: TERRY IZUMI Contact Telephone Number: (714) 826-1448 Accounting Period Ending: December 31 Foundation Status Classification: 509 (a) (2) Advance Ruling Period Begins: July 27, 1994 Advance Ruling Period Ends: Dec. 31, 1998 Addendum Applies: No 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 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 expect to be a publicly supported organization described in section 509(a)(2). Accordingly, during an advance ruling period you will be treated as a publicly supported organization, and not 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- ments of the applicable support test during the advance ruling period. If you establish that you have been a publicly supported organization, we will classi- fy you as a section 509(a)(1) or $09(a)(2) argani.zation 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, we 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 a final determination of your foundation status. If we publish a notice in the Internal Revenue Bulletin stating that we Letter 1045 (DO/CG) 2020�- O.Insa6 Public - - 2020, and ending Y0 D Emp ►.3d,st, rlau - h TS it ir4E—. lcyrr flltnl' isaSan nCM -1r =INS AnMr�t�. 33jC624570 25125 MADISON A1,1E. STE A MURRIETA, CA-925 5 2_ 951-314-2401 T SAME AS C ABOVE i1':� :'may ell{f}^ J --I website, - HTTP : //;4Wd , FANTHEATER . CCN / I Yff rla 1 h1 rA 1 l3tretty e- F-tre Ih orGani2atiCn's rr..s;; ^ :r mcs; g;yrlt'I[3nt a,:trvll;es TO m ,BRN�CALY : ATR-d_C_AL QTETMELA-VA1fY,PC6CTOS k!i_3> 7,7 d",ty:� 3 P4-, tCer at vc' s� r, er�.t,._rs ;1 , t.!5��5e �# —I'S ,h �- k7tb 4 h.-'•C '( ��te�,`r�c`1 [-�....... . r 3� ;eat ';'`.?;'. ,F. `�' ,rag 2a).7a Iv l� .r/.9?at..,•'b`et }le a •r -s :afar;; -e o m B �.::.ft;t•t,_, r� 3r:� �r_3.:,;i'ar+ . (?x <. S~ Q 11 .fl Oar, •:� v.,, ,�� ��fl I 1�. I I. :b��( .N' - ,4 1 12 Tota1 re,ier e - add i.res 8 rh ; _irr. ;' if Est equal R t; rf C,hnrs ;,fir ;�; e Ir 13 GranSr` Il3r s a td , Y �r'',(i l.f 1#.S �3i^. 4-•�•. ,Y :CItn't r? 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'r �rw' ; xL'Y^7 �hR�71. 'S J'u 1t 'a�:s a^9 _ :Yr ^, _ j •,� I •• . d t re�',n [t rr cr7 wt5 :Itds U, 3,0 Sign — Here 5TEPHANIE BEALS '; N ur: •Slr vW pre — TF' ASL'Rc #[. _i rtCr 1 t Paid LESLIE A. DCHERTY, CPA, LESLIE A. Do Paid ' ,r.-�;.j9,, EPOC�14492Q,j Preparer Firm's:a:nt w LESLIE A DJHERTY &COMPANY. PC Use Only F wi'ii 41880 KAI.KA ST STE 170 - 2 .-F082551 Mi7RRIETA. CA 92562 698-2260 4y the tFtS 3iszuzs this rtft,rr ro�th tt:e preparer st-own .FCve? Sae ir.dlruf•t00r.s No 3AA For Paperwork Reduction Act Notice, see tha separate Instructions. ~ ,._ Prior Year Current Year -' �746. 22,159. i5$,552. g 13p 4. - -.i19� 011. �.. _ 2G1 li5.I 114r612. 2M 115.1 114 612. -30. 947.:. 4, 689. Bagtnning of Current Year End of Year 1E,212. 36,D.J r 38,3QL. Star Way Systems Corporation Quote P. 0. Box 1357 Murrieta, CA 92564 9/8/2022 Phone # 951-678-5680 • ' " ' &0) ' Fax # 951-678-8052 19592 Fine Arts Network Beverly Stephenson 41391 Kalmia St Ste 200 Murrieta, CA 92562 Omnidirectional Condenser Miniature-Lavalier Mic-Black Shure WL93 30 95.00 80.00 2,400.00 Quad Digital Wireless Receiver with internal power Shure 6 9,034. 5,646.2 33,877.50 supply, 1 /2 Wave Antenna and Rack Mounting hardware ULXD4Q=-G50 Digital Wireless Bodypack Transmitter with Miniature 4-pin Shure ULXD1=-G5 1 24 794. 496.25 11,910.00 Connector Five -way active antenna and power distribution system. Shure UA845UWB 2 1,474. 921.25 1,842.50 Switchable frequency ranges: 147-216 MHz, 470-960 MHz, 1240-1260 MHz, 1492-1525 MHz, 1785-1805 MHz Passive Directional Antenna (470-952 MHz) Shure PA805SWB 2 373.0 261.25 522.50 includes 10' BNC/BNC Cable Rechargeable Battery Shure SB900B 48 126.00 100.0c 4,800.00 Rack Battery Charger Shure SBRC-US 4 835.00 621.25 2,485.00 Black Label 16-space Amp Rack with Wheels Odyssey 2 799.95 592.19 1,184.38 FZAR16WBL Utility Rack Drawer 3RU 5.25in Middle Atlantic 4 242.00 153.12- 612.50 UD3 3RU Snake Cable 12-channel XLR male to XLR female, 19 Sescom 2 189.4S 173.69 347.38 12XLM-12XLF-10 Labor - Rack Build 1,500.0 1,500.00 Estimated shipping 600.00 600.00 OPTIONAL UPGRADE: (30) Omnidirectional Earset Headworn Microphone, cocoa - Shure MX153C/0-TQG $226.25 each x 30 = $6,787.50 plus tax, if applicable NOTE: Prices are valid for 15 days from date of quote. Deposit of 50% is required to bind this quote. Once order is placed (ie. deposit is received), estimated delivery is 6 months due to supply chain issues. Sales Tax 8.75% 5,248.40 Total $67,330.16 To accept this quote, please sign, date and return: Prepared by CS Full Compass Systems, Ltd 9770 Silicon Prairie Parkway MADISON, WI 53593 608-831-7330 Fax:608-831-6330 Bill to: Fine Arts Network 41391 Kalmia St Ste 200 MURRIETA HOT Si'RINGS, CA 92562 Ship to: Fine Arts Network 41391 Kalmia St Ste 200 MURRIETA HOT SPRINGS, CA 92562 Quotation Confirmation # Page Date Sales order Purchase order # Ordered by _Salesperson Payment Customer account FOB Expiration date a SOC4836238-3 1of2 9/12/2022 SOC4836238 Dave Cradler Credit Card CUC2601395 FOBO 10/27/2022 Qty Extended Mfg Item number Description ordered Unit Ship via Unit jerice price Fin SHU MX153T/0-TQG Mic, Headworn Omni Cond. Tan 30 EA Bestway $224.12 $6723.60 https://www.fullcompass.com/prod/205081 SHU ULXD4Q-G50 Quad Digital Receiver 6 EA Bestway $5088.45 $30530.70 https://www.fullcompass.com/prod/215817 SHU ULXD1-G50 Transmitter, Bodypack 24 EA Bestway $491.58 $11797.92 https://www.fullcompass.com/prod/205101 SHU UA845UW-B Antenna/PowerDistSy 2 EA Bestway $917.28 $1834.56 https://www.fullcompass.com/prod/518501 SHU PA805SWB Antenna Wide Band 2 EA Bestway $272.42 $544.84 https-://www.fullcompass.com/prod/125440 SHU SB900B Lithium -Ion Rechargeable Battery 48 EA Bestway $101.92 $4892.16 https://www.fullcompass.com/prod/602392 SHU SBRCUS Axient Digital Rackmount 8-Bay 4 EA Bestway $613.72 $2454.88 Charging Station https://www.fullCOMpa5S.com/prod/530000 ODY FZAR16WBL Case,16sp w/Wheels,BlackLabel 2 EA Bestway $533.49 $1066.98 https-//www.fullcompass.com/prod/230379 MID UD3 3 Space Rack Drawer 4 EA Bestway $142.56 $570.24 https://www.fullcompass.com/prod/020422 PRO MT12XFXM-10 Snake 12chl XLRF-XLRM loft 2 EA Bestway $114.66 $229.32 Sales subtotal amount: $60645.20 Promotional discount: $0.00 Shipping & handling: $375.24 Net amount: $61020.44 Sales tax: $5306.46 Total: $66326.90 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 16 FIRST TEE INLAND EMPIRE AKA BRIGHTON HILL ACADEMY SPORTS AND LEARNING CENTER CITY OF TEMECUTA FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 I PROJECT/PROGRAM INFORMATION I Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: First Tee IE Life Skills Experience ClassesStart Date: 9/1/2022 End Date: Ongoing Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: First Tee — Inland Empire Mailing Address: 215 N. D Street, Suite 304 San Bernardino, CA 92401 I ORGANIZATION AND GEOGRAPHIC AREA SERVED I Name of Applicant Brighton Hill Academy SLC dba First Tee — Inland Empire Organization: Year Founded: g014 I Irs esln aTr�rre Website: %vww.firstteeiniandempir_e_,org Social Media: FB—firsttee-inlande►r+pire Number of Paid Staff: 4 Number of Volunteers: 35 Geographic Area(s) the Organization Serves: Raypyside and San Be[Dard no county Geographic Area(s) the Proiect/Program Serves Temecula Valley NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Pamela Tyler Title/Position: Executive Director Contact Person's Direct Telephone: 909,297.6262 _ Contact Person's Email: pamelatyler@thefirstteeinlandempire.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 2014 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 46-4933764 State Identification Number: 3671608 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: http-://aPI)s.irs.gov/app/eos/ 2. ® Attach State Entity Status Letter using this link: https://www.ftb.ca.gov/online/self serve entity status letter/index.as 3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: httr):/Iret.doi.ca..govNerification/Web/Search.asnx?faciiity=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 C APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee [N Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. To impact the lives of young people by providing educational programs that build character, instill live -enhancing values and promote healthy choices through the game of golf. Create a safe introduction to golf for Temecula Youth via three delivery channels: Green golf courses, Community Programs partnering with other Youth Organizations, and School Programs introducing the program via PE Classes in the Temecula Unified School District teaching youth CORE Values, life skills, and how to succeed in their communities. Participants ages 5-18 progress through the program, deepening their understanding of life skills and golf development. The integrated approach helps youth build confidence and resilience while on the course, at home and in school. The goal is to Build Game Changers who are committed to: Pursuing Goals, Growing through Challenge, Collaborating with others, Building Positive Self -Identity and Using Good Judgment. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ® IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP I First Tee Inland Empire Jr Golf Program $ 2000 -May 2021 CMO-MR First Tee Inland Empire Jr Golf Program $ 1000 May 2021 CMO-J Stewart First Tee Inland Empire Jr Golf Program $ 1000 May 2021 CMO- ME First Tee Inland Empire Jr Golf Program $ 2500 July 2021 CMO- Schwank $ $ $ I I OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ❑ Yes DKI IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT RECEIVED NAME OF ENITY J Michael or J Kathleen Smith (Quarterly) Tom Pernice, Jr. Charities, Inc. 20,000.00 MONTH + YEAR FUNDING RECEIVED $ $ 75,000 $ 20,000 $ 10,000 $ 99,910 67, 848 $ 5,826 $ 25,000 2020 12-2020 2020 Toyota -Corporate Corporate Contributions Government Grants Business Contributions Charles Schwab Matching Funds Grant 2021 2021 2021 2022 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. 1 First Tee — Inland Empire (FTIE) is a youth character development educational program teaching youth NINE CORE Values and NINE Healthy habits while learning to play golf. Youth learn life skills on how to better -communicate -with -family, —in school--and-how-to succeed -in tlTeir-future endeavors: -Supporting children ages 5-18 in the City of Temecula in the First Tee IE Junior Golf Program. The goal is to reach youth through After -School Program opportunities on local Golf Courses, School PE Programs and Community Programs through the City of Temecula Parks. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The grant funding will be utilized to expand FTIE programs in City of Temecula. This funding will allow FTIE to purchase curriculum, supplies for programs, hats, shirts, and other items needed to run the programs. It will help offset insurance, service costs and snacks. Additional Coaches will be needed which require Background Checks, training, and additional Program Expenses. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. FTIE exists to enable kids to build strength of character that empowers them through a lifetime of new challenges. Temecula's youth in our programs are: more confident in school, and active community members. A progressive curriculum that focuses on social and emotional learning objectives through activities that are developmentally appropriate, designed to meet kids where they are. FTIE is building Game Changers who can change and enrich a community. The outcome of being in First Tee programs are good citizens, better people, more confident youth with a higher self-esteem that helps heal their generation and community. This helps reduce juvenile delinquency, gang affiliation, and crime for the community. Stats show 98% graduate High School and 84% go onto College. FTIE is focused on diversity, equity and inclusion of all youth no matter their ethnicity or socioeconomic status. It provides an equal playing field for under -served kids who normally would not be able to afford playing golf. Scholarships are offered. No child is turned away. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 650 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM 35 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. By seamlessly integrating the game of golf with a life skills curriculum, FTIE creates learning --experiences that -build -inner strength, self=confidence,and resilience that -kids -carry to- — everything they do. FTIE offers after school programs at Golf Courses, Parks and Schools for eight weeks, four times a year and summer camps. We could not expand our program access to these youth programs without generous contributions from the City of Temecula! 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. FTIE lost 60% of committed funds during Covid-19 Pandemic. This resulted in reduced staff and reduced programming to the community. Increased costs during this inflationary period has driven up the cost for employees, program supplies, vendor and transportation costs, higher golf course fees, all materials affecting each area of the operation have increased. In an effort to help First Tee Chapters rebound from Covid and inflationary concerns, Charles Schwab is offering Matching Grant funds if the Chapter receives 50% more donations than the year before, FTIE will receive $32,500 in 2023. IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM- If approved, funds will expand and continue existing programming in more Temecula Parks, Schools, Golf Courses, Charter Schools and other Youth Organizations . OBJECTIVES: • Growing Participant base by 50%, increasing Girls participation by 15%, and BIPOC by 25% • Growing Coach base by 50% to reach 650 more participants while increasing diversity of staff/coach/volunteers to six more under -served, underrepresented program locations • Increasing after -school programming locations by 35% to help students reach their full potential as productive, caring, and responsible citizens City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES i EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula ' $ 50,000 � Community Services Grant -(Not to exceed-$50;000) � — Amount contributed to the Project/Program by the Applicant $ 105,000 I Organization Other grants or funding already awarded for Project/Program, if any $ 35,000 in-Kinci maTrn Amount nr vniiintppr rrpriit hmirc pctimntpri mmniint TOTAL REVENUE 1 $ 215,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services I _ _ Food Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET j $ 215,000 $ 2000 $ 2000 $ 1500 $ 10,000 1,500 $ 33,000 $ 165,000 $ I $ 215,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS` FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding.- City of -Temecula -reserves -the -right to conduct - an- audit -and/or-require -add itional-back=up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022, 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Name of Project/Program: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): EName of Company Eon Receipt or Invoice 4Z' 2 3 4 5 6 Date on Receipt/Invoice MUST BE ON OR BETWEEN JULY 1, 2021 - JUNE 30, 2022 EXPENDITURE TOTAL Amount Expenditure Description DESCRIBE THE EXPENDITURE EAh-LNUI I UKt I U I AL IVIUJ I bt tUUAL I U (OR GREATER) THAN TOTAL AWARD AMOUNT Purpose PURPOSE OF EXPENDITURE City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount ) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: I TOTAL FY 2022-2023 Amount of Grant Fund Awarded: $ Name of Project/Program: Month & Year FIRST $5,000 check was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) V Date on Expenditure 0 Name of Company Receipt/Invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER u E on Receipt or Invoice' MUST BE ON OR BETWEEN Z _ March 20, 2020 - JUNE 30, Amount Description Purpose E-1 EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please -allow -time -for -checks -to -be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Brighton Hill Academy SLC dba First Tee —Inland Empire MAILING ADDRESS: 215 N. D Sreet San Bernardino, CA 92401 PRESIDENT / AUTHORIZED OFFICER: Pamela Tyler aRINJ Nnrnr SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PHONE: (909 ) 297-6262 EMAIL: pamelatyler@thefirstteeiniandempire.org Co -Founder, Executive Director DATE: 8-18-2022 rA0N 1 1. —AV (-AP TrFi-F_ SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: 1 A N 28 2015 BRIGHTON HILL ACADEMY SPORTS AND LEARNING CENTER C/O MELODY FISCHETTI 3560 RAWLEY 5T CORONA, CA- 92882 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 46-4933764 DLN: 17053301366004 Contact Person: FAITH E CUMMINS ID# 31534 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170(b)(1)(A)(vi) Ford"990-Requ1red:J�"-�" Yes Effective Date of Exemption: April 30, 2014 Contribution Deductibility: Yes Addendum Applies: No 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. For important information about your responsibilities as a tax-exempt organization, go to wow.irs.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Sincerely, Director, Exempt Organizations Letter 947 STATE OF CALIFORNIA FRANCHISE TAX BOARD FTB PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/25/2022 ESL ID: 8861241572 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 3671608 Entity Name: BRIGHTON HILL ACADEMY SPORTS AND LEARNING CENTER ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) 990 -Return-oUOrganization-Exempt From -Income Tax OM13,NQ._1545.0047— .,- Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 2021 =.r—mot of the Treasury No Do not enter social security numbers on this form as it may be made public, a AFV_a� P.-venue Service ► Go to www.irs.gov/Form990 for instructions and the latest information. x. =or the 2021 calendar year, or tax year beginning , 2021, and ending, 20 e it applicable: o Name of organization BRIGHTON HILL ACADEMY, SPORTS AND LEARNING CENTER D Employer identification number .-esschange DW22 business as THE FIRST TEE OF INLAND EMPIRE 46-4933764 .A.,re change Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Telephone number s alraturn 215 NORTH D STREET 309 909) 297-62G2 =: ar rewrWtorminated City or town, state or province, country, and ZIP or foreign postal code k. b-,dadr©Sum SAN BERNARDINO, CA 92401 1 G Gross receipts $ _335r 669. _ AM. Mllon par4rig F Name and address of principal officer: H(a) Is this a group return for subordinates? [3 Yes © No JT VISBAL 215 NORTH D STREET ST. 304 SAN BERNARDINO CA 92401 H(b) Are all subordinates Included? ❑ Yes ❑ No --. exempt status: X❑ 501(c)(3) [] 501(e) ( ) -4 (Inien no.) ❑ 4947(a)(1) or ❑ 527 If "No," attach a list. See instructions. H(c] Group exemption number ► ► www. firstteein1andem ire. o rig A. of otganizalion: ©corporation ❑ Trust ❑ Association ❑ Other ► L Year of formation: 2 014 1 M State of legal domicile: CA Surnmaq , 1 - Briefly describe the organization's mission or most significant activities: EMPOWER YOUTH WITH TUTORIAL, ED_U_CATI.ONAL_ S SPORTS PROGRAMS WHICH INSTILL PERSONAL G QWT.l�1__PROVIDE LIFE PRINCIPLES - - - ---------------------------------------- _ ,a 2 C 3 4 AND STFZENGHTHEN CHARACTER VIA THE FIRST TEE LIFE SKILLS Check this box ► ❑ if the organization discontinued its operations or disposed of Number of voting members of the governing body (Part VI, line 1 a) . Number of independent voting members of the governing body (Part VI, line 1 b) . _w w_ _ __---------------------------- more than 25% of Its net assets. 3 . . . 4 - 15 15 5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) 5 9 ' 6 Total number of volunteers (estimate if necessary) , . . . . . . , , . . . . . 6 25 7a Total unrelated business revenue from Part VIII column C line 12 b Net unrelated business taxable income from Form 990-T, Part I, line 11 7b 0. Prior Year Current Your _ Contributions and grants (Part VIII, line 1h) , . . . . . , . . . . . 116 665. 286 355. = G Program service revenue (Part VIII, line 2g) . . , . . , , , - • 30 810. 49 314. Investment income (Part VIII, column (A), lines 3, 4, and 7d) . . . . . . 3 • U, - 1 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11 e) . ':2 Total revenue —add lines 8 through 11 must equal Part VIII, column , Iine 12 14' 4 7 8 . 335,669. 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) , , . , , 14 Benefits paid to or for members (Part IX, column (A), line 4) . . . , . . :5 Salarles, other compensation, employee benefits (Part IX, column (A), lines 5-10) 202 810 . 134 798. 299. '6a Professional fundraising fees (Part IX, column (A), line 11e) . . . , . , r b Total fundraising expenses (Part IX, column (D), line 25) ► __25 _691. 105 414. 131, 128. Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) . , . . . 'o Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 308 224 . 266 225, 19 Revenue less expenses, Subtract line 18 from line 12 -160 7 4 6. 69 4 4 4 . " = Beginning of Current Year Fnd of Year -_ 1 20 1_ 21 ' 22 Total assets (Part X, line 16) • , , , , , , , , , , , , , , , Total liabilities (Part X, line 26) , . . . . , . . , . . . . Net assets or fund balances. Subtract line 21 from line 20 63,022. 67 105. 225 391. 201 092 - -162 369. -133. 987. Signature Block =anaties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. 09 2022 Signature of officer Date �rl c'ere JT VISSA& CHAIRMAN EMERITUS Type or print name and title FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 17 FRED FINCH YOUTH CENTER CARES INC. CITY OF TEMECUI[A FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION I Amount Requested: $ 3,960.00 MAXIMUM ALLOWABLE Temecula BEST Program Project/Program Title: Equipment and Materials Start Date: Physical Address of Project/Program $50,000 PER ORGANIZATION End Date: 27555 Ynez Road, Suite 406 Temecula, CA 92591 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Fred Finch CARES, Inc. Mailing Address: 8787 Complex Drive, Suite 300 San Diego, CA 92123 I ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Fred Finch CARES, Inc. Organization: Website: fredfinch.rg/cares Number of Paid Staff: 132 Year Founded: 2017 Number of Volunteers: 5 Geographic Area(s) the Organization Serves: southern California Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Clay Myers -Bowman Title/Position: Development Officer Contact Person's Direct Telephone: (619) 972-1985 Contact Person's Email: claymyersbowman@fre NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes 0 Date of Incorporation as a Nonprofit: No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 81-4243450 State Identification Number: _3956277 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: htt ://a s.irs. ov/a /eos/ 2. ❑ Attach State Entity Status Letter using this link: httos:/Iwww.ftb.ca.gov/online/self serve entity status letter/index.aslo 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.doo.ca.g2v/Veri[ic3tiDn/Web/Search.asQx?facility,=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No U Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No A Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee [] Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The purpose of Fred Finch CARES is to set the standard for thorough developmental assessment and supportive services to children and families impacted by developmental disabilities, mental health concerns, and significant trauma and loss, in San Diego County and across Southern California. Our staff is diverse, compassionate, committed, and innovative. All our services respond to the needs of our local communities. At Fred Finch CARES, we are committed to having a workforce that is reflective of diversity as well as representative of the cultural and linguistic needs of those we serve. Children are empowered to foster self-reliance and independence, build, and improve healthy relationships, teach self-awareness, and increase their coping skills and self-esteem. Caregivers learn the skills to manage difficult situations, assess, and meet their child's needs. By providing an array of individualized, trauma -informed, and culturally responsive interventions that build upon each participant's strengths, we ensure strong positive outcomes. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA-SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No N Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT gMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO ■ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT Fred Finch CARES has developed the Behavior Education and Skills Training (BEST--)-program-in-order-to-bridge-the-behavioral-health- workforce -gap -while meeting the growing need for behavioral health workforce in communities of high need, including Temecula where we currently operate several social service and 'behavioral health programs for children, youth and families. Fred Finch CARES seeks support to implement a Bilingual BEST program to help build a behavioral health workforce in Temecula. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The BEST program will provide 10 participants with a paid training experience that will enhance their knowledge and skills in serving children, youth, and families with developmental disabilities; learn the basics of Applied Behavior Analysis, and medical and mental health terminology, while preparing them for job opportunities within our organization. Each successful graduate of the program who transitions into an entry-level position will be equipped to serve up to 10 bilingual (Spanish/English) and/or monolingual Spanish speaking children, youth, or families. This arantfu.nd n.c wFll Su = material.-andeaaicment_Gosts for _the tra.in.ino. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. The BEST program was developed out of the need for Registered Behavioral Technicians to work with children, youth and their families impacted by developmental disabilities. We are seeking to train qualified bilingual providers in the Temecula area who can deliver high quality services across a variety of sectors. By providing participants the training and skills that can be utilized across different treatment settings, we can ensure that the same quality of service is implemented to meet the growing needs of the community. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 11 0 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 0 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 C PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. In response to a dire need for cultural and linguistic diversity in -mental health care, Fred Finch CARES seeks funding to support a bilingual Behavior Education and Skills Training program in order to meet the growing need for behavioral health workers in Temecula. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 3,960.00 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ Organization Other grants or funding already awarded for Project/Program, if any $ In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food (requested funding) Other Participant Stipends; Contractors Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET $ I? $2396.00 $3960.00 $5000.00 $6526.39 $17,882.39 $17,882.39 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS` FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 I (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Fred Finch CARES, Inc. Name of Project/Program: Temecula BEST Program Equipment and Materials FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): EName of Company E on Receipt or Invoice <Z 1 2 3 4 5 6 Date on ReceiptlInvoice MUST BE ON OR BETWEEN JULY 1, 2021 - JUNE 30, 2022 Expend itu re -- Amount Description Purpose DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amuuld ur runds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $1OK). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Fred Finch CARES, Inc. Name of Project/Program: Temecula BEST Program Equipment and Matertats TOTAL FY 2022-2023 Month & Year FIRST $6,000 check Amount of Grant Fund Awarded: $ was received from City: _ I. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes__ or No (already submitted). 2. My organization has already received $ of the total FY 2022.23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92692 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) -Z-- --I- - Date on tm Name of Company Receiptllnvoice u E on Receipt or Invoice MUST BE ON OR BETWEEN A 2 March 20, 2020 - JUNE 30, a z 2024 2 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount I Description I EXPENDITURE TOTAL $ EXPENDITURE TOTAL Purpose City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. —Funding-is-not immediately available_ to -the -recipient, and requires an -award letter signature upon -approval. -- Please allow time for checks to be processed. The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Fred Finch CARES, Inc. 8787 Complex Drive, Suite 300 MAILING ADDRESS: _ PHONE: ( ) San Diego, CA 92123 EMAIL: PRESIDENT/ AUTHORIZED OFFICER: Julie Henderson, Director of Development SIGNATURE: DATE: 09/12/22 IF DIFFERENT THAN ABOVE, Alexander Grant Writer APPICATION PREPARED BY: SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 I��DCparhueut el'[he Trresury 1 IntFrnni Revrnue Srnlre P.O. Box 2508 In reply refer to: 0248364843 Cincinnati OH 65201 Dec. 05, 2017 LTR 4168C 0 B1-4243450 090000 00 00005054 BODC: TE FRED FINCH YOUTH CENTER CARTS INC TOM AL.EXANDER 3800 COOLIDGE AVE }` OAKLAND CA 94602 011299 Employer ID Number: 81-4243450 Form 990 required: Yes Dear Taxpayer: This is in response to your request dated Nov. 24, 2017, regarding Your tax-exempt status. We issued you a determination letter in August 2017, recognizing you as tax-exempt under Internal Revenue Code CIRC) Section 501(c) (3). Our records also indicate you're not a private foundation as defined under IRC Section 509(a) because you're described in IRC Sections 509(a)(1) and 170(b)(1)(A)(vi). Donors can deduct contributions they make to you as provided in IRC Section 170. You're also qualified to receive tax deductible bequests, legacies, devises, transfers, or gifts under IRC Sections 2055, 2106, and 2522. In the heading of this letter, we indicated whether you must file an annual information return. If a return is required, you must file Form 990, 990-EZ, 990-N, or 990-PF by the 15th day of the fifth month after the end of your annual accounting period. IRC Section 6033(j) provides that, if you don't file a required annual information return or notice for three consecutive years, your exempt status will be automatically revoked on the filing due date of the third required return or notice. For tax forms, instructions, and publications, visit www.irs.gov or call 1-800-TAX-FORM (1-800-829-3676). If you have questions, call 1-877-829-5500 between 8 a.m. and 5 p.m., local time, Monday through Friday (Alaska and Hawaii follow Pacific Time). FRED FINCH YOUTH CENTER CARES INC X TOM ALEXANDER 3800 COOLIDGE AVE OAKLAND CA 94602 0248364843 Dec. 05, 2017 LTR 4168C 0 81-4243450 000000 00 0000505S Sincerely yours, Kim A. Billups, Operations Manager Accounts Management Operations 1 STATE OF CALIFORNIA p FRANCHISE TAX BOARD F T W PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/12/2022 ESL ID: 6921971578 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 3956277 Entity Name: FRED FINCH YOUTH CENTER CARES, INC. ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) PUBLIC DISCLOSURE COPY PLEASE FILE IN A SAFE PLACE ARMAN I NO "P 12657 Alcosta Blvd., Suite 500 San Ramon, CA 94583 ph 925.790.2600 fx 925.790.2601 ** PUBLIC DISCLOSURE COPY ** Return of Organization Exempt From Income Tax D'°I` NU,150-W`r Farm 990 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) (Rev. January 2020) Oepar[ment of the Treasury Do not enter social security numbers on this form as it may made public. Open to Public 2019 Inl,rnal geyenun Wr Lo Go to www,.irs.gov/Form99O for Instructions and the latest Information. Inspection A For the 2019 calendar year, or tax ar beginning JUL 1, 2019 and endinn JUN 30, 2020 B CN,.klt C Name of organization .ppflr bta =Atld%W1104 FRED FINCH YOUTH CENTER CARES INC. n Of4amn dwloe Doing business as Number and street (or P.O. box if mail Is not delivered to street address) 3800 COOLIDGE AVENUE tarmm- .tad City or town, state or province, country, and ZIP or foreign postal code =olwn1tle� tOAKLAND, CA 94602 ph Di F Name and address of principal officer: ED HSU prardfnn SAME AS C ABOVE Tax exam t status. S 501 c 3 501 c insert rm. 4947 i J Website: HTTPS://WWW.FREDFINCH.ORG/CARES/ K Farm of arpanizalion; .0 Corporation 0 Trust n Association F-1 Other D Employer identification number 81-4243450 Room/suite E Telephone number 510-462-2244 G 0ormm"opl-s 2,891.868, H(a) Is this a group return for subordinates? „ ,-. [Yes Q No H(b) Are all subardlneles included? [� Yes El No lr 521 If "No," attach a list. (see instructions) 2016 CA 1 Briefly describe the organization's mission Or most significant activities: FRED FINCH YOUTH CENTER CARES INC. ("CARES") WAS FORMED IN NOVEMBER 2016 (CONTINUED ON SCHEDULE O) 2 Check this box if the organization discontinued its operations or disposed of more than 25% of its net assets. 0 3 Number of voting members of the governing body (Part VI, line 1 a) 3 4 0 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 3 Od d 5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) 5 132 M1 6 Total number of volunteers (estimate if necessary) 8 3 Q7 a Total unrelated business revenue from Part VIII, column (C), line 12 7a 0. b Net unrelated business taxable income from Form 9907line 39 7b 0. Prior Year Current Year 1.140.649. 1, 386 832. ry 8 Contributions and grants (Part VIII, line 1h) c 9 Program service revenue (Part VIII, line 2g) 959, 817. 1,505,036. 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) , , _ 0. 0. 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 633. G. 12 Total revenue - add lines 8 through 11 must equal Part VIII, column A fine 17 2,101.099, 2 891 868. 13 Grants and similar amounts paid (Part IX, column (A), lines 1.3) 0. 0. 14 Benefits paid to or for members (Part IX, column (A), line 4) 0. 0. 1,660,619. 2. 412 , 929. w? er 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) _ - 0. 0. 16a Professional fundraising fees (Part IX, column (A), line 11 e) -, - _ _ b Total fundraisingexpenses p (Part IX, column (D), line 25) lop, 0. 739 327. 983, 296. 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) , 2,394,946. 3.396, 225. 18 Total expenses. Add lines 13.17 (must equal Part IX, column (A), line 25) -293 , 847. -504 357. 19 Revenue less expenses. Subtract fine 18 from line 12 MC Bapinifinn of Caffeat Year End of Your 1 , 112 4D 2. 801 849. 20 TOtaI assets (Part X, line 16) 21 Total liabilities (Part X, line 26} 21972,233. 3,166,037. 2- 22 Net assets or fund balances. Sublract line 21 from line 20 .............. ........ . ....... -1, 859, 831. -2. 364, 188. r-Wr. n I Vrar,GLu,G UlVVd Under penalties of perjury, I declare that I have examined this return, including accompanying schedulds and statements, and to the best of my knowledge and belief, it is if correct, and complete. Declaration of preparer Jolliet man officer) is based on all information of which orDvafer has any knowledgu. Sign I Signaturc of officer Date Here I ED HSU. CFO Type or print name and title Print/Type preparer's name Preparer's signature Date Chif e6 0 PTIN Paid IATTHEW PETROSKI TTHEW PETROSKI lo5113/21 sell-emplo eA �00853132 Preparer Firm'sname ill, ARMANINO LLP Flrm'SElN 94-6214841 Use Only Firm's address 12657 ALCOSTA BLVD, STE. 500 SAN RAMON, CA 94583-4600 Pitone no,925-790-2600 May the IRS discuss this return with the preparer shown above? tqeq instructions R Yas No 932001 01-20-20 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2019) SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # GOOD SAMARITAN FOOD PANTRY CI'I`Y OF'IWIVI ECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Temecula Hunger Relief Program Start Date: 8/1/22 End Date: 8/1/23 Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Good Samaritan Community Food Pantry Mailing Address: 32127 Camino Rabago, Temecula CA 92592 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Good Samaritan Community Food Pantry Year Founded: 2019 Website: https://goodsamaritancommunity.oM Social Media: https://www.facebook.com/Good- Samaritan-Community-Food-Pantry-111174284381679 Number of Paid Staff: 0 Number of Volunteers: 12 Geographic Area(s) the Or action Serves: Temecula Residents Geographic Area(s) the Proiect/Program Serves: Exclusively used for Temecula residents NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Teri Sue Parker Title/Position: Founder Contact Person's Direct Telephone: 951-415-5731,_Contact Person's Email: terisuecate@hotmail.com_ NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes X Date of Incorporation as a Nonprofit: 8/5/2020_ No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 85-3139441 State Identification Number: 4636074 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: htt ://a s.irs. ov/a /eos/ 2. ❑ Attach State Entity Status Letter using this link: htti2s://www.ftb.ca.gov/online/self serve entity status letter/index.asp 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: httt)://rct.doj.ca.gov/VerificationiWeb/Search.aspx?facility_=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No IK] Yes []IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? Nog] Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION_ This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Our goal here at Good Samaritan is to provide and deliver healthy, fresh, food and essentials for Temecula residents, their families, and pets in a safe and courteous way. Our goal is to lift up as many residents as possible who are in need and help them get back on their feet by taking some of the pressure of food insecurity. Delivering food and essentials they need gives them hope, strength, nourishment, and essential items for themselves, their families and their pets. For the elderly and disabled we want to give them peace of mind they will not have to choose between food or medications or keeping their pets, and other essential living expenses they have. We focus on Isolated seniors, veterans, cancer patients, disabled, foster families, and families at risk. Providing fresh and healthy nourishment can and will help these residents get back on their feet quicker and feel supported by their community. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW, City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP $ 1 f OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO ❑ Yes g] IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR NAME OF ENITY RECEIVED FUNDING RECEIVED $ 1 ,000 Morongo Casino 3/2020 $ Chick-fil-A — They are awarding grants if we get one 12/2022 $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION ' IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. This grant would support our Hunger Relief Program for Temecula. Temecula residents who are experiencing food insecurity. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Healthy food to prepare breakfast, lunch, dinner, pet food, essential items and household goods, paper products and cleaning supplies for their homes. This grant would allow us to purchase food that we currently do not get enough of from the community. It is important that the weekly food bags have all of the essential items from all the major food groups and not just canned goods. We deliver meat, grains, dairy, fresh fruits, vegetables and per food that allows them to prepare their meals for their family and pets. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Good Samaritan Community Food Pantry is a local grassroots food pantry. We drop off exclusively to Temecula residents in need directly to their doorstep weekly and biweekly. This allows Temecula residents to stay in their homes. and keep their pets with them. We have found that many of the residents do not have reliable transportation, so delivering food and essentials directly to them has taken some of the burden from their shoulders. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 1000 FROM THIS PROJECT/PROGRAM: [3_c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 15+ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINULI) The funding from this grant will replenish the essential healthy food and essential items for the residents here in Temecula and their pets by providing Good Samaritan the resources to purchase the food locally and other essential items the homes need. By focusing on specific areas in Temecula we can provide residents with special dietary needs and restrictions for some, food prices have doubled and the food we drop off weekly or Bi-weekly has to be replenished and replaced. i 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. We depended 100% on donations of food and essentials from the residents locally, at the beginning we were able to keep adding residents in need due to the amount of food and essentials and pet food that was being dropped off to us. But now with food prices doubling and gas prices so high the donations of food and essentials and pet food has come to almost a complete halt. Inflation has devastated so many homes as well as food pantries since many people can only feed themselves and their families and can no longer afford to donate. We also deliver 99% of the food directly to the needy, so the gas prices for volunteers has become a big challenge for our drivers. We were serving residents that could not leave their home, shut ins and residents with high risk factors we had to deliver safely and many have diet restrictions and health issues. The number of residents in need now is staggering. We serve so many with health issues that going out and buying healthy food to help keep them healthy is a luxury, some that we serve had not had fresh produce for months and some were afraid of who handled their food as to not get infected with the virus. Our number of shut-in's has increased and our number of family's has tripled over the last year as the cost of food has made it very hard to keep the fridges and freezers and shelves stocked. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The funds from this grant would allow us to create new ways to add more residents in need and families with special needs. This grant would allow Good Samaritan to continue what we are doing daily - filling the food bags full of healthy foods, essentials, and pet food. We can continue "Adopt A Family" "Adopt A Senior" programs during the Holiday's which has brought so much joy to those who need it. We can continue to provide fresh, healthy, safe food so those in need so they can prepare good meals for breakfast, lunch, and dinner. It will also help us to keep providing paper goods and cleaning supplies, so they can keep germs from spreading and their homes safe and clean. We will be able to continue providing those with special dietary needs. It allows us to keep bringing pet foods and supplies, so they don't have to surrender their beloved pets to a shelter because they can no longer feed them. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $50,000 Community Services Grant (Not to exceed $50,000) EXPENSES Amount contributed to the Project/Program by the $1500 Applicant Organization - Estimated donations through out donate button on website for project Other grants or funding already awarded for Project/Program, if any $0 In -Kind match amount or volunteer credit hours estimated amount $85,000 as **OUR IN -KIND donations come in as dropped off food and supplies by donated food the community which has decreased substantially. Guesstimate for 2022 or essentials NOT CASH TOTAL REVENUE $51,500 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/Insurance — Electric/Gas $6500.00 Supplies — Baggies/Wrapping/Bags/Flyers/Boxes $2500.00 Marketing $ Services $ Food and Essentials $41,000 Other $ Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, $0 HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $ TOTAL BUDGET $50,000 $50,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Name of Project/Program: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): 4 Name of Company RecDate on eipt/Invoice on Receipt or Invoice MUST BE ON OR BETWEEN Amount JULY 1, 2021 - JUNE 30, 202-2 Z Q 2 3 4 5 6 EXPENDITURE TOTAL Expenditure_ Description Purpose DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE _ 1 The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow_time_ for checks - to -be -processed.-. The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. ■ The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. ® If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Good Samaritan Community Food Pantry MAILING ADDRESS: 21227 Camino Rabago Temecula CA 92592 PHONE: 951-415-5731 EMAIL: terisuecate@hotmail.com PRESIDENT / AUTHOOFF R. Teri S e Parker Founder SIGNATURE: _ : =f ;� L OLI` l r�� Q DATE: All IF DIFFERENTTHAN ABOVE, APPICATION PREPARED BY: ` G� I Jul C3r1� SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 104 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 94285757 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/7/2022 ESL ID:7074774595 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 4636074 Entity Name: GOOD SAMARITAN COMMUNITY FOOD PANTRY INC ❑X 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board, 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . 4, We do not have current information about the entity, 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information • This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304,5, 23305a, 23305.1). • The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 19 GREEN ACRES INTERACTIVE THERAPY INC. CITY OF TEMECUI[A FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 I PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 Project/Program Title: Walk, Ride, Run for Gait MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Start Date: 5/1/23 End Date: 6/30/23 Physical Address of ProjectlProgram: 35750 De Portola Road Temecula. Ca. 92592 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make check Payable to: Green Acres Interactive Therapy Mailing Address: 35750 De Portola Road Temecula. CA 92592 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Green Acres Interactive Organization: Therapy Website: Gaitprogram.org Number of Paid Staff., 9 Year Founded: 2014 Social Media: FT, Twitter Number of Volunteers: 20 Geographic Area(s) the Organization Serves: Temeucla Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Margaret Rich Title/Position: Founder Contact Person's Direct Telephone: 909-240-4500 Contact Person's Email: info@gairprogram.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 2014 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 46-4355227 State Identification Number: 3547698 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: http://aRps.irs.gov/aop/east 2. ❑ Attach State Entity Status Letter using this link: Mps://www.ftb.ca.gov/online/self serve entity status lefterlindexasip 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http:lfrct.do}.ca.cLovlVerification/Web/Search.aspx?faci€ily=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No [AJ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No 41 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors 0 Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. To enrich lives by providing physical and emotional therapy through horse interaction. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. 1 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT MONTH + YEAR NAME OF CITY GRANT AMOUNT -FUNDED_BY-THE-CITY-GRANT-OR-SPONSORSHIP-- -FUNDING-RECEIVED— OR3PONSORSHIP-- E i $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No ❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ $5,000 Staples 8/22 $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. To celebrate the growth of Gait and to keep t6he therapeutic riding accessible to the community of Temecula. We invite the community to join us for Walk, Ride, Run for Gait, a fun reason to get outdoors and raise awareness. This was a virtual program because of Covid but now we would like it to be a City of Temecula event. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT Funds will be used to pay for the boarding, care and feeding of the horses inbolved in the program. Funds ill be used to provide safety equipment (helmets, Gloves and any other tack) as needed to keep participants safe. Funds will be used to clear the trail that will be used for the participants. Funs will be used to provide water, snacks and T-shirts for the participants. S 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. With the funding we can open up the ranch to the Temecula residents to get involved with the program that night not have the financial funds available to participate in the program. There isn't another facility in Temecula that handles special needs, PTSD for Veterans and other public servants, and helping families that are in need of group therapy because of adoption or group home facilities. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 50 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. This- program -is -to -raise -awareness -for -the -City -of Temecula-about-itis-therapeutic- program and provide a facility to help families in need of therapy that is interactive with animals and be outdoors. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. During Covid we had to shut down our facility and lay off employees and we could not secure volunteers even when we opened up the doors. We have to use extensive funds to make the environment safe by purchasing products to clean helmets and reins and tack. We have also had to deal with the rising costs of fuel, horse feed and vet care and food and have not raised our prices as to keep it affordable for the community. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The additional funds will help expand out program from virtual to a physical event that the city of Temecula can participate in. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill In shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES I EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money -requested -from -this -City of Temecula— - -$ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ Organization Other grants or funding already awarded for Project/Program, if any $ 5,000 In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 55,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $10,000 f $15,000 $ 5,000 $ 2, 500 $4.200 S $10,000 TOTAL EXPENSES $ 511700. TOTAL BUDGET $ 1$50,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Green Acres Interactive Name of Project/Program: Walk, Ride, Run for Gait Therapy FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): El Name of Company Eon Receipt or Invoice aZ Date on Receipt/Invoice MUST BE ON OR BETWEEN Amount JULY 1, 2021 - JUNE 30, 2022 Expenditure I Description Purpose DESCRIBE THE EXPENDITURE I PURPOSE OF EXPENDITURE txF'tNUI 1 UKt I U I AL P (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit andror require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the _approved/awarded_application,_the_organization_may_not receive -and/or will be -required -to -return -said - amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. (If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $51<4501K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED_ Organization: Green Acres Interactive Name of Project/Program: Walk, Ride, Run for Gait Therapy TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92690, 92691, 92692 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) Date on rm Name of Company Receiptlinvoice u E �on Receipt or Invoice MUST BE ON OR BETWEEN US March 20. 2020 - JUNE 30, a z 1 2024 2 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount J Description I Purpose EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: ■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. -• Funding -is -not immediately -available -to the -recipient,, and requires -an -award letter signature -upon approval. - Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Green Acres Interactive Therapy MAILING ADDRESS: 35750 De Portola Rd Temecula, CA 92592 PHONE: ( 90') 240-4500 EMAIL: info@gaitprogram.org PRESIDENT/AUTHORIZED OFFICER: Margaret Rich, Founder DR, INT NAIV; tiT[ r SIGNATURE: -btar aret Rich DATE: 9/12/2022 IF DIFFERENTTHAN ABOVE, APPICATION PREPARED BY: SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 GREEN ACRES INTERACTIVE THERAPY, INC. (3547698)- Request Certificate Initial Filing Date 02/01/2013 Status Active Standing - SOS Good Standing - FTB Good Standing - Agent Good Standing - VCFCF Good Formed In CALIFORNIA Entity Type Nonprofit Corporation - CA - Public Benefit Principal Address 35750 DE PORTOLA ROAD TEMECULA, CA 92592 Mailing Address 35750 DE PORTOLA ROAD TEMECULA, CA 92592 Statement of Info 02/28/2023 Due Date Agent Individual 2810395 MARGARET RICH 35750 DE PORTOLA RD TEMECULA, CA 92592 Entity Information Initial Status Entity Type Formed In Agent Filing Date GREEN ACRES Nonprofit INTERACTIVE Corporation - MARGARET THERAPY, INC, 02/O1/2013 Active CA - Public CALIFORNIA RICH (3547698) Benefit INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date : q U G 18 2014 GREEN ACRES INTERACTIVE THERAPY, INC> C/O SELINA STEELE PO BOX 890339 TEMECULA, CA 92589-0339 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 46-4355227 DLN: 17053167363024 Contact Person: CUSTOMER SERVICE ID# 31954 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: February' 28 Public Charity status: 170 (b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: February 1, 2013 Contribution Deductibility: Yes Addendum Applies: No 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 0£ 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. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 914221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 Short Form OMB No. 154e-0047 Form 990-EI Return of Organization Exempt From Income Tax 2020 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) ► Do not enter social security numbers on this form, as it may be made public. puparnnont of the treasury M Internal nevonue Service 0-Go to www.irs.gov/Form990EZ for instructions and the latest information. A For the 2020 calendar year, or tax year beginning Ma r 2020, and ending Feb 22 2021 B check it applicable: C Name of Organization D Employer identification number ❑ Address change GREEN ACRES INTERACTIVE 'THERAPY INC 46-4355227 ❑ Name change Number and street (or P.O. box if mail is not delivered to street address) oom swte E Talophone number ❑ initialren,rn 35-750 DE PORTOLA 9513022384 Find roturn/terminated Amended return City or town, state or province, country, and ZIP or foreign postal code F Group Exemption Applicallan pending TEMECULA, CA 92592 Number ► G Accounting Method: 0 Cash ❑ Accrual' Other (specify) ► H Check ► ❑X if the organization is not Website: ► N/A required to attach Schedule B J TiLK-exempt status (check orgy one) -- ® 5olicje ❑Set a nsart no. ❑ 4947 1 or 11527 (Form 990, 990-EZ, or 990-PF). K Form of organization: © Corporation ❑ Trust Association ❑ Other L Add lines 5b, 5c, and 7b to line 9 to determine grass receipts, If gross receipts are $200,000 or more, or if total assets (Part II, column (B)) are $500,000 or more, file Form 990 instead of Form 990-EZ . . . . . . . . . . ► $ 13, , 1 r, . Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part 1) Check if the gr anixation used Schedule O to respond to anyguestion in this Part ! . IJ 1 Contributions, gifts, grants, and similar amounts received . . . . . . . . . . . . . 1 !2 993 2 Program service revenue including government fees and contracts . . . , . . . , . 2 3 Membership dues and assessments . . . . . . . . . . . . . . . . , 3 4 Investment income . . . . . . . . . . . . . . . . . . . , , , 4 5a Gross amount from sale of assets other than inventory . , , . IJR-1-- b Less: cost or other basis and sales expenses . , , . . . . . 5b c Gain or (loss) from sale of assets other than inventory (subtract line 5b from line 5a) 5c 6 Gaming and fundraising events: a Gross income from gaming (attach Schedule G if greater than $15,000) . . . . . . . . . , . . c 6a b Gross income from fundralsing events (not including $ of contributions cc from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributlons exceeds $15,000) . 6b 1 845. c Less: direct expenses from gaming and fundraising events . . , ec 5 854 . d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) . . . . . . . . . . . . . . . . . . . . . . . . 6d —4, 009 7a Gross sales of inventory, less. returns and allowances 7a b Less: cost of goods sold . . . . . . . . . . . . . 70 c Gross profit or (loss) from sales of inventory (subtract line 7b from line 7a) . . . . 7c 8 Other revenue (describe in Schedule O) , . , . . . . . . . SP-E, Line 8 Stmt. . 8 1.8 _ 1 3 . 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d'. 7c, and 8 . ► 9 12 8 312 . 10 Grants and similar amounts paid (fist in Schedule O) . . . . . . . . . . . . . . 10 11 Benefits paid to or for members; . . . . . . . . . . . . . . . . . . . 11 v 12 Salaries, other compensation, and employee benefits . . . . . . . . . . . . . . 12 f3 0 7 5 . c 13 Professional fees and other payments to Independent contractors . . . . . . . . . . 13 2 100. X14 Occupancy, rent, utilities, and maintenance 14 42 703. w 15 Printing, publications, postage, and shipping , . . . . . . . . . . 15 2,071 . 16 Other expenses (describe in Schedule O) . . . . . . . . . see. Line 16. stmt 16 60 849. 17 Total expenses. Add lines 10 through 16 . ► 17 1 195, 798.. rn 18 Excess or (deficit) for the year (subtract line 17 from line 9) . . . . . . . . . . . . 18 —6, 7, 186. 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with 4 end -of -year figure reported on prior year's return) . . . . . . . . . . . . . . I19 6 f, 06 5. Z20 Other changes in net assets or fund balances (explain in Schedule 0) . . . . . . . . . 20 21 Net assets or fund balances at end of year. Combine lines 18 through 20 . 1'-21 579 . For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 09/08/21 PRO Form 990-EZ (2020) r • r. 1 a - „ _ ::,;; . it • „ �: ' y- , `r ' ;�, • ;•� , tip•; ts'r''vFt.: In o b o > LID to p >. 0 ° U H a O 4p W u G. Fx Cd w w op m r Qr Fx M. �+ v U a+ tl O ►- W 0 O � a+ '� a Z M O F u 0 ?_ W y b 3 ¢� ul y w [ IL LV 1 � N a a, a v Q 2 p LL u 'd . z 3 n, Vf V) ° w Z O v o ea ajo Z , V) in a � o a ° °- a. y 3 O y ° g _ ebo b a z 3 J °' r o � o, a 0 oo a O O " IL 0 + O o 0 i •� v to aa� H v .5 F- Im W IL 0 LO F- u7 O U 0. z 0 CA �p Cd b 4 bb ,, a v v 3 v aIA 4j 4 L o b°D bA y b y LL1 oo lzLL a IA ❑ �,., ti � �', � .� � v .moo k N 0 M 2 ƒ 7 � \ tg k § § k � § 3 t «,. •�_ // tj\'a \\)ƒ\ }\ �Z) &22) § �o . $lu _ �kE ¥\(2 ° �9 - � _ m 7 _ _ o rz ; ( ) LUa / $'2 ƒ } 2 \ \ /} §) � k\ kƒ g& 3 UA O 0 F- w Y U H m _Z X ,F- V O LL W 0 Y J Q 3 a F- 0 a 0 a F- a O a O LL Z 0 J a l7 0 a 0 w EL 1- a cD a 0 LL Z Ln rn a x Rancho California Arabian Horse Association Presents at 61V.111 A['>'iIA RAH111 35750 De Portola Road in Temecula 11 10rses 101 Apru -v_ _- PDA TRIO 16 A FREE EVENT THAT IS OPEN TO THE PUBLIC Parking$5 clonjat.ionn* per car inch-mles I FREE � a fle ticke—t, *donation to benefit r,A1T Thnr,-4nn!rtl^ Rir4iri(s PI-ograirj and Temecula Valley Rural Lifestyles CELEBRATING THE AMAZING WORLD OF ALL THINGS MOR60 The beauty of the horse transcends all labels and preferences. Behind every horse person lies the child that simply fell in love with a horse. # DEMONSTRATIONS # VENDORS 0 CLUBS FOOD * RAFFLE PONY RIDES I& PETTING ZOO* HAY RIDES Any questions contact Heather - heather@greenacresranchinc.com (951) 302-6045 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 20 HABITAT FOR HUMANITY INLAND VALLEY INC. CITY OF TEMECULA. FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING M REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MOND", SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 44,094 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Temecula Real Estate and Project/Program Title: nf,,r Start Date: 10.1.22 End Date: 6.30.23 Physical Address of Project/Program: 41615 Winchester Rd Ste 214,Temecula CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Habitat for Humanity Inland Valley Mailing Address: 27475 Ynez Road #390 Temecula, CA 92591 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Habitat for Humanity Inland Organization: Valley Year Founded: 1991 Website: habitativ.org Number of Paid Staff. 42 Social Media: facebook.com/HabitatIV/ Number of Volunteers: 1,266 Geographic Area(s) the Organization Serves: Southwest Riverside County Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Mary Stein Title/Position: Associate Director Contact Person's Direct Telephone: 951-296-3362 Contact Person's Email: mary!Rhabitativ.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 2/21/91 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0461804 State Identification Number: C1681922 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ■❑ Attach IRS Deductibility Status using this link: http:/Iapl2s.irs.gov/ap.p/eosl 2. ❑■ Attach State Entity Status Letter using this link: https://www.ftb.ca.gov/onfine/self serve entity_status lettertindex.as 3. >]■ Attach first page only of most recent IRS Form 990 or attach printout of detailed info about your charity found on this State Registry's Search Tool: hit ://rcLdo -ca. oy/Vedfication/WebiS t rch.as x?faciiit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No If Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ® Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The mission of Habitat for Humanity Inland Valley, in partnership with God, is to facilitate the dream of homeownership as well as improve the living conditions for those in the community. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes E IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Critical Home Repair Program $ 50,000 20/21 � CDBG Critical Home Repair Program $ 52,662.71� 21/22 A Brush with Kindness $5,000 21/22 Critical Home Repair Program $49,724 122/23 CDBG ICSF CDBG Temecula Home Repair Program $ 500,000 22/24 Covid19 Reinvest I$ - I$ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO E Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. f----. r -- - - City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Temecula Real Estate and Education Center will provide resources, training and -home buyer counseling servicesto-help Temecula residents with affordable homeownership. Homebuyer orientations, resource fairs, financial literacy and Healthy Homes workshops will provide educational support to empower residents towards homeownership and preserving home affordability. 1:1 home buyer counseling will guide qualified clients through the complicated affordable home buying process with licensed real estate support and advocacy while also utilizing other available collaborative resources like downpayment assistance. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT Habitat IV will spend the grant funding on launching and supporting the Temecula Real Estate and Education Center. Funds will be spent on facility costs to house the Center, including expenses related to securing space including rent, utilities, liability insurance, etc. Funds will also be spent on classroom supplies and materials for the workshops, including tables and chairs, minor improvements like shelving and partitions for the educational space, and marketing materials and signage for the Center and resource fairs. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. This program will be provided to Temecula residents at the Real Estate and Education Center in Temecula and at community events or sites throughout the City. While any resident is welcome to attend and participate, we expect that most will be low -to -moderate income residents working towards affordable homeownership and struggling to navigate the complicated affordable home buying process, such as layering multiple sources of assistance towards their purchase. 3b 3c ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 371 FROM THIS PROJECT/PROGRAM: ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: cJ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 14 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. The Temecula Real Estate and Education Center will provide home -buyer orientations, resource fairs, financial literacy and Healthy Homes workshops, and counseling to empower residents towards home affordability. 1:1 counseling will guide participants through the complicated affordable home buying process with licensed real-estate support while utilizing collaborative resources like down -payment assistance. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. COVID-19 impacted our ReStores, which provide a substantial source of revenue used to support and launch programs. The pandemic and historic inflation also significantly impacted the rising cost of housing, driving affordable homeownership even farther away for many residents. I The launch of the Temecula Real Estate and Education Center is part of a broader affordable homeownership solution as we collaborate with other agencies and advocate for residents by combining resources, along with Habitat IV support, to impact the affordable homeownership crisis. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. 1) This funding would launch the Temecula Real Estate and Education Center by providing funds for facilities along with classroom materials, supplies, and marketing/signage. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 44,094 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ Organization Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 44,094 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/insurance Facility expenses: Rent, insurance, utilities, ! $ 28 944 landscaping, shelvin 1 arlitions, _POA dues, etc r Supplies Classroom materials and supplies including $ 7 650 printed materials , Marketing Signage and marketing materials $ 7,500 Services I $ Food Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET $44,094 $44,094 $44,094 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT xIF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper rinnumRntatipn may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3., Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Habitat for Humanity Name of Project/Program: A Brush with Kindness f ani d Vai ev FY 2021-2022 Amount of $ CSF Grant Fund Awarded: 5000 Month & Year CSF Grant Received from City: 2021-2022 Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted 31 from this Program/Project (approximate number of beneficiaries If you do not have precise number): E Name of Company Eon Receipt or Invoice Q Z Seaeftached 1 spreadsheet 2 1 3 I 4 5 6 Date on ReceiptlInvoice Amount MUST BE ON OR BETWEEN JULY 1, 2021 - JUNE 30, 2022 FIN Description I Purpose DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE EXPENDITURE TOTAL $S (Q 5 EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022.2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive andlor will be required to return said amount of fundc to the City. To substantiate that grant funds from thu City me, spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Habitat for Humanity Name of Project/Program: Temecula Real Estate and Inland Vallev Education Center TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report Is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $,_ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report Is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) Date on Expenditure t MUST SUPPORT PROJECT/PROGRAM IN APPLICATION &AWARD LETTER Name of Company Receipt/invoice a E on Receipt or Invoice MUST BE ON OR BETWEEN a= March 20, 2020 - JUNE 30, Amount Description Purpose Z 2024 2 3 EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Habitat for Humanity Inland Valley MAILING ADDRESS: 27475 Ynez Rd #390 Temecula, CA 92591 PRESIDENT/ AUTHORIZED OFFICER: Tammy Marine, SIGNATURE: PHONE: ( 951 ) 296-3362 EMAIL: mary@habitativ.org Executive Director DATE: 9/9/22 RI'll ON11i2:, i 1's1, IF DIFFERENT THAN ABOVE, Mary Stein, Associate Director APPICATION PREPARED BY: P:�iN 111AT11_ I'i. 1 SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Habitat for Humanity® September 29, 2015 Inland Valley HFH 27475 Ynez Rd #390 Temecula, CA 92591-4612 RE: 501(c)(3) Letter for Inland Valley HFH, Partner ID# 1101-5322 Dear Affiliate Leader: Help build it! This letter will confirm that Inland Valley HFH, with employer identification number 33- 0461804, is considered a subordinate under the group tax exemption umbrella of Habitat for Humanity International, Inc. ("HFHI") under Section 501(c)(3) of the Internal Revenue Code. The group exemption number assigned to HFHI by the IRS is 8545. This number may be provided to prospective donors, foundations and other grant organizations as they request it and is required on certain IRS forms. Enclosed is a copy of the determination letter dated March 9, 2015, provided by the IRS as evidence of HFHI's tax exempt status as well as its group exemption. The determination letter, together with this letter, confirms Inland Valley HFH's subordinate status and provides evidence of its tax exempt status under Section 501(c)(3) of the Code. In partnership, Beverly Huffman Director, US/Canadian Support Services Center Habitat for Humanity International 877-434-4435 USSupp artCenter 1Tabitat.or • habitat.org !Habitat. We build - Enclosure INTERNATIONAL HEADQUARTERS: 121 Habitat St., Americus, GA 31709-3498 USA www,habitat.org (229) 924-6935 toll free (800) 422-4828 h } jl i j(�� 3 POIF11 ineut of the I'FLniumy � ��f jj lnfvirol Rovonue tirrvlce In reply refer to: 4077550277 OGDEN UT 84201-0029 Mar. 09, 2015 LTR 4167C 0 91-1914868 000000 00 00040704 BODC: TE HABITAT FOR HUMANITY INTERNATIONAL INC HABITAT FOR HUMANITY INTRNL PARENT n V. EDWARD K QUIBELL - CFO/SR VP 121 HABITAT ST AMERICUS GA 31709-3423 052913 Employer Identification Number: 91-1914868 Group Exemption Number: 8545 Person to Contact: Ms Benjamin Toll Free Telephone Number: 1-877-829-5500 Dear Taxpayer: This is in response to your Jan. 20, 2015, request for information about your tax-exempt status. Our records indicate that you were issued a determination letter in January 1987, and that you are currently exempt under section 501(c)(3) of the Internal Revenue Code. Based on the information supplied, we recognized the subordinates named on the list you submitted as exempt from Federal incnme tax under section 501(c)(3) of the Code. 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, Tamera Ripperda Director, Exempt Organizations IRS GI-OLIp Exemption FAQs The IRS refers to "central" or "parent" organizations, as well as "subordinate" organizations? What does these terms mean? An organization that has been granted a 501(c)(3) group exemptinn by the IRS is referred to as the central or parent organization. The central organization generally supervises many affiliates or chapters, called subordinate organizations. The subordinate organizations have similar structures, purposes, missions and activities. ❖ In Habitat's case, HFHI is the central organization and each Affiliate is a subordinate organization. What is the reason for group exemptions vs individual exemptions? Group exemptions are an administrative convenience for both the IRS and organizations with many affiliated organizations. Subordinates in a group exemption do not have to file, and the IRS does not have to process, separate applications for exemption. Instead, the IRS allows the central organization to include its subordinate organizations under its tax exempt "umbrella." ❖ Group exemptions are more convenient because only one central organization (HFHI) needs to be checked for tax exempt status. Who determines if a subordinate organization may be included under the central organizations' group exemption? The central organization, not the IRS, determines who is exempt under its 501(c)(3) umbrella. The IRS does not approve or deny a subordinate's inclusion on HFHI's roster of exempt subordinates. It is solely at the discretion of the central organization holding the 501(c)(3) designation as long as the subordinate is similar in mission, purpose, structure and activities. The IRS leaves it up to the central organization to police its own list of subordinate entities and to report any changes. Failure to monitor the list in accordance with the rules set forth by the IRS may result in the central organization having its 501(c)(3) status revoked. •D, HFHI is the final determiner of whether Affiliates are on its group exempt list. The IRS will not issue a letter with regard to an individual Affiliate. How does a donor verify that an organization is included as a subordinate in a group exemption ruling? The central organization which holds the group exemption (rather than the IRS) determines which organizations are included as subordinates under its grnilp exemption umbrella. Therefore, a donor should verify that an organization is a subordinate eligible to receive tax deductible donations by requesting a copy of a letter provided by the central organization to the subordinate confirming the subordinate entity's inclusion on its roster of exempt subordinates. This letter, coupled with a copy of the central organizations 501(c)(3) determination letter provides adequate proof of the entity's tax exempt status. ❖ Affiliate should provide donors a copy of the confirmation letter (with the HFHI IRS determination letter attached) that HFHI provides to each Affiliate on an annual basis. ❖ Donors should be told that the IRS determination letter will not reference the Affiliate by name. How do donors verify that contributions are deductible with respect to a subordinate organization in a section 501(c)(3) group exemption ruling? Many donors are accustomed to consulting the IRS database known as EOS Select Check to confirm that donations to a specific organization are tax deductible. This works well for organizations that have an individual tax exemption; however, it creates a bit of confusion when it comes to organizations with a group tax exemption status. The EOS Select Check database does NOT list all subordinate entities. It lists the central organization because the central organization is the entity that applied for, and was granted, a 501(c)(3) designation. Many times donors become alarmed when they do not see the individual Affiliate listed in the database. It is important to explain to your donor that providing HFHI's group exemption number (GEN) along with a confirmation letter from HFHI, as the central organization, is sufficient proof of the subordinate entity's tax exempt status. Donors may rely upon central organization verification with respect to deductibility of contributions to subordinates covered in a section 501(c)(3) group exemption ruling. ❖ Explain to your donors early the procedure so that they will not be surprised when the Affiliate is not referenced on the EOS database. Employer Identification Number (EIN) vs Group Exemption Number (GEN) The Employer Identification Number (EIN) is a nine -digit number that is unique to each business and generally appears in the following format: XX-XXXXXXX. Its role for a business is similar to that of the Social Security number for an individual. The number includes information about which state the corporation is registered in. This unique identification number is assigned to a business entity so that they can easily be identified by the Internal Revenue Service. The EIN is also known as a Federal Identification Number (FIN) or Tax ID. This number is apart and separate from a company's group exemption number (GEN). The EIN identifies the specific organization. The GEN identifies the entity's further designation as a tax exempt organization. The GEN number is a number assigned by the IRS which identifies the central organization who was granted the group exemption. The GEN number is a 4 digit number that should be supplied to donors when they make a donation. This number allows the donor to make a tax deduction based on the donation to the tax exempt entity. • HFHI's GEN is 8545. This should be given to your donors. • Do not use HFHI's EIN in your Affiliate's tax return and other documents. This will cause the IRS to confuse your Affiliate with HFHI (including accidentally holding you responsible HFHI's payroll taxes, misreporting on Form 990, etc.) ❖ HFHI's GEN is 8545. This should be given to your donors. :• Do not use HFHI's EIN in your Affiliate's tax return and other documents. This will cause the IRS to confuse your Affiliate with HFHI (including accidentally holding you responsible HFHI's payroll taxes, misreporting on Form 990, etc.) STATE OF CALIFORNIA FRANCHISE TAX BOARD Fop� BOA 94257 SA SACRAMENTO CA 94257-0540 Entity Status Letter Date: 7/14/2022 ESL ID: 8461025921 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1681922 Entity Name: HABITAT FOR HUMANITY INLAND VALLEY, INC. 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information • This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). • The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) State of California 06__� Office of the Department of Justice Attorney General HOME ABOUT MEDIA CAREERS REGULATIONS RESOURCES PROGRAMS CONTACT Registrant Details Entity type: CorporaLe Class as registered �AiiLh the Secretary of State or based on 1`01-inding & registration do Organization Name: HABITAT FOR HUMANITY INLAND VALLEY, INC. IRS FEIN: 330461804 Entity Type: Public Benefit SOS/FTB Corporate/Organization Number: 1681922 Registry Status: Current Renewal Due/Exp. Date: 11/15/2022 RCT Registration Number: 081196 Issue Date: 6/30/2006 Record Type: Charity Registration Effective Date: 6/30/2006 Date of Last Renewal: DBA: r • Address Street: 41615 WINCHESTER RD #214 Street Line 2: City, State Zip: TEMECULA CA 92590 Filings & Correspondence S:_ 550 2010 CT-550 2010 BEL-LM R R E -_ L 2011 RRF-1 2012 IRS Farm 920 2012 2010 RRF-I 2011 RRF-1 2012 RRF-I 2012 IRS Form 990 IRS Form 990 2010 F0A&gDoeuments RRE-1 2009 � 2010 IRS Form 990 Founding Documents 2009 RRF-1 IRS -Form 22QM BREA- 1RSFnrm 990 200$ � M Form 920 2007 2009 IRS Form 990 2008 RRF-1 2008 IRS Form 990 2007 RRF-1 2007 IRS Form 990 RRF-1 2006 2006 RRF-1 IRS Form 990 2006 2006 IRS Form 990 ERE-1 20D5 2005 RRF-1 IRS Form 990 2005 2005 IRS Form 990 RRF-1 2004 2004 RRF-1 RRF-1 2003 2003 RRF-1 IRS Form 990 2003 2003 IRS Form 990 BELL= 2002 RRF-1 IRS Fonn 990 2002 2002 IRS Form 990 RRF- I�0 2000 RRF-I t D uency Notice 1st Delinquency Notice I;&OWgl Filing 2017 Renewal Filing 2020 RRF- 120 l 3 2013 RRF-1 IRS Form 990 20 l3 2013 IRS Form 990 ERE --I 20 l 1 2011 RRF-1 - — IRS Form 990 2Q1.1 2011 IRS Form 990 RRE L2M 2014 RRF-i IRS_ Form 99 2a i a 2014 IRS Form 990 20 ! 5 IZR A 2015 RRF-1 2015 lR,S, Egan 290 2015 IRS Form 990 - 2016 Form RRF-1 2016 IRS Eolm .990 Series 2016 IRS Fonn 990 Series Renewal Filing 2018 Renewal Filing 2019 IRS Form 990 S r-LCS 2021 AnnualData Status of Filing: Accepted Accounting Period Begin Date: 7/l/2009 Accounting Period End Date: 6/30/2010 Filing Received Date: 9/17/2012 Form RRF-1 Reject/Incomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notts From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: 7/1/2010 Accounting Period End Date: 6/30/2011 Filing Received Date: 7/16/2012 Form RRF-1 Reject/incomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: 7/1/2011 Accounting Period End Date: 6/30/2012 Filing Received Date: 11/19/2012 Form RRF-1 Reject/Incomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: 7/1/2012 Accounting Period End Date: 6/30/2013 Filing Received Date: 2/20/2014 Form RRF-1 Reject/incomplete Reason: Form CT-TR-I Rejectlincomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Statris of Filing: Accepted Accounting Period Begin Date: 7/1/2013 Accounting Period End Date: 6/30/2014 Filing Received Date: 12/23/2014 Form RRF-I Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: (Votes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/incomplete Reason: Foi m CT-TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-i Reject/Incomplete Reason: Form C'T-TR-I Reject/lncomplete Rcason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I RejectAncomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accountine Period End Date: Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filln2 Received Date: (Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End,Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Furor CT TR-I Reject/Incomplete Reason: IRS Form 990 Rejectlincomplete Reason: Notes From Registry Staff: .Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-t Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Prereq Type: Registrant: Registration No: Date Established: Prereq Type: Registrant: Registration No: Date Established: Proroquisito Relationship: Charily BEYOND DIRECT MARKETING LLC I;D01!]E93 Registration Type: Fundraising Event Registration Status: Complete 1/23/2014 Association Date: 1/1/2014 Expiration Date: 12/31/2014 Prerequisite Relationship: Charity BEYOND DIRECT MARKETING LLC F0022149 Registration Type: Fundraising Event Registration Status: 1/20/2015 Association Date: 1/1/2015 Expiration Date: Complete 12/31/2015 Return of Organization Exempt From Income Tax ro- A Form990 Under section 501(c), 527, or 4947(aH1) of the Internal Revenue Code (except private foundations) Qnparlment of Ina iroeALey _Do _ not enter social security numbers on this form as itmay be made public. For the 2020 Calendar year, or tax year baglnnIn 9 JUL 1 2020 and ending JN 30, 2021 B Check If C Name of organization D Employer identification number applicable: HABITAT FOR HUMANITY Inge INLAND VALLEY INC. Name change Doing business as * * — * * * 18 0 4 Initial return Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Telephone number Final 41615 WINCHESTER RD #214 951-296-3362 return/ termin- ated City or town, state or province, country, and ZIP or foreign postal code G Gross receipts $ 4Z572,741 retturnded TEME CULA CA 92590 H(a) Is this a group return tb�eca F Name and address of officer. TAMARA MARINE principal for subordinates? Yes [XI No pending SAME AS `+ ABOVE H(b) Are an subordinates included? Yes NO I Tax. exem Rit status: W 501 c 3 5o1 c ■ ]n5ert no. 4447 a 1 or 527 If "No," attach a list. See instructions J Web site: 10, WWW . HABITAT IV . ORG I H c Grou2 exemption number K Form of or anization; Corporation Trust Association Other ■ t_ Year of formation: 19 9 21 M Stain of leoal domicile, CA 1 1 Briefly describe the organization's mission or most significant activities: THE MISSION OF HAB I TAT FOR HUMANITY INLAND VALLEY INC. IN PARTNERSHIP WITH GOD IS TO c 2 Check this box if the organization discontinued its operations or disposed of more than 25% of its net assets. '0 3 Number of voting members of the governing body (Part VI, line 1 a) ...--................................................. 3 15 0 4 Number of independent voting members of the governing body (Part VI, line 1 b) ...... a 15 5 5 4 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) .........................................• 6 7 Total number of volunteers (estimate if necessary) ....................... .................................... Total 6 725 7a 0. a unrelated business revenue from Part VIII, column (C), line 12 ................ ...... ............................... b Net unrelated business taxable income from Form 9901Part I line 11 _ 7b 0. Prior Year Current Year y 6 Contributions and grants (Part VIII, line 1 h) „ „ --- ..-,-, . 331,397. 118,129. v 9 Program service revenue Part Vlll, line 2 „„ ( 9) ........... 1,074,355. 523,207. d 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) 799. 778. ......„--,,,,-,- 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) --..... 2 71 b 698. 3 2 61 1 255 , 12 Total revenue - add Imes 8 t h roug h 11 irrivst eq ual Part VI 11, column A fine 12 4,123,249. 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) ........................... 0. 0. 14 Benefits paid to or for members (Part IX, column (A), line 4) 0. 0. 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 16a Professional fundraising fees (Part IX, column (A)line 11 e .............. b Total fundraising expenses (Part IX, column (D), line 25) ► 85,418. 17 Other expenses (Part IX, column (A), lines 11s-11d, 11f-24e) ._ .................... 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) .,... ... ,- 19 Revenue less expenses, Subtract line 16 from line 12 ........ - ... o. 20 Total assets (Part X, line 16) ..................... 21 Total liabilities (Part X, line 26) ---, ............. 22 Not assels or fund balances. Subtract line 21 1 571,254. 1 6914 805. Q a 2,521,583. 2,378,37z. 4,092,837. 4 073 176. 30 412. Beginning of Currant Year 430 193. End of Year 3,769,205. 3,491,798. 1,676,224-1 9681624 2,092,981. 2,523,174. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it Is true, correct, and complete. Declaration of preparor other than officer is based art all information of which preparer has an knowlod e. Sign I Signature of officer CLIENTS COPY Date Here TAMAR.A MARINE, EXECUTIVE DIRECTOR Type or print name and title Print/Type preparer's name Prepare Date Check PflN Paid )ANIEL P. SCHREIBER 189202 Preparer Firm's name JGD & ASSOCIATES LLF Firm's EIN * * * * * 2551 Use Only Firm's addressila. 9191 TOWNE CENTRE DRIVE 0340 SAN DIEGO CA 92122-1274 Phonena.858-587-1000 May the IRS discuss this return with tho Rreparer shown above? See Instructions Yes No . ........................... ... 092001 12-23-20 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2020) SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 21 HIS LITTLE FEET INC. CITY OF TEMECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ - 04 600 . MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Q� �1�C ��� Start Date: End Date: (7 3 L 23 Physical Address of Project/Program: -�-«� �6-()et "C�M��� �l C� 9 zsg2 INCLUDE IF DIFFERENT THAN ORGANIZATI`ON's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: s t l )c - Mailing Address: 344,5, r chC I On ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant I j Organization: l5 l 1 r�� Year Founded: 1 _ Website: V4 V��S L��[ Social Media: [r\C-4 Number of Paid Staff: S Number of Volunteers: Geographic Area(s) the Organization Serves: V L a 1\ I}U�1�11°.S Geographic Area(s) the Project/Program Serves: %Q v; do- co-� NOTE: COMMUNITY SERVICE F�U`DI�G GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SE VE TEEMECULA. Contact Name:� A� t jltin�j o\ Title/Position:XG(I • Contact Person's Direct Telephone: V" (�ontact Person's Email: l5 mQi•`.�„ NONPROFIT STATUS Is this organization incorporated as a nonprofit? YesKDate of incorporation as a Nonprofit: 20 NO ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: l -3 1 611W State Identification Number: PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: http://apps.irs.gov/apl /eos/ 2. ❑ Attach State Entity Status Letter using this link: htti)s://www.ftb.ca,gov/online/self serve entity status letter/index.as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool htip://rct.doi.ca.clovNerificationlWeblSearch.aspx?facility=Y APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No M Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No X Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. rAP NCA ` e� a��., o v Vo f �� 4e -�.� sto t It I��Qc`a , a��- aid���� c� C Q-[ s. ll s ii W r7 5 S �. Z � j �'�� � � � �C � OU� of SU �1es w VA qn� s oa �s / A�° i ►n� and �s Q� , Soo D W*ac D FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED 9MN§TKATt %@UNP FINAN9IAL M/ANAQlKMENT•. ID® NOT SUBMIT NOW-, FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No 2rY@5 ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ❑ Yes IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ , 000 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. h vm go bt ul Cr\ c +r r 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF A ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. elr `` 5�� C PS � � Ok�s ��� ki �0 � 1 " too �0i��iS/C�i��c �r Gns�S - ow 3D0- -0g, a-�� , sa s �S - r G�► 1�,rec� .� 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING, EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. ��,�•s �ar� S -���sQ o�� �(e CGN � GoMMU ..�_�..1awl.i �s Ce�kloh� vt�dQr aae �-F i �oU`�.•'o�i�r �8 \\NA 0 �U� r %aA�Ms� M4 NIDe-/ 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: CJ 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 3r� PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. cmss Le„Wkt�� V� �A\ iO�f�Un �n 2D�3� aliSl` S alno,- 1 h Q [,F to 4 EM L �1q 2?knce, il Ins C`e ^ jh-� �0 awl o of h s 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Q -A' �e t1 Q ovr 0� o� S p,� v OW �G.`Q- o� s ha es �v4 Q�h air �s 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $01000 Community Services Grant (Not to exceed <rn nn0) Amount contributed to the Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any $ I—) I0b0 In -Kind match amount or volunteer credit hours estimated amount $ N /A TOTAL REVENUE $1(,006 LIST OF EXPENSES FOR PROJECT/PROGRAM EXPENSES Tools/Equipment $ Facilities/Rent/Insurance $ D i Supplies $ 1G1� '(Cl Z Marketing $ 3 00 Services $ Foody Other �v� ����� $ 2-1,1 3 3 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ Zt(- b HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET $ /`:1.. _.r :- /-O A PIT A 001 1/' A T1/1P 1 0--- 4 n -4: 413 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF I Organization: EXPE FY 2021-2022 Amount of $ CSF Grant Fund Awarded: REPORT due on or before September 12, 2022 Name of Project/Program: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): qEw Date onExpenditure Name of Company Receipt/Invoice Description I Purpose Receipt or Invoice MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE I PURPOSE OF EXPENDITURE JULY 1. 2021 - JUNE 30. 2022 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ EXPENDITURE TOTAL MUST BE EQUAL TO EXPENDITURE TOTAL (OR GREATER) THAN TOTAL AWARD AMOUNT. Tn.........1.. / MAKIT AMMI 1/"ATI/1k1 0nnn 4A nF �7 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: I Organization:_ City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Name of Project/Program: TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) v Date on r Name of Company Receipt/Invoice E on Receipt oir Invoice MUST BE ON OR BETWEEN Q Z March 20, 2020 - JUNE 30, 2 3 1 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER EXPENDITURE TOTAL $ Amount Description EXPENDITURE TOTAL !_4....F If.... A:-,- 0..;........I..,.....4 ;.. T,....., .., ,1.. !?OAAIT AOOI 1f%ATIP1k1 0--- 4n ..F 47 L ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. ■ Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. s Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. ■ If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: MAILING ADDRESS: -i� S V �� �Ae 1;-Q • PHONE: 6L2,) 4-7 - 03 10 ON e" � ,�0V EMAIL: 1�1.5`1\ `C�Q� � qm%\ •Coflh PRESIDENT / AUTHORIZED OFFICER: ��'� WOO-- CX� � � D o(^t Ck),(- T I ` SIGNATURE: K' _ DATE: US Lo l L1' `1-)N 7 ! I, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: t,A- SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 11:4.. C.....4:.... i.. !'MAKIT A001 1/"ATI/1A1 0...... 47 -4! 412 ea f)4- Stoic of California wFranchise Tax Board PO Box 1286 Rancho Cordova CA 95741-1286 HIS LITTLE FEET, INC. PO BOX 11572 SANTA ANA CA 92711 Regarding: Organization's Name: CCN: Purpose: R&TC Section: Form of Organization: Accounting Period Ending: Tax -Exempt Status Effective: Tax -Exempt Status HIS LITTLE FEET, INC. 3776899 Charitable 23701d Incorporated 07/31 04/13/2015 Date: 02.11.16 Case: 30820600701287076 Case Unit: 30820600701287080 In reply refer to: 760:GRW:F120 Exempt Acknowledgement Letter We have received your federal determination letter that shows tax exemption under Internal Revenue Code (IRC) Section 501(c)(3). Under California law, Revenue and Taxation Code (R&TC) Section 23701 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. Generally, the effective date of an organization's California tax-exempt status is the same date as the federal tax-exempt status. To retain tax-exempt status, the organization must be organized and operating for nonprofit purposes within the provisions of the above R&TC section. An inactive organization is not entitled to tax-exempt status. In order for us to determine any effect on the tax-exempt status, the organization must immediately report to us any change in: Operation • Character • Purpose • Name • Address FTB 9944 PASS (REV 12-2014) Exempt Applfcatfon\Correspondence \LTR 001-EAL .,INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date -DEC 14 2015 HIS LITTLE FEET INC C/O BRIAN MCDONALD 7755 CENTER AVE STE 1100 HUNTINGTON BEACH, CA 92647 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 47-3769966 DLN: 17053308318025 Contact Person: MICHELLE A GLUTZ ID# 31213 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170 (b) (1) (A) (vi) Form 990/99o-EZ/990-N Required: Yes Effective Date of Exemption: April 13, 2015 Contribution Deductibility: Yes Addendum Applies: No We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(C)(3). Donors can deduct contributions they make to you under IRC Section i70. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990—Ezt99V- -our-records show you're required to file an annual - - information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 Form 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Department of the Treasury ► Do not enter social security numbers on this form as it may he made public, Internal Revenue'Servtoe ► Go to www-frs.gev1Form990 for instructions and the latest information. A For the 2021 calendar year, or tax year beginning B Check if applicable: Address change HIS LITTLE FEET INC Name change 3445 STUDEBAKER ROAD nitial rebim LONG BEACH, CA 90808 Final return/tennmeled Amended rehrn AppnCaFron perdrng F Name and address of principal officer: Same As C Above Tax-ezewpt status: N 501(e)(3) Ll 501(c) (insert no,) J Website: ► WWW.HISLITFEET.ORG K Form oferganization 1XI C01p01aNG11 Ll Trusf 11 Association Other, art Summate 0Po1e No. 1545.0047 2021, and ending 20 D Employer identification number 47-3769966 _ Telephone number 562 397-0370 G Gross re qft $ 202 I Is IhiS a group return for5ubptdmales? Yes HIM Are ali subordinates included? Yes If "Nc," attach a list. See instructions, 4947(a)(1) or 527 X(c) Group exemption number ► L Year o` forruabon: M state of legal domicile: CA No No 1 Briii de_sc_ribe_tile_orga_nizatio_Ws fission or_most signsttrani a_rllvltle_s:T_0_P_R_OV_I_D_E_A_S_SI_S_T_AN_C_E_T_O NEED----------------..__-________------------------_----__----__ _CH_ILDR_E_N_Z_N___ --------------------------------------------------------------- cE 2 __ _______________ ____ _ ____ __ ___ _ Check this box ► If the organization discontinued its operations or disposed of more than 25°% of its net assets. � — — — — — f — — 3 Number of voting members of the governing body (Part VI-, line 1 a) . , ... . .. 3 7 °d N 4 Number of independent voting members of the governing body (Part VI, line 1 b)... ........ . ..... 4 5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) .. ..... . .. , ... 5 0 6 Total number of volunteers (estimate if necessary), • , • , .... ....... 6 0 a 7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 142. b Net unrelated business taxable Income from Form 990-T, Part I, line 11 .. ..... 7b 0 , Prior Year Current Year 8 Contributions and grants (Part VIII, line 1h) 146 640. 201 F 924. m 9 Program service revenue (Part VIII, line 2g) 142 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) 11 Other revenue (Part VII'i, column (A), lines 5, 6d, 8c, 9c, 10c, and 11 e).......... 12 Total revenue — add lines 8 through 11 (must equal Part VIII, column (A), line 12) 146,640. 202,065. 13 Grants and similar amounts paid (Part IX, column (A), lines 1.3). ... ....... , 83 950. 14 Benefits paid to or for members (Part IX, column (A), line 4) ....................... 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) ,.- • . 24 713. 43 114. H 16a Professional fundraising fees (Part IX, column (A), line Ile) .. . ........ —.,. ... 657. C b Total fundraising expenses (Part IX, column i line 25) ^i— 4,409. 31,155. 17 Other expenses (Part IX, column (A), lines 1la-lId, 1If-24e)- 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25).. .... 25,370. 158 222, 19 Revenue less expBRses, Subtract line 18from line 12....................... . ..... 121 270. 43 844. Beginning of Current Year End of Year 20 Total assets (Part X, line 16). ...... ..-.... ................ 96 878. 140 722. 21 Total liabilities (Part X, line 26) - — ... , .. ," 0. 07 p i 22 Net assets or fund balances. Subtract line 21 from line 20............... .... ..... 96 878. 140 722 , rarz ii I za nature 13loctt L4kWr penalties of pepury, I declare that i have exampled this return, rnckidIng accorrvanying schedules and stal9ttgRfs, and to the best of my knowledge and belief, it is true, correct, and rpnpllete, Declaration of prepare., (other than officer) 6 bused on all lnlormatiin of WIWI preparer has any knowtgdyb- Sign IsIcnaingoreulcef pale Here ` HALI WOLF President TyrW or prnl n:irrve Aml lrlle Print/Type preparer's name Preparer's signature Date Check Lj it I PTIN Paid Tanya R Lansin E.A. Tana R Lansing,E.A. 5 04/22 selhernployed P0I219573 Preparer Furmsname ' LENNING & CO., INC. Use Only Firm'saddress ► 13924 Seal Beach Blvd Ste C Firm'sEIN ► 20-2141302 Seal Beach CA 90740 Phonenp 562 594-9729 May the IRS discuss this return with the preparer shown above? See instructions.... . JXJ Yes I I No BAA For Paperwork Reduction Act Notice, see the separate instructions. TEEA01011 09/22121 Form 990 (2021) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # HOSPICE OF THE VALLEYS CITY OF TEMECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 j PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 Project/Program Title: Senior Assistance Program MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Physical Address of Project/Program: Same as below Start Date: 3/20/20 End Date: 6/30/24 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Hospice of the Valleys Mailing Address; 25240 Hancock Ave. Ste 120 Murrieta, CA 92562 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Hospice of the Valleys Year Founded: 1982 htt s //hos lce mlps:/twww.facebook.som/HospiceoflheValleys Website: P P ofthevalleys.org/ Social Media: hUps:+ANww.+nslasram.commosplreofthevalleyssd Number of Paid Staff: 58 Number of Volunteers: 40 Geographic Area(s) the Organization Serves: Southwest Riverside County Geographic Area(s) the Pro"ect/Pro ram Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Melanie House Contact Person's Direct Telephone: 951-972-2189 Title/Position: Development Coordinator Contact Person's Email: mhouse@hovsc.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: June 29,1983 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 95-3846314 State Identification Number: 1131444 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. N Attach IRS Deductibility Status using this link: htti)://aps.irs.gov/agp/eos/, 2_ x❑ Attach State Entity Status Letter using this link: hftps.*I/www.ftb.ca.gov/online/self serve_gntity status letter/index.as 3. x❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: hitp.i/rct.doi.ca.gov/VerificationfWeb/Search.aSpx?facilitv=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑x Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors x❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES - Hospice of the Valleys Mission is: We foster reverence for life, relief of suffering, and compassion in loss for the terminally ill residents and their families in the communities we serve. Our Vision is:To be a recognized leader of excellence in comprehensive end -of -life care, Hospice of the Valleys began in early 1982 by two sisters in Sun City, California who recognized the need for specialized end -of -life care for people in their community. In order to make this care available, these sisters received hospice training as volunteers and began going door-to-door raising money on their patients' behalf. After years as a volunteer -run organization, Hospice of the Valleys eventually became a full -service, nonprofit 501(c)(3) organization. Today, Hospice of the Valleys employs a team of experienced clinicians and administrative professionals, and continues to have a group of dedicated volunteers who touch the lives of our patients each and every day. After 40 years of caring for hospice patients living in Southwest Riverside County and Fallbrook, Hospice of the Valleys remains committed to the mission of its founders by providing loving hospice care to all who need it, regardless of their ability to pay. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes N IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Senior Assistance Program Senior Assistance Program $ 5,000 January 2021 Community Service Funding jary 2022 Community Service Funding I OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No ❑ Yes ❑x IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ 5,491 CDBG Temecula May 2021 (FY 20-21) $ 7,226 CDBG Temecula Funds not yet received _ (FY 22-23) $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT, The Senior Assistance Program provides compassionate hospice care to terminally ill patients and support to their families. The Program pays for the direct cost of hospice care for senior citizens and the severely disabled. Direct hospice care includes, but is not limited to, personal visits by physicians, nurses, home health aides, social workers, and spiritual care advisors; the provision of durable medical equipment, medical supplies, medication delivery, and bereavement support services. Our services are extended to our patients and their families while the patient is living and up to at least 13 months after death. After the patient passes, caregivers receive bereavement support that includes phone calls and/ or personal visits by a bereavement counselor or chaplain, access to grief support groups, bereavement books and mailings, as well as memorial services of remembrance twice per year, Hospice of the Valleys does not believe in adding to the burden of patients or their families by asking for reimbursements or co - pays that are not covered by insurance. For example, Medicare does not cover a $5.00 co -pay for each medication that each of our patients are prescribed; however, Hospice of the Valleys takes care of that cost and does not pass the co -pay on to our oatients. During times when end of life is imminent, we do not want our patients and their families to incur yet another expense. Dur goal is to ensure no one is turned away or provided with limited hospice care simply due to their inability to pay. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. For every patient on our service. Hospice of the Valleys makes numerous visits to the the patient and their family, to wherever they call home. From nurses, to home health aides; doctors, to social workers; and even spiritual care and bereavement staff we see patients many times a week to care for them as they near the end of their lives. These visits are all hours of the day and night, as well as on weekends and holidays. Funds will be used towards patient care and costs not covered by Medicare or other insurances. This includes, but is not limited to, provisions such as medication delivery services, incontinence supplies, overbed tables, medication co -pays, and mobile shower equipment, just to name a few. We estimate that we will serve approximately 240 patients in Temecula from March 20, 2020 through June 30, 2024 (already served 125 from 3/20/20 to 8/15122) for a total of $20,285 54 spent from 3/20/20 to 8/15/22 and we can project that we will double that by June 30, 2024 ($40,571.08). These items keep our patients comfortable; alleviate the burden to their caregivers; and help with added expenses that families shouldn't have to amass at the end of their loved one's lives. Additionally, our Hospice Hearts have become an invaluable gift we offer to our patients' families and caregivers. When separated, the tiny inner heart can be placed with the loved one who has died as a reminder of their unbroken connection to those who remain behind. Numerous families who have received the hospice hearts have told us how meaningful they are and how they would be treasured. Hospice Hearts are $6 per and we offer an unlimited amount to families when their loved one has passed. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS We serve approximately 350 patients a year in Southwest Riverside County, and since year 2000, 15% of our patients reside in Temecula. When looking at our patient count, since March 20, 2020, we have served 120 Temecula patients (residents as of 8/15/22) and can estimate that at least one of these patient's family members or friends also benefited from our services (as many of the provisions we provide ease the burden for the caregiver). We can also estimate that our services in the City of Temecula, will double the 120 patients number through June 30, 2024, for a total of 240 patients that we are including in this grant. The patients we serve are presumed low -moderate income persons based on the fact that they are either severely disabled adults and/ or senior citizens (age 62 and above). Our patients have been diagnosed with a terminal illness and have 6 months or less to live, as certified by a physician. While we expect to serve approximately 240 total patients residing in the City of Temecula (from March 20, 2020 through June 30 2024), the scope of our service extends beyond the patient. Our hospice team also assists each patient's caregiver as they journey through the dying process. Our interdisciplinary team is available to assist caregivers in making difficult end -of -life decisions and help families navigate the many issues surrounding death. Once the patient dies, Hospice of the Valleys provides comprehensive bereavement support and education to families/ caregivers, extending the number of individuals we serve 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT I 240 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 1 20 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION L CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS The Senior Assistance Program provides compassionate hospice care to the terminally ill patients of Temecula and to support to their families. During times when end of life is imminent, we ensure no one is turned away or provided with limited hospice care simply due to their inability to pay. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. The COVID-19 pandemic affected Hospice of the Valleys and in turn, serving the Temecula community, in a number of ways which are listed below: • The pandemic forced people to remain in their homes and not frequent their doctor's office. As a result the number of patients that were admitted was down considerably; lowering our census and funding. • Patients also were coming on to service later than usual as a result of not visiting their doctor; again causing a deficit to our per day funding/insurance reimbursements. • Some patients did not want staff in the home for fear of transmission so giving care brought many new challenges. • Our doctors were only allowed to do tele-visits as opposed to in person care. • Volunteers were not allowed to visit patients which put a further strain on caregivers and patients alike. • Staffing shortages as a result of illness and burnout. • Increased costs in terms of PPE (Personal Protective Equipment) as staff had to be protected to work at facilities or patient homes. • Staff who are not vaccinated needed and continue need to be tested each week at a cost to us. • Significant labor expenses in regards to COVID training, tracking, contact tracing, reporting. • Certain items, gloves for example, were in short supply and cost more than ever before. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM- The U.S. Census Bureau (American Community Survey) estimates Temecula's population to be approximately 110,846 as of 2021, with over 10.5% being 65 years and older. While Hospice of the Valleys provides care to all hospice patients regardless of age, the majority of our patients are senior citizens. Hospice of the Valleys currently cares for approximately 350 patients per year, with 15% of those patients residing in Temecula. As this group of 11,639 senior citizens in the City continues to age, there will likely be a greater need for hospice services in the grant service area. In order to meet this anticipated demand, Hospice of the Valleys will continue to raise funds through grants, donations, fundraisers, community support, and our planned giving program. The work we do with our Senior Assistance Program has been existing since our founding 40 years ago and will be indefinitely ongoing City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM $ 50,000 Amount of money requested from this City of Temecula Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 3,326,212 Organization Other grants or funding already awarded for Project/Program, if any $12,717 In -Kind match amount or volunteer credit hours estimated amount $ 49,837 TOTAL REVENUE $ 3,438,766 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment I $626,298 Facilities/Rent/Insurance $151,571 Sup p lies :overbed tables, full -electric beds, incontinence supplies, and medication co -pays 3/20/20-6/30/24 $ 40,571.08 $ 33,493 $156,828 $53,146 Marketing Services Mileage exp for patient visits Other Hospice Hearts: 240 patients x 10 hearts/family x $6.00 each $ 14,400.00 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ 2,681,346 $3,757,653.08 TOTAL EXPENSES $ TOTAL BUDGET $ (318,887.08) City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Hospice of the Valleys_ MAILING ADDRESS: 25240 Hancock Ave. Ste. 120 PHONE: (951) 200-7800 Murrieta. CA 92562 _ _ EMAIL: _omathias@hovsc.or _ PRESIDENT / AUTHORIZED OFFICER: _Paul Mathias CFO SIGNATURE: /01uw to IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Melanie House Nr DATE: September 9, 2022 Development Coordinator SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions. Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA TAX BOARD BPO Q!)FRANCHISE BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 7/14/2022 ESL ID: 8598323706 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1131444 Entity Name: HOSPICE OF THE VALLEYS SC 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information ■ This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). • The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m, weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2D19) Q HELPB MENU Home > Tax Exemganization Search > Hospice Of The Valleys Sc < Bla&to Search Results Hospice Of The Valleys Sc EIN: 95-3846314 1 Murrieta, CA, United States Other Names Publication 78 Data e Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits, Tax Year 2019 Form 990 Tax Year 2018 Form 990 Tax Year 2017 Form 990 Tax Year 2016 Form 990 Tax Year 2015 Form 990 Page Last Reviewed or Updated. 20-November-2020 P► Share $ Print Form 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) uepfrrr MIt of Ihq TrNrxury ► Do not enter social security numbers on this form as it may be made public. InlMeo rRevenue S40 rta ► Go to wwjJrs.AfovIFormB 0 for Instructions and the latest information. OMG No, 1545-0347 Open to Public Inspecllan H ror me zuzu cafenoar year, or tax yenr beginning 2020, and ending , 20 B Checx if applicable; C D gmptoyH Identification numher Addfesschange HOSPICE OF THE VALLEYS SC, INC. 95-3846314 Name, change 25240 HANCOCK AVE, STE 120 E Telephone number Initial return MURRIETA, CA 92562 951-200-7800 Final relurn/terminated Amended rclurn G Gross mc,l.pU $ 6 297 143. Application pending F Name and address of principal officer: LYNET E CVAR MfA) Ix INh a group return for nowaolmesi Yes No Same As C Above Ill l Are all subo,drnates included? Yes tic If'No.' attach a list See inslruclions I Tax-exempt status: X 501(C}{3) 501W (iourt no.) 4947(a)(1) or 527 J Webslte: ► Hllr W.1joSpICEOPTHEVALLEYS.ORG Mil Group exemption number ► K Form of organizalicn: {;prpfpalilHl Trust Association Other"` L Year of lorrnalion: 1983 1 M state of legal domicile: CA r nrerjrry aescnee Inc organlzatfon-s nusslon or roost signiCCant activilies:(�e foster reverence _f_or__1_ifeJ_relief of-----ngs-----m---In in loss for the_ter_Mi_na.1�i11 residents -.and -their families in the communities we serve,_ E- - -- - - - - - -- - - -----_--------- c 2 Check This box ► if the organization discontinued its operations or disposed of more than 25% of its net assets, -------.---------e-------_-_-_._---------- . - - - 0 3 Number of voting members of the governing body (Part VI, line la)... ... 3 9 e'a 4 Number of independent voting members of the governing body (Part Vl, line lb),....... , , , 4 ayi A 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a). -5 64 6 Total number of volunteers (estimate if necessary) ... _ .. . .... . ......... . .... 6 -52 a 7a Total unrelated business revenue from Part VIII, column (C), line 12 ................ . . ... 7a 0. b Net unrelated business taxable income from Form 990-T, Part 1, line I ... 7b 0 . Prior Year Current Year 8 Contributions and grants (Part Vill, line Ih)........... _ 66,351, 531 200_ 9 Program service revenue (Part VIII, line 2g), .. . 5, 861 297. 5 704 345. 10 Investment income (Part VIII, column (A), lines 3, 4, an dj 14,323, 16,311. 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9 , I 1 107 795. 42 952. 12 Total revenue - add lines 8 through 1 I (must equal P , co Nnur (A), line 12) 6 049 766. 6 2 4 808. 13 Grants and similar amounts paid (Part IX, column (A), lines 1.3). 14 Benefits paid to or for members (Part IX, column (A), line 4) ... .. . . 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)..... 3_ 857, 048: 4 306 846. 16a Professional fundraising fees (Part IX, column (A), line l le),.. . . b Total Fundraising expenses (Part IX, column (D), line 25) ► 113, 477. 17 Other expenses (Part IX, column (A), lines Ila-1 ld, 11f-24e). 1 783 463. 1 875 r 6I7. 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) _y1 .t 5 640,511, ,� 6 182 463. 19 Revenue less expenses, Subtract line 18 from line 12 . , . , , . • • • • • , , . , . • • • , _40 9, 255 . BeAnof Current Year 112 345. End of Year 6 20 Total assets (Part X, line 16) ...... 2 820 982. 2,899,195. 21 Total liabilities (Part X, line 26).... . 363 380. 320 322, 22 Net assets or fund balances. Subtract line 21 front line 20. 2,457,602. 2 57a .863. Part ff Signature Block penalties of perjury, I declare Ihet I nave examined This returnincluding accptrlpanymg schedules and slatornents, and to line besl of my knowledge and belief, it is true, correcl, Declaration of preyarer (other Ihan nl6i 0 Is based on all information of o i preparer has any knowledge, and l now Cernplele. Sign r 5rrralwaorallkrrr —nai4 — Here LYNETTE CVAR CA0/CF0 Tpa -, "nnnf nnmo Ww Irulu Prinlrrype preparer's name Proparel'e signature male Check PTIN Paid Paul J Ka ark, CPA Paul J Ka mark CPA eu-empleyj d P01873961 Preparer FwW, nanr.= ► NIGRO & NIGRO PC _ Use Only F,.,,,; adLfe„ ► 25220 Hancock Ave Ste 400 Furrrs FIN � 30•-0636241 _ MURRIETA, CA 925624 Phow-lo. (951) 698-8783 May the IRS discuss this return with the preparer shown above? See instructions., IXI Yes I T—No BAA For Paperwork Reduction Act Notice, see the separate Instructions. TEen01011- 0111901 Form 990 (2020) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 23 INLAND VALLEY SYMPHONY AKA TEMECULA VALLEY SYMPNONY CITY OF TEMCULA FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICAMON (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ S* 0 0 O MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: n � E ASO rJ Of 14 0 P e Start Date: of. I End Date: 70.23 Physical Address of Project/Program: Tfrx¢eAt dj$1I 1 SsS AMCL& VIr+� ��, '��rrirr,+ �• INCLUDE IF DIFFERENT THAN ORGANIZATIONS MAILING ADDRESS Cat u 9L If Grant is Awarded, Make Check Payable to: xN C- w b IA ON �qpkW, TW e Mailing Address: ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant v AM e' Organization: a Year Founded: q Q R Website: WWLV-'rEFAF-CI.LA fA11 M Iw. •O�Social Media: w�• IFACEAoOK.CQ rmBcuAA- Number of Paid Staff: '� oZ- Number of Volunteers: Geographic Area(s) the Organization Serves: 11 fA E Geographic Area(s) the Prolect/Program Serves: T M r,0 UAA \101 iq NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY US D TO SERVE TEMECULA. Contact Name: QLQ KA To 0 5 Title/Position: C �W-rrVC IDIAEGTOA Contact Person's Direct Telephone: SI g• 271 — Contact Person's Email: GJ4AIA Too S 09ai 0 Gon,414. Parr NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: -I• U - 77 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 15002000 State Identification Number: a 0 r PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: hItpA/appsjrs.Aov1app1eos1 2. ❑ Attach State Entity Status Letter using this link: httl5-9'-:1/www.ft.c . ov n Ine e f serve entity status letter/inde?x.as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt ://rct.do .ca. avN dfica ion eb/Sears s 0f ilt -Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 4 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations Investments, or interests in real property with a Temecula City Council Member during the past 12 months? No Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No � Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee V\] Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES, MISSION STATEMENT Temecula Valley Symphony aspires to provide quality, innovative, and compelling music programming and serves as a leader of the arlS in our community, through an organization that provides the support necessary for these efforts, in an atmosphere that is fun, positive, and supportive. MISSION STATEMENT The purpose of Temecula Valley Youth Symphony is to enrich the lives of student musicians with outstanding educational and performance opportunities for all levels, in a nurturing and challenging environment without discrimination. Working together with parents, private and school music instructors, TVYS will provide the finest possible training with rehearsal and performance opportunities to enable the students to develop, share and Further enrich their lives through the power of music. TVYS believes that music is proven to enhance student performance in all academic areas. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FMDMG SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes P9 IF YES, PROVIDE BELOW, -' "LiF% vv101wM 0UUKGES—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PRDIIECT OO IN THIS APPLICATION? NO Yes IF YES, PROVIDE INFORMATION IN TABLE BELOW. City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Ft ev +z�t�.5 Grant funds will support "SEASON OF HOPE" and allow us to invite Is of school children and senior citizens to our concerts with FREE ADMISSION. Monies will be used for marketing and outreach materials to spread throughout the community. Payment will be made to various musicians for participating in the program and demonstrating their instruments. Printed materials distributed at concerts will contain educational information about the composer, the style of music, and the instruments featured on the concert. i 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO. INCLUDE A LIST OF GOODS, EQUIPMEMENT. AND/OR SERVICES THIS ORGANIZATION HAS �— PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Compensate musicians for performances, website improvements, increase marketing to promote higher visibility and recognition in the community. TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Two large concerts will be held at Temecula Valley High School with outreach to local students, music studios, and school band programs. Dv outreach through the Temecula Valley UttiHed school district. Special concert invitations will be distributed at places like the Mary Phillips Senior Center, and various senior housing communities in Temecula, offering FREE Tickets to the concerts. Free tickets will also be distributed to the Boys and Girls Club and other local charities. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION 1056 50 Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. SEASON OF HOPE will focus on providing FREE concert tickets to hundreds of local Temecula residents (focusing on the elderly population), and local students and their families. Concerts will include some music selections composed by minority or female composers and will include educational elements in the presentation of materials and/or the music performance itself. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Due to lockdowns, we had to cancel 6 concerts and were unable to schedule further concerts until Covid-19 restrictions were lifted. Consequently we not only lost performance revenues but also most of our sources of donations. Were it not for a couple of pandemic related relief grants received from the State and Riverside County, we would have been forced to close down our organization completely. Due to lack of funds we were unable to resume full concert scheduling for both the last and the upcoming season. Inflationary pressures have increased most of our basic general operating expenses as well as the cost of musicians because of higher cost of living, especially gas prices. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. One of our goals for our 2022-2023 Season is to offer FREE CONCERTS to Temecula Valley Uuiflic School District's students and families to educate them about symphonic music which is proven to improve the mental health of students. We will use grant funds for marketing and outreach throughout the community to also offer free tickets for the elderly and senior citizens in the Temecula Valley. As part of our educational program we also host a young artist concerto competition and will select winners to perform at our April 22, 2023 concert with the Symphony. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) I - -LINE ITEMS FOR PROJECT/PROGRAM REVENUES jEXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50 000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ Organization 19,333 Other grants or funding already awarded for Project/Program, if any $ 3,000 In -Kind match amount or volunteer credit hours estimated amount $ 38,500 — _ TOTAL REVENUE $ 110 833 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment a $ 0 Facilities/Rent/Insurance $ 9,275 Supplies $ - — 2,090 Marketing I $ 16,133 Services $ 50,560 ~ Food - — I 1,000 Other $ 14,495 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; f HOWEVER PLEASE INCLUDE, $ 17,280 TOTAL EXPENSES TOTAL BUDGET' $ 110,833 $ 110,833 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACIK7. O WLEDGEWNTISIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient Is subject to aft COrnmunityServlce Funding Program requirements inciudingsubmittal deadlines and payment disbursements. • Every Community .Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. ■ The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding.should accrue to the City of Temecula. • Commurlfty Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were .used apprOpriately. F Community Service Fund€nggrants will not be awarded or announced within the 60 days before an election In which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as Incomplete. Vwe hereby certify the information contained in this Application is true to the .best of our knowledge and belief. ORGANIZATION NAME: Inland Valley Symphony, Inc. dba Temecula Valley Symphony MAILING ADDRESS: PO Bay. &17 Temecula, CA 92593 PHONE: ( 9511333-4945 (Alwia) or 818-?31-09314,A�na) - EMAIL,• W&najoos a) a�Lcnna PRESIDENT / AUTHORIZED OFFICER: MAIA CANTIRELL TREASU..RFR y -Pl ;rNr NA F TITLE SIGNATURE: DATE: Q� �[)�� IF DIFFERENT TH MQNT}I, DAY, YEAR A�AI30VF, APPICATION PREPARED BY:. ALANA 100S - EXECUTWE DIRECTOR PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MQNDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn., City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@Temecul,-)CA.gov (951) 694-6413 Betsy.Lowrey@TerneculaCA.gov (951) 6W-3959 C€ty of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELP® MENU E Home > Tax ExemQrganization Search > Inland Valley Symphony Inland Valley Symphony EIN: 33-0862000 1 Temecula, CA, United States Publication 78 Data e Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-13F, 990-T) e Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2020 Form 990EZ Tax Year 2019 Form 990 Tax Year 2018 Form 990EZ Tax Year 2017 Form 990EZ Tax Year 2016 Form 990EZ STATE OF CALIFORNIA rry� FRANCHISE TAX BOARD f r F• 1 S PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/9/2022 ESL ID: 5729240826 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 2045812 Entity Name: INLAND VALLEY SYMPHONY 0 I. The entity is in good standing with the Franchise Tax Board, ❑ 2. The entity is not in good standing with the Franchise Tax Board. X3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California al a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidabllity of contracts made by the Entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-862-5711 from 7 a.ni. to 5 p.m. weekdays, except state holidays 916-845-6500 from outsisie tlu United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) HOME ABOJI- MEDIA CA R --: E R EGC -AT I 0Nf--; RES0 R S PROGRAMS CUDNT/1U, Registrant Detail Entry ype Cot por;; e Class u5 registered with the secc2Lai v of e. or based ran fol,r6ng 60CL11 Organization Name: INLAND VALLEY SYMPHONY IRS FEIN: —3.10862000 Entity Type; Public Benefit SOS/FfB Corporate/Organization Number: 2045812 Registry Status: Current Renewal Due/Exp. Date: 11/15/2022 W.-I'Registration Number: CT0162898 Issue Date: 7/19/2010 Record rfy . pe: Charity Registration Effective Date: 7/19/2010 Date of Last Reneivak 11/18/2021 DBA: MaHing Address Street: PO BOX 637 Street Line 2., City, State Zip: 'I'EMECULA CA 92593 Filings & Correspondence UWiW=y—ULUaUQ,11 Delinquency 1st Notice ondi g—DAmmenta Uarm 990--EZ 412 M1 L-1-= RKE-11 IQL6 IME-1 2009 &ULZJ�() I Form 9901? Lk 7M) LRE- L 2 QL1 IRUIDGNTP-9 21L L. L" RS ul t,1 ()9() Z(L Return Check Letter Founding Documents 2012 RRLF-I 2012 IRS Form 990-EZ 2004 RR F- 1. 2005 RRF-1 2006 RRF-1 2007 RRF-1 2009 RRF-1 2010 IRS Fonm 990-EZ 2008 RRF-1 2011 RRF-I 2011 IRS Foirn 990-F7 2009 IRS Form 990 2008 IRS Form 990-EZ Confirmation ol'Registration First Notice to Register Secolld Notice to Register 2021 2018 2019 2020 2013 RRF-1 2013 IRS Form 990-1 Z 2015 RRF-1 1 ' -Z 2015 IRS Fonn 990-E.Z ?415 rm-���'1"��w 2015 IRS Forrn 940-F1 2016 RRF-1 �'.511T17 RAF-1 2017 IS { =92017 Annual; Renewal Data Status of filing: Accepted Accounting Period Begin Date: 7/1/2009 Accounting Period End Date: 6/30/2010 Filing Received Date: 12/1/2010 Furin RRF-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason; Notes From Registry Staff; Status of Filing; Accounting Period Begin Date: Accounting Period End Date: Filing; Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Rejecl/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/incomplete Reason: 1, arm CT-TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason; Notes from Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period Fnd Date: Filing Received Date; Form RRF-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff. - Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form C'r-'i'R-I Reject/Incomplete Reason. - IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff; Status of Filing: - Accounting. Period Begin Date: Accounting Period End Dates Filing Received Date: Accepted 7/ 1 /2010 6/30/201 1 11/17/2011 Accepted 7/ 1 /201 1 6/3 0/2012 10/31 /2012 Accepted 7/1/2012 6/30/2013 11/1K2013 Accepted 7/1/2013 6/30/2014 2/9./20 Li Accepted 7/ 1/2014 0./3 0/2015 1!5/2016 Form RRF-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/lncomplete Reason: Motes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-t RejectAncomplete Reason: Form CT-TR-I Reject/incomplete Reason: IRS Form 990 Reject/Incomplete Reason: ]Votes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Forst RRF-1 Reject/Incomplete Reason: Forst CT-TR-I Reject/incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Accepted 7/1/2015 6/30/2016 11 /18/2016 Accepted 7/1/2016 6/30/2017 11/16/2017 Status of Filing: TAccepted Accounting Period Begin Date: 7/1/2017 Accounting Period End Date: 6/30/2018 Filing Received Dale: 11/20/2018 Form RRF-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason: IRS Form 990 RejectAncomplete Reason: Nalm From Registry itnff! Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CC TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/incomplete Reason: Notes From Registry Staff. - Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date- Forin RRF-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason., IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Sialux of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/lncomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reiect/Incomplete Reason: Votes From Registry Staff: Accepted 7/ U2018 6/30/2019 11/12/2019 r+"Up *u 7/1/2019 6/30/2020 5/10/2021 Accepted 7/ 1 / 2020 6/3 N2021 10/20/2021 04 Nay}/~�1 5£•, I I(7W r,HOU r MECIA CAREERS REGU! ATOMS RE OUROES PROCRWOS 1ONTAC:T Cack on the Organization tYlemn- for details about the registration Or report record, The maximum number of records shown per page Is 5t7. If there are multiple pageq of th, reaulu, the c{ickable page numheis, wilt be d,splavud at tha bottom, If rots get trio many results or do not Sind ttte aryartlzation fur wttfGt you arts searchmQ, rfFrk the 'Sears button and Change the search cdterfa. it Is lft+st to search oy something that I as unique to the Olganiaatlan as Ogsibie sues as State Charity Registratlori Number. FCIN, � Corporate Number, ur an ilnuSual porLium Of their name. TO See pli regI$tratmn and report records aSWoated with an'IN"Metron. avoid "archmg by State Charity Reoistra Number as that Is regard-speciflc. 9earcit►L in I ORGANIZATION MADE RECORD TYPE REGISTRY STATUS RCT NUMBER FEI liC17 CharityF�egtstration-- — _,C.urret}t 330$62000tiEME[ 2020 FEDERAL EXEMPT ORGANIZATION TAX SUMMARY (EZ) PAGE 1 INLAND VALLEY SYMPHONY 3R-0862ann FORM 990-EZ REVENUE 2020 2019 DIFF CONTRIBUTIONS, GIFTS, AND GRANTS....... PROGRAM SERVICE REVENUE 40,196 98,769 -58,573 ..................... INVESTMENT INCOME....... 12,973 , 1 83, 744 -70, 771 ........ . ........... 1 0 TOTAL REVENUE., ....... . ....... ...... .... 53,170 182,514 -129, 344 EXPENSES PROFESSIONAL FEES/PYMT TO CONTRACTORS PRINTING, PUBLICATIONS, AND POSTAGE....... 36,683 119,218 -82,535 OTHER EXPENSES. .... .... I ......... -.......... 441 18,521 250 48,445 191 -29, 924 TOTAL EXPENSES ....................................... 55,645 167,913 -112, 268 NET ASSETS OR FUND BALANCES EXCESS OR (DEFICIT) FOR THE YEAR... NET ASSETS/FUND SAL. AT BFG. OF YEAR.... -2, 475 35,235 14,601 20,409 -17, 076 14,826 OTHER CHANGES IN NET ASSETS/FUND BAL.. 1 225 -224 NET ASSETS/FUND BAL. AT END OF YEAR ... 32,761 35,235 -2,474 coy. Registry of Charitable Trusts P.O. Box 903447 Sacramento, CA 94203-4470 Telephone: (916) 445-2021 WEBSITE ADDRESS: ht1 Wa4j.ca.uov1charitiesl c7V/6 z eo?8 INITIAL REGISTRATION FORM STATE OF CALIFORNIA OFFICE OF THE ATTORNEY GENERAL REGISTRY OF CHARITABLE TRUSTS (Government Code Sections 12580-12599.7) Pursuant to Section 12585, registration is required of every trustee subject to the Supervision of Trustees'and__ Fundraisers for Charitable Purposes Act within thirty days after receipt of assets (cash or other forms of property) for the charitable purposes for which organized. Every charitable (public benefit) corporation, association and trustee holding assets for charitable purposes or doing business in the State of California must register with the Attorney General, except those exempted by California Government Code section 12583. Corporations that are organized primarily as a hospital, a school, or a religions organization are exempted by Section 12583. Name of Organization: Inland Valley Symphony, Inc. Yin:. -- --- - T:.: y,,, uumci r�): „ Official Mailing Address for Organization: Address: 4035 Kenosha Ave. city: San Diego State: CA ZIP Code: 92117 Organization's telephone number: (858)270-4521 Organization's e-mail address: info@iniandvalleysymphony,org Organization's fax number: N/A organization's website: In(andValleySymph6ny.Org All organizations rr►ust'apl�ly Car a F ,. erali rrip3ciye d(„�-,M,iMatlan[Nu bat 'ti brganizatloris'thaf;Haire a` rou 3 ek tons riile'oinucl'returns 't�"'' :.,..,.ls......I—- S. I P a Federal Employer Identification Number (FEIN): Group Exemption FEIN (if applicable): 33-0862000 x�yk?..• '" llfl Caifiarnia'corpora tlons air�cl fpreigit�.fir corpor7.7 -f the �umpo �cr. UnincorrAtecl o'{rjanlzaiion5 3re_AZ91i cl m California tax.exesnEitin,i .' : ;l��h [Corporate or Organization Number: C2045812_ Attorney JUN a 1 2010 Ch:1mof ie ffusto CT-1 REGISTRATION FORM (6/2007) Names and addresses of ALL trustees or directors and officers (attach a list If necessary): Name Alana Joos Position President Address 3359 Savannah Way city Palm Springs state CA ZIP Code 92262 Name Douglas Bast Position Vice President Address 29670 Cottonwood Cove Dr. city Menifee state CA ZIP code 92584 Name Emily Miller Position Secretary Address 30207 Silver Ridge Ct. city Temecula state CA ZIP Code 92591 Name Linda Daugherty Position Treasurer Address 27041 Rock Bluff Ave. city Temecula state CA ZIP Code 92591 Name Sharon Rollinson Position: Coordinator Address 4035 Kenosha Ave. city San Diego Describe the primary activity of the organization. (A Copy or the material submitted with the application for federal or state tax exemption will normally provide this Information-} If the organization is based ouIsIdc California, comment fully on the extent of activities In California and how the California activities relate to total activities. In addition, list all funds, property, and other assets held or expected to be held In California. indicate whether you are monitored In your home state, and I so, by wham. Attach additional sheets If necessary, The specific purpose of Inland Valley Symphony is to provide orchestral experience for all age groups, to train younger musicians, to create an interest in musical careers by performing In schools and in public concerts and to improve the cultural experiences available to all citizens in the Inland Valley clgl;mports annualfj Been.days Jitvr'the: or',etotai �isseYs'are'a wehsiter at htlp llac If assets (funds, property, etc.) have been received, enter the date first received Date assets first received: July 1999 What annual accounting period has the organization adopted? Fiscal Year Ending June 30 Calendar Year CT-1 REGISTRATION FORM (6I2007) Attach your founding documents as follows: A) QQLPRERILPEL5 - Furnish a copy of the articles of incorporation and all amendments and current bylaws, if Incorporated outside California, enter the date the corporation qualifled through the California secretary of State's Office to conduct activities In California. B) Associatlons - Furnish a copy of the instrument creating the organization (bylaws, constitution, and/or articles of association). C) Trusts - Furnish a copy of the trust Instrument or will and decree of final distribution. D) Trustees for char table ur oses - Furnish a statement describing your operations and charitable purpose. Has the organization applied for or been granted IRS tax exempt status Yes E) No 0 Date of application for Federal tax exemption: Jilly 26, 1999 Date of exemption letter: July 2000 3 Exempt under Internal Revenue Code section 501(c) If known, are contributions to the organization tax deductible? Yes EJ No p (IRS Attach a cop y of the Application for Recognition of Exemption IRS Form 1023) and the determination letter issued by the IRS, Does your organization contract with or otherwise engage the services Of any commercial fundraiser for charitable purposes, fundralsing counsel, or commercial coventurer? If yes, provide the name(s), address(es), and telephone number(s) of the provider(s): Commercial Fundraiser Fundraising Counsel E Commercial Coventurer Name -- Address city State ZIP Code Telephone Number Commercial Fundraiser Fundraising Counsel Commercial Coventurer Name Address City State ZIP Code Telephone Number Commercial Fundraiser ❑ Fundralsing Counsel [ Commercial Coventurer Name Address City State ZIP Code Telephone Number I declare under penalty of perjury that I have examined this registration form, Including accompanying documents, and to the best of my knowledge and belief, the form and a�p9 cumenl are true, correct, and complete. Title Date CT-1 REGISTRATION FORM (6/2007) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 24 INTERNATIONAL CHRISTIAN ADOPTIONS CITY OF TEMECUL& FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 Amount Requested: $ Project/Program Title: PROJECT/PROGRAM INFORMATION 18,160 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Community Counseling Start Date: 9/12/2022 End Date: 5/3012023 Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: ICA Mailing Address: 41745 Rider Way, Suite 2 Temecula, CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: International Christian Adoptions (ICA) Year Founded: 1990 Website: 4achild.org Number of Paid Staff.. 53 Social Media: @4achild on Instagram and Facebook Number of Volunteers: 0 Geographic Area(s) the Organization Serves: State of California and North Carolina Geographic Area(s) the Project/Program Serves: Temecula Valley Residents NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Charlotte Paulsen Title/Position: Executive Director Contact Person's Direct Telephone: (951) 704-4354 Contact Person's Email: chadottep@4achild.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes 0 Date of Incorporation as a Nonprofit: 1990 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0412343 State Identification Number: 33-0412343 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: http://apps.irs.govta2pleosl 2. ❑ Attach State Entity Status Letter using this link: RECEWED httr)s:lfwww.ftb.co.00v/online/self serve entity status letter/index.as 7�t 3. El Attach first page only of most recent IRS Form 990 or attach print out of dejLppd i gb your charity found on this State Registry's Search Tool: http:llrct.doi.ca.gov/VedficatlonNVebl a rc s ?� x faclillv�Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, Investments, or interests in real property with a Temecula City Council Member during the past 12 months? No K Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑■ Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors [j Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCI " See Attachec FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT, DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Pane R of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes 0 IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Sunridge Community Church $ 410g0 September 2022 - May 2023 Community Counseling Donation $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO ❑ Yes [ j IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR NAME OF ENITY RECEIVED FUNDING RECEIVED $ q55 U SCRI FY Jul 22 - Jun 23 $ J351 201) U RM Reimbursement Contract 1 FY Jul 22 - Jun 23 ' $ 2-2, / S,2 County Riverside Foster Services FY Jul 22 - Jun 23 $ C�), a#p PAARP Services FY Jul 22 - Jun 23 $ io, 03,q Heartland HS - PRS Contract FY Jul 22 - Jun 23 $ USCCB-US Conf. Catholic Bishops FY Jul 22 - Jun 23 $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE F— ------- — --- --- 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. * See Attached Form 12 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. * See Attached Form — - - - - 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. * See Attached Form — — — i 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 50 Children & Families 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 10 City of Temecula Community Service Fundinq - Reinvestment in Temecula GRANT APPI Ir.ATlnti D.— A -f 1 a PROJECT/PROGRAM DESCRIPTION C'ON77NUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. * See Attached Form 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. " See Attached Form 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. " See Attached Form City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 International Christian Adoptions City of Terneculo Community Service Funding Reinvestment in Temeculo Grant Program Policy Applicotion 01).12-22 Mission Statement of Organization: International Christian Adoptions (ICA) believes in the sanctity of life in that all children born and unborn are valued and uniquely made. Our overriding mission is to offer children hope in the love and compassion of Jesus Christ; hope for basic needs; hope for an education and bright future; and hope for a home in a family they can call their own. The mission is fulfilled through adoption, foster care, humanitarian aid, counseling and support. In addition, the following is our Covenant: • To promote and secure the emotional, spiritual and physical welfare of children who have been victimized, abandoned or persecuted; found in the streets, war zones, government run institutions, refugee camps or family homes. To actively engage in providing immigration and refugee resettlement services to those fleeing persecution, war, oppression and poverty. To provide an environment of peaceful and humanitarian exchange to foreign students and those who go abroad. • To offer an environment where hard working artisans can be paid a fair wage and a given the dignity of self-determination through fair trade. • To provide opportunities for orphans to experience culture ad sense of family with camps to America and in their country. • To widen the horizons of Americans by sending them to foreign countries to experience differing cultures through a myriad of work projects, camps and activities. • Maintain a Haque compliant licensed child placement agency under a different name in accordance with the laws of the State of California in order to provide temporal foster care and adoptive placement. • Maintain several programs to enhance ICA's mission which is not limited to but includes immigration and refugee resettlement services; foreign student exchange program; fair trade; cultural camps; mission programs and tours, and other social service programs. 1.Describe the project/program the Temecula grant funding will support: The Child Trauma and Learning Center at ICA provides mental health and counseling services and support to children, youth and families. Our counseling office in Temecula services all surrounding areas including residents of the City of Temecula. We specialize in serving diverse populations: foster and adoption backgrounds, trauma, childhood, adolescent and family issues, anxiety, depression, addiction, trafficking victims, refugee and immigrant youth, under 18 years of age. Additional services include parent support, case management, educational support/advocacy, etc. It is our desire for children and youth who are struggling with mental and behavioral health concerns, trauma, and grief, can receive the support and services they need in order to attain a well-balanced independent lifestyle, despite any financial hardship. For this reason, one of the goals of the Child Trauma and Learning Center at ICA is help any member in need of services despite lack of financial means. It is our goal to continue to provide financial assistance through scholarships and financial aid for all support services, including but not limited to: provide trauma -informed, person -centered, comprehensive case management services, facilitating timely access to vital services they need to stabilize and re-establish their ability to live independently. These comprehensive services include, but are not limited to, receiving emergency assistance, housing, safety planning, basic needs, health, legal, education, employment, language support. pg 1 of 5 international Christion Adoptions City of Terneculo Community Service Funding Reinvestment in Temecula Gront Program Policy Application 0.9.12.22 Most of our counseling clients/families are referred through Riverside County for Foster Care and two other sources of our programs funded by California Department of Social Services for which our counselors provide services: The Unaccompanied Refugee Minor (URM) Foster Care Program, helps children or youth who have been separated from their families due to war, conflict, natural disaster or abuse by caregivers who were meant to protect them. These situations create upheaval in their lives forcing them to flee from countries to the United States. ICA's counseling services help to ensure children are placed into safe and secure homes. ICA social workers conduct home visits and ongoing case management services. The central purpose of the Trafficking Victim Assistance Program (TVAP) program is to help foreign national survivors of human trafficking achieve HHS certification and provide trauma -informed, person -centered, comprehensive case management services, facilitating timely access to vital services they need to stabilize and re-establish their ability to live independently. These comprehensive services include, but are not limited to, receiving emergency assistance, housing, safety planning, basic needs, health, legal, education, employment, language, and assistance in accessing HHS Certification 2. Describe how the organization will spend the grant funding, if awarded: (Also, include a list of goods, equipment, and/or services this organization has purchased or plans to purchase with awarded funds to support the program/project) 1. A primary goal of the Child Trauma and Learning Center at ICA is to offer counseling services despite a client's inability to pay. It is our goal to continue to provide financial assistance through scholarships and financial aid for all support services. While the Trauma Center program budget carries approximately 4% of the agency's $4.5M budget, the Trauma Center relies on funding from our other state and grant programs to support its professional services. Currently, the program budget receives $216,166 in revenues to cover $240,392 in expenses. Direct Counseling income from clients is projected at $38,643 yet direct cost of counseling services is $61,769. ICA would like to request a grant to A grant fund from the City of Temecula in the amount of $18,164 to partner with ICA in providing for 80 sessions (8 client/family units at an average of 10 sessions per client/family unit). (See next page for FY22-23 Program Budget detail). Iig, � '.,f `. Internotionol Christian Adoptions Community Service Funding Reinvestment in Temecula INTERNATIONAL CHRISTIAN ADOPTIONS 4000 - Contribution Revenues 4100 • Contracts for Services (4% E)asting Contracts) Grant Proposal - City of Temecula 4109 • USCRI 4111 • State of CA- URM Reimbursable Contract 4112 • CountyRiverside Foster Services 4113 • PAARP Services 4114 • Heartland HS-PRS Contract 4115 • USCCB-US Conf.Catholic Bishops Total 4100 • Contracts for Services 4200 • Program Service Fees 4220 • Counseling Income 4222 Psychological Evaluation 4223 Counseling Discount 4220 Counseling Income - Other Total 4220 • Counseling Income Total Income Grants Summaryof Expenses Counseling Services Program Tools & Equipment Facilities, Rent& Insurance Supplies Marketing Services Food Other Personnel Total Expenses NET Income/Loss City of Temecula Grant Program Policy Application 09.12.22 FY22-23 Budget 4,080 455 135,200 22,182 2,240 10,032 3,514 173,623 2,200 (8,938) 45.381 �t:tZ:tIKE 216,346 11,149 12,083 1,282 331 56,269 1,200 12,617 inn Alli 195,262 Grant Request 18,164 (18.164) 21,084 $ 18,164 3: Explain how the grant funding specifically benefits Temecula Residents: (Temecula residents must benefit from this program/project if awarded city funding) The Child Trauma and Learning Center at ICA offers counseling services to the residents of the City of Temecula despite a resident's inability to pay. Partnership with the City of Temecula would provide a continued and reliable source of financial assistance through scholarships and financial aid. Last year our counselors served 86 clients and 865 sessions. This is an average of 10 sessions per family at a unit cost of $278, yet ICA charged on average only $55 per session. Most clients/families cannot afford to pay so we offer financial assistance. International Christian Adoptions City of Temecula Community Service Funding Reinvestment in Temecula Grant Program Policy Application 09,12.22 ICA would like to ask the City of Temecula to consider sponsoring eight families at an average of 10 sessions. The program cost is $18,164.00, Proiection based on FY21-22Service Records Number of Clients/Family N u m be r of Sessi ons Unit Per Unit Cost 86 $ 2,270 865 $ Average Number of Sessions per Client/Family 10 Grant Request: t 8) Families @ ( 10) Sessions Aver 8 226 2,270.49 18,163.91 Due to the nature of the clients we serve, there is a high level of confidentiality so families in Temecula who are currently struggling with the lack of mental and behavioral health services and who are suffering from economic hardship would still be able to receive counseling services. The City of Temecula would play a vital role in sustaining a healthier community by providing social services to families and children through counseling services on how to maintain positive mental health techniques, implement coping skills, reducing the current trauma in society, and joining in the need for healing. Our agency could be an additional resource to the City. 4: Summary Statement — Summarize answers 1-3 above in 50 words or less ICA is not only an ada2tion aeency. Child Trauma and Learning Center provides mental health counseling services support to families in Temecula Valley. We specialize in foster care, adoptions, trauma, childhood, adolescent and family issues, anxiety, depression, addiction, human trafficking victims, refugee and immigrant youth under 18 years of age. S. If applying for more than $5,000, please explain how the COVID-19 Pandemic affected this nonprofit organization's ability to serve the Temecula Community. You may also include inflationary concerns. The Child Trauma and Learning Center at ICA offers counseling services to the residents of the City of Temecula despite a resident's inability to pay. During the Covid-19 Pandemic, when business was forced to shut down, families struggled not only economically, but also to keep their children active and engaged. Families in Temecula saw a rise in depression and anxiety while their youth were struggling with mental and behavioral health dysfunctions. Now that our city is moving back to a sense of normal business operations, many families cannot afford counseling services. Many are struggling to find gainful employment. Yet the youth continue to internalize the effects of the shutdown as children and youth were forced into isolation and education was moved to distance learning. Today, there are many who continue to struggle to get back to sense of normalcy. The Trauma Center saw a decrease of in-house counseling services during the shutdown of March 16, 2020 and thereafter. Not having the ability to see children in -person at the office, which is the most beneficial course of therapy for most children, created a backlog of services. Our counseling team was able to pivot our company completely on-line for Teletherapy services. However, the retention of clients dropped significantly due to many of our clients who fall under the age of 10, or who suffer from ADD/ADHD had struggles focusing for therapy on a computer screen for any length of time. There were also those clients who did not have the means to a confidential and safe space to conduct therapy, or those children and youth who did not have access to an electronic device and/orinternet. International Christian Adoptions City of Temecula Community Service Funding Reinvestment in Temecula Grant Program Policy Application 09,12.22 6. If applying for more than $5,000, explain how funds have or will- (1) CREATE new Project/Program (2) EXPAND existing Project/Program AND/OR (3) CONTINUE existing Project/Program 2. A primary goal of the Child Trauma and Learning Center at ICA is to offer counseling services despite a client's inability to pay or inability to attend in-house sessions. It is our goal to continue to provide services through financial aid. ICA's Program Budget for FY22-23 provides for Direct Counseling income from clients at $38,643 and direct cost of counseling services is projected at $61,769. ICA would like to request a grant to A grant fund from the City of Temecula in the amount of $28,164 to partner with ICA in providing for 80 sessions (8 client/family units at an average of 10 sessions per client/family unit). In the hopes of receiving grant funding from the City of Temecula, and in order to continue providing existing services, ICA has expanded it program budget to include the following: 3. Purchase of 4 iPad Pros for client use at a total of $3,600. The cost of $900 per Wad is a small cost compared to the loss of services for the family members who could not afford an electronic devise and were not able to receive consistent services during times when access to in -office services was not available. Because the Covid variants continue to grow, this method of continuity of services will help serve our client's needs in desperate times. Alternatively, for a family who may not have the transportation means to attend in-house services, this may keep our counselors connected with a needy family. 4. A grant fund from the City of Temecula in the amount of $18,164 providing for 80 sessions (8 client/family units at an average of 10 sessions per client/family unit). Inflationary cost estimates all already factored into FY22-23 program budget for all our program needs including, but not limited to, office rent utilities, program and therapy supplies. p of PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $18,164 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ Organization 212,264 Other grants or funding already awarded for Project/Program, if any 4,080 In -Kind match amount or volunteer credit hours estimated amount $0 TOTAL REVENUE $234,510 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food —Other I Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET $234,510 EXPENSES $11,149 $121083 $1,282 $331 s56,269 17200 $6,987 $105,961 $195,262 $195,262 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 [==-- ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. ■ Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately, • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: International Christian Adoptions (ICA) MAILING ADDRESS: 41745 Rider Way, Suite 2 Temecula, CA 92590 PHONE: (951 695-3336 EMAIL: charlottep@4achild.org PRESIDENT/AUTH RlzEDOFFICER: C arlot Paulsen WI IN17INTA SIGNATURE: IF DIFFERENTTHAN ABOVE, Jennifer Mitchell APPICATION PREPARED BY: Executive Director 'IT�E DATE: 09/12/2022 MONTH, DAY, YEM Office Manager of Child Trauma & Learning Center SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey,Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemecuiaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELPB MENU Home > Tax Exempt Organization Search > International Christian Adoptions International Christian Adoptions EIN: 33-0412343 1 Temecula, CA, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: GROUP Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2020 Form 990 Tax Year 2019 Form 990 Tax Year 2018 Form 990 Tax Year 2016 Form 990 STATE OF CALIFORNIA FRANCHISE TAX BOARD nTB POCRBOX 942857 SAAMENTO CA 94257-0540 Entity Status Letter Date: 9/8/2022 ESL ID: 5733937788 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1664688 Entity Name: INTERNATIONAL CHRISTIAN ADOPTIONS ❑X 1. The entity is in good standing with the Franchise Tax Board. EJ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d EJ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Form 990 OMB No 1545-0047 2020 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Oppeen to Pubfre lnspecton "apatbnent of the Treasi,ry ► Do not enter social security rt imbers an this form as it may be made public. tnitrmnl rLevenue Service ► Go to wHrv.irs.govIl'oraifor instructions and the latest information. A For the 2020 calendar year, or tax year beginning 7/01 2020, and ending 6/30 .202021 B Check if applicable: c D Employer Identification number Address change INTERNATIONAL CHRISTIAN ADOPTIONS 33-0412343 Name change INSTITUTE FOR CHILDRENS AID E Telephone number Initial return 41745 RIDER WAY #2 951) 695-3336 TEMECULA, CA 92590 I anal relurn/leimiratcd Amondea return G Gross-e"ipcti $ 4, 228, 400. Lj Application pending F Name and address of principal officer: CHARLOTTE PAULSEN K(a) is this a group return for subarnglnTcs� Yes x No Same As C Above HIM Are all subordinates included Yes Do I Tax-exempt status: If "No;" attach a list- See instructions K 501(c)(3) 501(1) ( )� (insert flo,) 4947(ax1) or 527 J Website: ► WWW. 4ACHILD.ORG tr(c) Group eiinmphon number ► 6068 K Form of organization 7X Coiperation I I Trust I I Assocalion Ll Other ► L Year of formaton: 1990 lift stale of low, domicile: CA Part I I Summary 1 Brie Illy describe the organi zati o n's mission or most significant activities -TO OFFER CHILDREN HOPE IN THE LOVE AND COMPASSION OF�JESUS CHRIST nk BASIC NEEDSL FOR AN AND BRIGHT U _EDUCATION _ AND HeOPF FAR A HOME IN A FAMILY THEY CAN CALF, THEIR OWN. THIS I5 FEILFILLED ccFUTURE,_ _TH_R_0_UG_H_ CARES HLUI fANITARIAN CD_UNSE_L_ING AND SUPPORT - - -_ -_ -- - - - - 0 _ADa_PTIa_Nt _F'tiSTER _AID_ 2 Check this box ► if the organization discontinued its operations or disposed of more than 25%-of its net assets._ _ _ 0 3 Number of voting members of the governing body (Part VI, line la)....... 3 7 ee 4 Number of independent voting :members of the governing body (Part VI, line ib) 4 w 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) .. 5 C9 ? ;_ 6 Total number of volunteers (estimate if necessary) 6 a 7a Total unrelated business revenue from Part VIII, column (C), line 12 7a 0, b Net unrelated business taxable income from Form 990-T, Part I, line 11 7b Q, Prior Year Current Year d 8 Contributions and grants (Part VIII, line IF) 3 851 399. 3 787 276. 9 Program service revenue (Part VIII, line 2g). 134 438. 110 300_ m10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) 267 cc 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 1 le) 2,236. 326 345. 12 Total revenue - add lines 8 through 1 1 (must equal Part VIII, column: (A), line l2) 3, 988, 073. 4,224,188. 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 19 049. 14 Benefits paid to or for members (Part IX, column (A), line 4) .. a 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 2, 013 061. 2 r 0320 581. 16a Professional fundraising fees (Part IX, column (A), line Ile) b Total fundraising expenses (Part IX, column (D), line 25) ► uFL 1,365, 589. 1, 564, 992, 17 Other expenses (Part IX, column (A), lines 1 la-11d, l if-24e) 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 3,397, 699, 3 597 573. 19 Revenue less expenses, Subtract line 18 from line 12 590 374, 626 615. 8 Beginning of Current Year End of Year 2,582, 687. 2,947,255. m 20 Total assets (Part X, line 16) - 21 Total liabilities (Part X, line 26) .. 513 049. 251 002 . 2 069 638, 2 696 253. zLL 22 Net assets or fund balances. Subtract line 21 from line 20 ran 11 1 as nature C31UGR :1ndcrpar47lbm of parjoy. I declare that thave eKam i.ned tf+ o tn. including xc pany1n9 Schedules and stolements, and to the Des of my knowledge and 'belief, it is bile, correct, and compfeto rliecfArat on of prap8tpir (glhar han ef!pci) is "4 oe II lnrarmnnan of QWn rimparri tins my kr•awlydq� Sign Here '4Jignalffne or officer 1 v-r+---- ..- — — CHARLOTTE PAULSEN Data Executive Director ype or print name and tit e, Paid PrimType preparer's name William A Harris III Preparer's signature William A Harris III Date Check U a Self-en,ploynn IP00614689 PTIN Preparer Use Only Firm's name ' ELITE FINANCIAL SOLUTIONS firm'=_address ' 301 E FOOTHILL BLVD., STE. 201 ARCADIA, CA 91006 Firm'sFIN ► 20-8044652 Phone no 626 Z56-1400 May the IRS discuss th s return with the preoarer shown above? See instructions JXJ Yes I I No BAA For Paperwork Reduction Act Notice, see the separate instructions. TEEAOl01L 01n9121 Form 990 (2020) EXECUTIVE SUMMARY International Christian Adoptions institute for Children's Aid (ICA) is not just an adoption agency. The institute began in 1990 as a non-profit 501(c)(3) corporation with its principal office in Temecula, CA. The institute consists of two major divisions: International Christian Adoptions and the Institute for Children's Aid (ICA) which is inclusive of the Chill ,rrauma Esc Learning Center, We stand on Biblical principles in all we do, lending hospitality and sanctuary to all who are in need. We are a voice For those who cannot speak for themselves, believing that all life is sacred. Our staff is multi-lingual, multi -ethnic and professionally trained to assist in various capacities. This mission of protecting, supporting, and assisting the most vulnerable within our. community is fulfilled at ICA through adoption, foster cart, humanitarian aid, counseling and support. Mission Statement International Christian Adoptions (ICA) believes in the sanctity of life in that all children born and unborn are valued and uniquely made. Our overriding mission is to offer children hope in the love and compassion of jesus Christ; hope for basic needs; hope for an education and bright Future; and hope for a home Ina family they can call their own. The mission is fulfilled through adoption, foster care, humanitarian aid, counseling and support. Our Covenant a To promote and secure the emotional, spiritual and physical welfare of children who have been victimized, abandoned or persecuted; found in the streets, war zones, government run institutions, refugee camps or family homes. • To actively engage in providing immigration and refugee resettlement services to those fleeing persecution, war, oppression and poverty. ■ To provide an environment of peaceful and humanitarian exchange to foreign students and those who go abroad. To offer an environment where harts working artisans can be paid a fair wage and e given the dignity of .self-determination through Fair trade. • To provide opportunities for orphans to experience culture ad sense of family with camps to America and in their country. ■ To widen the horizons of Americans by sending theirs to foreign countries to experience differing cultures through a myriad of work projects, camps and activities. • Maintain a Haque compliant licensed child placement agency under a different name in accordance with the laws of the State of California in order to provide temporal foster care and adoptive placement. Maintain several programs to enhance ICA's mission which is not limited to but includes immigration and refugee resettlement services; foreign student exchange program; fair rralLIC; cultural camps; mission programs and tours,and other social service programs. ICA is a well -established organization that me:cts the standards and qualification of many accreditations such as Accreditation of Rehabilitation Facilities (CARF), Intercountry Adoption Accreditation and Maintenance Entity. Inc. (IAAME), United States Agency of International ❑evelopment (USAID), National Council for Adoption (NCFA) and Evangelical Child and Family Agency (ECFA). In addition, ICA is a Full -service fosterrcare and adoption agency for International and Domestic Adoptions, as well as multi -County Domestic Foster Care and Refugee Foster Care programs. ICA also operates a Jubilee Exchange Fair -Trade Store in efforts to educate the commun i ty of the benefits and impact of purchasi ng fair-trade items both locally and world-wide. Our beautiful hand. -crafted fair-trade items can be found in our office or at various educational events. (Farmers Markets, conferences, pop -ups) DEMOGRAPHICS AND COVID PANDEMIC ICA has seen a rise in mental and behavioral dysregulation since the onset of the COVID-19 pandemic with escalated emotional and psychological traumas for children, youth and families in the community. According to a U.S. Census Bureau report, the number of people experiencing acute anxiety, depression and dysregulation are up 42'yo in the US (Leonhardt, 2021). As COVID- 19 protocols loosen, more families are seeking counseling services for their children. This is being reflected at ICA as the average monthly services provided have risen by 38% during the first quarter of 2022 in comparison to that of 2021, The Narional Alliance on Mental Health (NAM[) (2020) reported that 16% of adolescents (ages 12.17) experienced a major depressive episode (MDE), while 33% of young adults (ages 18-25) experienced a mental illness during the COV [D-19 pandemic. Further, 20%of young people report that the pandemic had a significant negative impact on their mental health. As a society, we must recognize that ouryouth have experienced unique circumstances during the pandemic:, including isolation, transition to virtual learning and drastic changes to routine that severely impacted the mental health of youth and young adults. The impact on children and youth has been significant, and the need far support and care is imperative (NAMI, 2020). Another 2021 study on the mental health of U.S. high school students during the pandemic, conducted by the Centers for Disease Control and Prevention (CDC), showed how impactful the pandemic was on the mental health of high school youth. This study indicated that 37% of students reported they experienced poor mental health during the COVID-19 pandemic, and 44% reported they persistently felt sad or hopeless during the past year (CDC, 2022). The Office of Population Affairs quoted in a Mental Health for Adolescents article, "Globally, the prevalence of youth experiencing clinically elevated anxiety symptoms - roughly 1 in 5 - nearly doubled during the first year of the COVID-19 pandemic", (OPA)(n.d.) (Racine, McArthur, Cooke) (2021). ICA serves people from diverse backgrounds, including many who have experienced trauma or come from the child welfare system. Half of all youth in foster care have a diagnosable mental health disorder (OPA, md.) (Youth.Gov, 2018). Children who are living in foster care have a substantially greater risk of experiencing mental health disorders, especially those connected with traumatic stress, such as abuse and neglect (OPA, n.d.) (Youth.Gov, 2018). In addition, 21% Of youth ages 6 to 17 who live in poverty have mental health disorders (OPA, n.d.) (Lipari, Hedden, Blau, Rubenstein) (2016). It is estimates! that 49.5% of adolescents have dealt with a mental health disorder at one point in their lives (OPA, n.d.). As a non-profit, [CA seeks to offer low -cast, high duality services to our clients. However, many families who have a great need for services find even these low-cost services a hardship. PARTNERSHIP Institute For Children's Aid (ICA) Child Trauma & Learning Center would like to partner with the City of Temecula in Fulfilling the mission of serving vulnerable populations within the Temecula Valley. ICA is requesting the City of Ternecula's consideration for a financial grant. The Institute for C:hildren's Aid Child Trauma & Learning Center serves the community by providing therapeutic support to children, adolescent youth and families. We specialize in serving diverse populations; Faster and adoption backgrounds, trauma, childhood, adolescent and family issues, anxiety, depression, addiction, trafficking victims, refugee and imrnigrant youth, ranging From 0- 18 years of age. Additional services include parent support, case management, educational support/advocacy, etc. It is our desire for children, youth and families who are struggling; with mental and behavioral health concerns, trauma, and grief, can receive the support and services they need, despite any financial hardships a family may face. PROGRAM COSTS In California, the average cost of an hour-long traditional therapeutic session ranges from $65 to $250 for those without insurance (Leonhardt, 2021). As a non-profit 501(c)(3) and as a service to our community, [CA's Child Trauma & Learning Center desires to be as affordable as possible. The fee charged to our clients for an hour of therapy at ICA is $55 per session. But FY22-23 Program Budget estimates costs her session are $278. The center offers services well under market value and has utilized previously awarded financial donations as scholarships to families who are suffering from economic hardship, sometimes on a sliding scale depending on the scholarship awarded or level of need. Our therapists see the need For and importance of conducting services in office and in person, especially for our young clients who struggle to sit still or focus thmugh an hour-long telehealth session. However, for those clients who prefer, we continue to offer telehealth sessions as an option. The comfort of our clients is always a top priority when offering options for therapeutic care. Our therapists also offer 24/7 on -call support to our clients and families. With the addition of grant funds, the ICA Child Trauma & Learning Center would have the ability to continue offering scholarship services to families impacted by financial hardships including individual therapy, group therapy, family clinics, parental skills training, life skills training, educational support services, or case management. A financial grant would provide support to families who are unable to cover the weekly or bi-weekly services. This is especially important when considering high risk clients, those with self -harm concerns, and/or suicidal ideation. The program cost for a standard individual therapeutic session is $278. A client/Family unit will be serviced. at an average of 10 sessions valued at $2,270. Therefore, a grant of $18,1.64 would provide financial assistance for 100 sessions or 8 families at 10 individual therapeutic sessions to clients who have a financial need, and at no cost to the client. THE NEED FOR SERVICES IN OUR COMMUNITY ICA continues to see the clients despite lack of ability to pay for service. This meets with the California hoard of Behavioral Sciences. ethical standards, until mental and/or behavioral issues resolve, accepting whatever financial compensation the client was able to afford. For example, in one particular circumstance, we accepted $10 per therapeutic session from a previous client who was experiencing a financial hardship. As part of a larger agency, the ICA Child Trauma & Learning Center can operate at little to no over -head costs allowing for continual treatment for clients. Overall, the grant funds would allow the Child Trauma & Learning Center to have a lasting positive impact, promoting mental health and healing by increasing the amount of services that: are offered to the families and children with financial hardships that are suffering in our community. There is a high need For therapeutic services for children and youth in the Temecula Valley, many offices are overflowing and have had to place prospective clients on wait lists to be seen, sometimes those clients must wait a full-12 weeks before seeing a clinician. At ICA, we do everything we can to see clients within 1 week from the day they initially call the office. After the past almost three years dealing with a world-wide pandemic, our youth need to be able to receive the help they and their families need. With the addition of grant funds, ICA would also have the possibility to hire another clinician to meet those needs within our community. Last year (FY) UNN-JUL22), ou r pwgram serviced 86 client/family emits: (59) from the Temecula Valley area, (12-Domestic and Foster care families referred from Riverside County and (5) International adoption families. Services to residents in the Temecula Valley area were 82% of our total counseling services. The Child Trauma &x Learning Center provides a comfortable office with trait ma -in formed staff, including licensed clinicians and supervised associates. The clinicians have access to any of our five therapy rooms and many therapeutic tools. Each therapy roam is equipped with a variety of warm and welcoming decor, lighting and activities to meet the specific needs of each client. For example, some clients who have experienced trauma and/or have a specific diagnosis/disability, may have sensitivities to fluorescent lighting requiring a warmer light environment, or may require therapy to take place in an open spars, Each of ICA's therapy rooms were intentionally designed for children with adverse bacl(grounds in mint!. The Child Trauma & Learning Center is equipped with various tools: arts and crafts, board games, hooks and toys, along with many sensory tools like sand/bean buckets, sand tables, blanlcers, stuffed animals and weighted therapy blankets designed to help with sensory processing. The staff at ICA create tailored treatment plans to best suit each client and their needs. Our clinicians value their clients input and strive to create a sense of empowerment and investment from the client's ixrspective. The clinicians take a holistic approach tocach client's case, in order to hest serve their needs, The: client is paired with theclinician that would have the best approach and potentially strongest therapeutic relationship with the client. By doing this, the greatest outcome for therapeutic success for the client can be achieved. To make this achievable, ICA's C:hilcl Trauma &r Learning Centcrnnakes available multiple options for scheduling to allow families to receive the support they need. Adhering, to COVID-19 CDC Guidelines, ICA offers services through telchealth, in -person and in -home therapeutic services (when therapeutically appropriate). Understanding our client's hesitancy regarding COVID-19, ICA provides options, to make each client feel comfortable with their therapeutic experience Therapeutically, we use a combination of the following to provide the most effective approach to healing for each client: evidenced --based modalities including Trauma Focused Cognitive Behavioral Therapy (TF-C BT), Cognitive Behavioral Therapy .(C13T), Dialectical Behavioral Therapy (DBT), SOlution-Focused, narrative Therapy, Trust Based Relational Interventions (TBRi), and evidenced -based techniques (such as Guided Imagery, Mindfulness, Play Therapy, Art Therapy, deep breathing, etc.). After determining the best modality for each client, our clinicians will provide tailored treatment places with adapted techniques suited for each client and decide with the client and fain the hest option for success. An individualized plan will be developed for cacti client to determine the best course of healing. In order to maintain growth and sustained progress, our clinicians will frequently re-evaluate the plan for each client. Due to the Child Trauma &z Learning Center being part of a larger organization with many different programs, the center can thrive without touch overhead costs, allowing fees for services to remain low For clients. This allows For a long-term presence of therapeutic services being available to the community. With the acid itionaI grant funds from the City of -f emecula, the Child rratima &r Learning Center would he equipped to provide support and services to more children and famiIics who are currently struggling with the lacl< of mental and behavioral health services. Through this, we can have a greater impact to reach and sustain our community by teaching the families and children how to maintain positive mental health techniques, implement coping skills, reducing the current trauma in society, and joining in the need for healing. Thank you for your consideration in partnering with ICA in support of our children and families in need. The support is appreciated and will aid in the healing, empowerment and growth for the children that we serve in our local community. ft 0 , �.. r I AIL d. 3�I Aw• i 2021 ANNUAL REPORT �.�MINSTITUTE FOR CHILDREN'S AID,(dba �11 OJ 2 2 104 =1 WOTOUN 9 ro -v XF Headquarters Branch Office Branch Office Pi 41 /1800 Mal Lin Lutl-lot King 4-5 der Way P2 6248 Birdcage St. P�:Irkwy 20'1 I ern E-.Nc u I a, C59 A 92.0 Citrus Heights. CA 95610 1--)urharyla, NC 77707 'Ca IAA E 7�j C'Ir� kP44 2021 Annual Report OUR MISSION International Christian Adoptions (ICA) began in 1990 as a non-profit 501(c)(3) corporation with its principal office in Temecula, CA. ICA consist of two major divisions; International Christian Adoptions and the Institute for Children's Aid. We stand on Biblical principles in all we do lending hospitality and sanctuary to all who are in need. We are a voice for those who cannot speak for themselves believing that all life is sacred. Whoever you are, and whatever your need as a family, we are here to help you. ICA is dedicated in helping children and their families around the world and in the United States. Our staff are multi- lingual, multi -ethnic and professionally trained to assist in various capacities. ICA believes in the sanctity of life in that all children born and unborn are valued and uniquely made. Our overriding mission is to offer children: • HOPE in the love and compassion of Jesus Christ • HOPE for basic needs • HOPE for an education and bright future • HOPE for a home in a family they can call their own. This mission is fulfilled through adoption, foster care, humanitarian aid, counseling and support. 2 ` 2021 Annual Report OUR SERVICES 3 Everything we do is for the children. We have comprised a set of comprehensive services and programs to provide children with loving and safe homes. We work closely with the parents and forever families to ensure an environment where the child can continue to grow and become their best self. Contact our caring and professional staff to learn more. Adoption Services r As a licensed, non-profit adoption agency, ICA provides compassionate and caring services to the adoptive triad (birth parents, adoptive parents and children). Foster Family Services Providing loving support and comfort to abused and neglected children through mentoring programs, reunification services and respite care. Humanitarian Aid Providing relief services to foreign and domestic orphanages and to the children in domestic residential facilities. This relief includes goods delivered, foreign exchange programs, transitional homes and micro business support. Child Trauma & Learning Center up Qualified, well -trained Christian professionals provide counseling services and support groups to birth parents, adopted children, adoptive parents, foster children and foster parents. Family Training We provide ongoing support to the adoptive family and the children they are parenting, both before and after placement. These classes prepare the adoptive and foster families for the special emotional and developmental challenges that they can expect when raising children who have been in institutional care. a 2021 Annual Report 4 Children's Peace Exhibit Institute for Children's Aid presents the first registered museum of its kind to Southern California's Temecula Valley. The Children's Peace Exhibit offers an interactive journey for children and adults of all ages, where they travel through the complexity of contemporary issues affecting children on a global scale. Children and Adults start theirjourney with their own exhibit passport and work through 14 exhibits tackling problems that many children face such as abuse, child slavery, child labor, war, refugees, homelessness, hunger, education and others. Each exhibit is designed to equip and inspire its visitors to learn the facts, identify the problems and become an important advocate for change. The Children's Peace Exhibit is an experience all in itself with the purpose of educating others of the plight of children worldwide while providing innovative ways to make a difference. Interactive stations and artwork provide a unique forum to view exhibits from museums around the country, giving tangible depictions of challenges to children's rights that are rarely discussed or seen. 0 Explore Children's Rights Connect for Positive Change This interactive exhibit showcases Discover, support, and work children's universal rights and the 0 alongside a variety of groups and problems/conflicts they face on a day organizations that seek to protect to day basis when those rights are and support sustainable change for suppressed or violated. children worldwide. 0Understand the Issues Care for Children �;� This exhibit engages with individuals �� Cultivate compassion and care for and communities on an interactive these children. Be equipped to make level to bring about understanding a difference within your local and and cooperative action. global community. ` 2021 Annual Report RECRUITMENT In 2021, due to the pandemic and cultural shifts, our primary way of meeting for all programs was through digital conference calls. We shifted from monthly in -person and on site Info Meetings to individually planned and focused Info Meetings through Zoom. Towards the end of 2021, we were able to thankfully host 1 in -person event. ' Tem- Temecula CH- Citrus Heights D - Durham Info Meetings (Total Number of Families: 94) Tem-4, CH-7, D-1 ■ Tern-5, CH-8, D-0 Tem-5, CH-5, D-0 • Tem-6, CH-7, D-7 Tem-3, CH-5, D-0 Tem-3, CH-2, D-0 Tem-2, CH-0, D-0 a Tem-3, CH-1, D-0 - • Tem-3, CH-2, D-0 0 Tem-2, CH-8, D-0 • Tem-2, CH-6, D-0 e - Tem-2, CH-1, D-0 Significant Events for 2021 Due to Covid 19 Restrictions, we were only able to hold 1 Pastors & Leaders Breakfast in October. 2021 Annual Report SOCIAL MEDIA 1,034 Facebook Followers 754 Instagram Followers awe amelr a 0 Aw a arA.r e 20% fOM e le -EA 3e . e-ea Si +. eea a-H r AA-« 1.-Aa ee. • ■ AA . A wan.n A AMF Tap.k. Top C.. bola., G -- CA gayaq G Aa,Nfn,G w,G � e e.{ rrrrrr• E n eY, nbpe.G NNtlo,mr,G Nena., G u4 ENYNre G �,eN r� 13M iY.dmk� CA N'CA lJa ENme� CA 1M EY�.G .. LLeM ppCwnVb .>.Ywra e 1DN a t,K p3M I V 6N 1VIM �VI 3M RupY. 1 Yr.M I aA% BralA I p.3N I p 3M NpeN I U.JM Facebook • 7,034 facebook.com/4achild 754 instagram.com/4achild 6 With seeing the need to improve our digital presence, it has become of major importance to streamline all of our digital and graphical presentations. In 2021, we have seen the need to continue to establish our "brand", we have done so with a slight logo update, fonts, colors, social media shifts, PowerPoint implementation and website updates. Our goal is to continue with stability of posts, but with an emphasis on streamlining our brand. In order to streamline the overall process, it started with our social media and has since branched into every other department and a lot of our forms and documents. We learned that our families were receiving a disconnect in the Recruitment Process from beginning to placement because we hadn't kept the ICA brand intact. It has been a slow -going process, but a fruitful process as our families have been blessed by the shift. AV2021 Annual Report INTERNATIONAL PROGRAMS International Adoptions 7 ICA is Hague Accredited and fully licensed to do adoption related services in both incoming and out -going cases. It also serves relative families who are adopting related children in the US or out -of -country. ICA has statewide licenses in California and North Carolina but can also work in other states through its partner agencies. ICA is registered in Bulgaria, India, Latvia, Philippines, Poland, Romania, and Taiwan and works in partnership with other Hague approved agencies in many other countries. In addition, ICA offers supervisory services in Hungary and China. ICA conducts a 4-week Welcome Home Program in the countries of Latvia and Philippines for children who are eligible for adoption. We track International families adopting in countries where ICA is registered. ICA is considered the "Primary Provider", which means ICA receives the referral of the child. When ICA is the "Supervising Provider", the adoptive family is working with another agency (who becomes the Primary Provider), ICA completes the home study and supervision reports which are submitted to the Primary Agency. An ICA social worker will typically be assigned to these cases. Respite Care Qualified foster families are needed to provide after school care, transportation to medical/ dental appointments, tutoring, mentoring or temporary care for a child. Temporary care can extend for a few hours, to overnight or weekend visits. This allows primary caregivers and/or child a break from their routine. It a Iso assists families who may have out of town obligations or celebrations wherein the child is not allowed to leave the country (24 hours or more). The hallmark of this program is that foster families help each other. Multiple families provide this ca re. all 2021 Annual Report N DOMESTIC PROGRAMS New Beginnings We provide counseling to expecting parents to determine the best plan for them. Should the birth parents decide to make an adoptive plan, they participate in selecting a family profile of home study approved adoptive families. ICA provides services and support for the adoption triad (child, birth parent, and adoptive parents.) Inquiry meetings between interested families and ICA have taken place. Safe Harbor 0 This is our domestic traditional foster care program for children. Resource Families become an extension of the Court system, "safe harboring" children with the goal of reunification with their birth family. A Resource family interfaces with the birth parents, supervises visitations, transports to medical/ counseling appointments while caring for the wellbeing of the child. Resource families continue to care for and support the child through the different phases of the child's cou rt case. Resou rce pa rents a re a vita I pa rt of the child's team. This program includes infants, toddlers, school aged children, teens, and non - minor dependents. Resource Families receive monthly financial aid for the care of the child and the children receive Medi-Cal benefits. ON 4 2021 Annual Report NOW DOMESTIC PROGRAMS America's Orphans These are children currently in placement within the foster care system. ICA holds contracts with multiple County Department of Children's Service agencies. At any given moment there are over 423,997 children nationwide within the Foster Care System and over 122,216 are waiting to be adopted (Children's Bureau, June 23rd, 2019). School -aged children, sibling groups, boys, and teens are currently available for adoption. This is a no -agency fee program with minor incidental costs for assessment. Once families are assessed and approved they are considered Resource Families. Resource Families will be challenged to equip themselves through books, videos, seminars, and live trainings to meet the needs of these children on their path towards healing. Resource Families receive monthly financial aid for the care of the child and the children receive Medi-Cal benefits. A 2021 Annual Report JOURNEY OF HOPE IoLong Term Foster Care (LTFC) On March 1, 2003, the Homeland Security Act of 2002, Section 462, transferred responsibilities for the care and placement of unaccompanied children from the Commissioner of the Immigration and Naturalization Service to the Director of the Office of Refugee Resettlement (ORR). Unaccompanied children apprehended by the Department of Homeland Security (DHS) are transferred to the care and custody of ORR. ORR promptly places an unaccompanied child in the least restrictive setting that is in the best interests of the child, taking into consideration danger to self, danger to the community, and risk of flight. ORR takes into consideration the unique nature of each child's situation and incorporates child welfare principles when making placement, clinical, case management, and release decisions that are in the best interest of the child. Long- term foster care is the care plan for a child/youth to remain in a specific fostering placement for an extended period of time until the child's18th birthday. This is the least restrictive, most family -like environment for children in care. The population served are mainly children from Central and South America who have migrated to the US for various reasons of safety, economic or political turmoil, community violence, etc. Children in LTFC receive the following services; case management, legal/immigration, mental health, medical/dental/vision, psychiatric as needed, educational, independent living, cultural support, and extra -curricular. 10 AV2021 Annual Report JOURNEY OF HOPE Gunaccompanied Refugee Minor (URM) ICA works with the most vulnerable populations. The URM program ensures that eligible youth populations receive the full range of assistance, care and services available to all foster children in the state by establishing a legal authority to act in place of the child's unavailable parent(s). Our programs encourage reunification of children with their parents or other appropriate adult relatives through family tracing and coordination with local refugee resettlement agencies. However, if reunification is not possible, each program works to design a case specific permanency plan for each minor oryouth in care. 11 kK 2021 Annual Report JOURNEY OF HOPE Special Family Finding ICA is opening homes for Unaccompanied Refugee Minors (URM) and Unaccompanied Children (UC) and is leaning away from traditional terminology by calling the homes Trauma Based Caregiver Families instead of foster homes. Technicallythey continue to fall within the foster -care systems. Some specialized homes are for female youth who have been trafficked and are struggling. These youth will be given 24/7 care to include evidence -based trauma counseling in Cognitive Behavioral Therapy (CBT). Other homes are for youth who have aged out of the systems like foster care or residential care. They learn independent living skills to include how to applyfor a job, resume writing, taking care of a home, budget planning, shopping, dating and many other valuable tools. 19 Family Preservation & Reunification Services (PRS) ICA helps to ensure unaccompanied children are safe, healthy, resilient and thriving, and that parents and caregivers are supported to create a safe and nurturing home environment. ICA does not endorse situations where these children are separated from safe family and helps to reunite them with loved ones who are well-equipped to care for them. Every child has the right to life, access to clean water, food, education, a safe environment and most of all HOPE for a future. 1 2021 Annual Report JOURNEY OF HOPE eTraff icking Victim Assistance Program (TVAP) ICA a partners with USCRI. TVAP supports foreign national adults and minors who have experienced human trafficking and are pursuing the Department of Health and Human Services (HHS) certification —a process that allows certified survivors access to public benefits and services under any federal program to the same extent as refugees. NAP facilitates timely access to vital services to stabilize and reestablish survivors' ability to live independently through needs -based financial assistance and comprehensive, trauma- infnrmorJ r Y . ,., ..* -•'-L- _ 13 2021 Annual Report CHILD TRAUMA & LEARNING CENTER The Child and Family Counseling Services program offers community -based counseling services in the Riverside County area. ICA has many years of expertise in assisting families and children, especially those children who come from trauma based circumstances. Many children come into a family through "blended" circumstances; many may have come from foster care; many have come from orphan institutional care and adoption. We understand the issues and the challenges many are facing. Our goal is to help our clients'unglue'the situations and get back to a healthy functioning family. There are a variety of individual, family or group sessions using strength -based therapeutic techniques. We provide services primarily to children, including individual and family, through Play Therapy, Trauma -Focused Cognitive Behavioral Therapy, etc. Sessions: 782 Afto- ` 2021 Annual Report 15 JUBILEE EXCHANGE ry.� Fair Trade Jubilee Exchange is a Fair Trade shop that promotes connecting producers and consumers in ethical trading partnerships through wholesale retail. Your support, provides long-term stable incomes and self sufficiencyto people in otherwise impoverished areas. Local artisans are paid above -market wages which provides a higher quality of life for themselves and their children. This ethical marketplace brings many fun and functional gifts and products to local consumers by partnering with a vast network of fair trade certified organizations such as Equal Exchange (Worldwide), SERRV (Worldwide), Altiplano (Guatemala), Prosperity Candle (Worldwide), Divine Chocolate (Ghana), UPAVIM (Guatemala), Rahab's Rope (India), Child's Cup Full (West Bank), Darzah (West Bank), Mayan Hands (Guatemala), Sak Saum (Camobdia), and Ten Thousand Villages (Worldwide), to name a few. Jubilee Exchange is a separate non-profit under the umbrella of ICA. ICA has expanded its services to include the fair trade store, artisans, assisting missionaries who will be working alongside prospective artisans, job training and employment for young adult refugees in this country (teaching them warehousing, clerical skills, store management, inventory control, etc.) The shop items are mobile and are taken to various invitational events used to encourage an open dialog of our various programs. Sales from the Jubilee Exchange shop are used to do good and make a positive difference in the lives of children, families, and communities worldwide. r Local Business Support WCarter's children's clothing brand and local businesses donated clothing to the children in our Foster to Adopt programs. r Christmas Gift Program r We partnered with Calvary Chapel Bible College who hosted a toy drive and Fair Trade Bazaar which collected Christmas gifts for children in our Foster and Refugee programs. We also received toy donations from Rose Again Foundation which we distributed to children throughout all our programs. MyStuffBags Foundation My Stuff bags Foundations granted ICA duffel bags filled with travel - sized hygienic products, blankets, toys, and books/puzzles for distribution to the many foster care children and foster care agencies in the California counties. ` 2021 Annual Report 16 HUMANITARIAN AID Local Church Support r Over a dozen churches in '9 the Riverside and San Diego counties including; Rancho Christian, Calvary Murrieta, and Calvary Chapel Bible College participated in sponsoring events and toy drives. They also invited families and individuals to participate by donating Hope Paks designed to support children in need. Each child in the Transitional Foster Care Program was provided with at least one 40 lb. bag of humanitarian aid items when they reunited with their family. Haiti & Philippines Throughout the year, ICA staff and our supporting families happily send donations and funding to children in Haiti and the Philippines. r Local Community Support The local community, along with Rose Again Foundation of Temecula have donated new clothes, shoes, school supplies, educational toys, diapers, wipes, toiletries, gift cards, and backpacks year-round. These items were distributed to children throughout our programs including our foster to adopt program, as well as any child in the community who had a need. ` 2021 Annual Report HAITI PROJECT ICA has built a transition home for orphan children receiving care in Haiti. Currently the home is being managed by the local Nazarene Church and the house parents are volunteering from the U.S. to help get the program started. Haiti has had such horrible disasters in the past years leaving its people without homes, food, adequate water and medical care. In a response to the needs of Haiti, in 2013, ICA reached out to the government, met with them and asked what the greatest need was. The resounding answer was homes for children in transitions. So, ICA began a long process that ended in an amazing partnership with Haitian nationals and a U.S. Church denomination. ICA will be building a "village" that will provide a home for children on the streets; a garden to help feed everyone and teach skills; sheep to herd; 'a small recreational area; a well for safe drinking water (which is very difficult to fix in Haiti) and a church. This is quite an undertaking for us. Some funds have been raised but we are farfrom our goal. ICA needs your help and support. Together with the local Haitians, we have designed our programs to protect children, preserve families, promote economic independence, all while proclaiming the gospel. We hope to empower future generations with a life of hope and possibility. Our mission is to prevent orphans and building strong families and communities in Haiti, We seek to help the most vulnerable families stay together and to encourage extended families and local communities to care for the orphans among them. �P42021 Annual Report FINANCIALS Revenues Earned 18 Revenues by Program - 2021 rM a long-term Fos ter Care (International( 3$! Unaccompanied Refugee Mnors (internatlonal) America's Orphans - Foster (domestic) Private Adoption Agency Reimbursement Program (PAARP) ■ Counseling 4 International adoptions llnternatlonal) ■ Contributions, grants and donations a JubileeStae sales EPcst-release 2021 ton Lterm ForterCert ntOrr WOrtel 1 298,s71 Unworn PAnt wtJ a M11 ns"ntsrnatton81 I8 U95 AJ WIn'LG! hsna•f a, demestIl 596 1011 Prh*taAdo t{on en RefrnbUr111MWtPrp s6PAARP i14000 Mal 44 321 lions: n11*ratfone!' 85,971j CcnA'hw1on tsend don wons 362802 Jub11*rStarera16 2,604 Rcrt release 112,91E Totet $ 4 22R 401,00 OFUNCTIONAL EXPENSES Expenses by Function - 2021 ■ Domestic 12 International Foster & Refugee a Institute Administrative 2021 DotileAic $ 894,201 International Foster & Retu ee 2,136,532 Institute 46,159 Admanj#rat;va 467,437 Total $ 3.594,329 25% 61% 1% 13% Hope Paks(Humanitarian Aid Gifts) Child Sponsorship Family Sponsorship Fund Gift of Life Fund Gifts of purpose Amazon Smile Program Shop Jubilee Exchange (Fair Trade Store) Monetary Donations/Gift Cards Child Trauma & Learning Center Scholarships ~7 ^� ����� ~ A~.�^/, . `u, n�N�~ n ZOO � � ' -.. .CQrf". IAWE FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 25 JACOB,pS HOUSE INC. CITY OF TEMECKJLA FISCAL YEAR 2022.202:3 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 f PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Jacob's House Inc. Start Date: 09101/2022 End Date: 08/3112022 Physical Address of Project/Program: 31525 Jedediah Smith Road Temecula, CA 92592 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Jacob's House Inc. Mailing Address: Same as above ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Jacob's House Inc. Website: Www•jacobshousetemecula.org Number of Paid Staff: 2 Year Founded: Dec. 2012 Social Media: Facebook, Instagram, Linkedin Number of Volunteers: 70+ Geographic Area(s) the Drctanizatian Serves: City, County, State, National & Internationally Geographic Area(s) the Promect/Pro rRI11 Serves: Citywide -Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXC UI� SIVELY USED TO SERVE TEMECULA. Contact Name: Martin Barrera-Martinez Title/Position: Executive Director Contact Person's Direct Telephone: 951452-2627 Contact Person's Email: martin@jacobshousetemecula.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes [I Date of Incorporation as a Nonprofit: 8/16/2007 NO ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 26-1183832 State Identification Number: PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. Al Attach IRS Deductibility Status using this link: htt ://a sirs. ov/a loos/ 2. 0 Attach State Entity Status Letter using this link: m https:/Iwww.ftb,ca.gov/online/self serve entity.status letterlindex.as 3. 0 Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt Jlrct.do .ca. avlVcrificatial�iWeblSearcl�.as x?faciiit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ❑K Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No [NJ Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND I I I LE WITHIN THE ORGANIZATION. This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ❑■ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Jacob's House is a home of refuge where families and loved ones of those in hospitalized traumatic medical need can find hope, comfort, peace, and inspiration. We are a community resource dedicated to serving families in crisis. We do this by providing a shelter for the physical, emotional and spiritual support. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY 13E rgEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Jacob's House $ Feb. 2022 City of Temecula CSF Grant Jacob's House $ Feb. 2021 City of Temecula CSF Grant City of Temecula CSF Grant Jacob's House $ Jan. 2020 $ S OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ❑ Yes L] IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ 5,000 $ 2,500 $ 1,500 Morongo Band of Mission Indian Grant Apr. 2022 Stater Bros. Foundation Grant t Jan. 2022 Riverside County BOS Community Improvement Designation Grant f Jul. 2022 $ 16,458 Small Business Administration (SBA) Paycheck Protection Program (PPP) Grant I Feb. 2021 $ 2,625 The Schultz Family Foundation $ 3,000 Harrah's Casino $ 15,000 California Relief Grant $ 420,000 Anonymous Medical Group (earmarked ONLY to payoff our mortgage) Mar. 2-021 Sep. 2021 Oct. 2021 Dec. 2021 � City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Jacob's House's City of Temecula Grant Application seeks to secure funds to sustain program services extended to families displaced by a medical crisis. Success is measured based on two formulas including: number of individual family members served, and number of nightsllength of stay. This total is calculated by 4 rooms by the number of days per year 365 aqua ling 1460 total nights of occupancy opportunities for the year. During the program years 2022-23 Jacob's House intends to serve a minimum of 100 family members, and provide a minimum of 500 overnight stays. These projections seek to maintain the current level of services in the wake of COVID-19, which reflects a 76% increase in program impact from Jan -Jul 2021 vs 2022. A continued partnership with the City of Temecula's more robust grant opportunity will help Jacob's House sustain services provided in Temecula Valley, where Jacob's House remains the sole provider of emergency lodging for families displaced by a traumatic medical crisis. The second important benefit is engaging Temecula residents with a unique opportunity to strengthen community ties to each other and with the larger community. This also provides a vehicle that broadens Temecula's support network, plus exposes Temecula citizens to other residents with common interests, neighborhood resources, and fun and fulfilling activities. Our hope is to extend our partnership, leverage these funds and stakeholder's support that comes with being awarded with a Temecula City grant. Finally, with expanded funding we will continue our mission in providing a physical refuge, emotional comfort, and financial solvency to the area's families facing an emergent medical crisis. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. As Southwest Riverside County's only healthcare hospitality home, funding sources, be they from municipalities (including the City of Temecula), foundations, businesses and/or endowments, will be instrumental in meeting the uptick trend in families experiencing a traumatic medical event resulting in Jacob's House providing services. Expenses will/may take the form of expanded direct mission delivery services for families, purchase inventory, deferred maintenance, repairs, marketing campaigns, outreach events, new equipment, furnishings .and/or social service programmatic guest experience enhancements that strengthen human services programs like Jacob's House. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Ways that Jacob's House has met and will continue to meet the needs of the local Community is by providing the citizenry of Temecula an opportunity to give back ever since our opening In December 2012. Be it sweat equity, development, Fundraising, maintenance, guests family services, service projects andlor outreach, Jacob's House has become that vehicle for businesses, community based organizations, students, retirees, faith -based communities, and area stakeholders to utilize their experience, learn new skills, make a connection, develop new bonds, and profoundly make a difference in the lives of their brethren through community volunteerism. Temecula volunteers' role In the community is a unique one, where they can measure their resolve by their commitment to helping other. This Includes bull is not limited to, helping reduce stress and ffnanclai burdens for famllies when they must travel far from home when their loved one has a health Care emergency, in turn allowing families the ability to stay together when there loved one is sick or Injured. Another benefit to corn munity Is when an area's citlzenry is engaged In the welfare of others in the community, the community itself begins to thrive. With Jacob's House's size, mission, and scale of volunteer service opportunities, we are uniquely positioned so Temecula residents can give back in meaningful ways. We believe that significant changes can and does occur with individuals. cotes and communities when the adage of "being of service" Is realized through a stable, respected and valued entity. Throughout It all, we have been able to serve as a critical Temecula resource, showing up during times of need and helping families, be they Temecula residents or visitors, with the support during their most vulnerable times. Jacob's House is proud to serve through a network of more than 70 Temecula volunteers, 100's of businesses. CBO's, houses of warship, School districts' students and countless service groups, such as National Charity League, Boys/Girls Scouts, etc, in benefiting both volunteer and recipient of that kindness. 3b ESTIMATEFROM THISDNUMBER OF PEOPLE PROJECT PROGRAM FROM TEMECULA EXPECTED TO BENEFIT �170 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 70 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS, With the City of Temecula 2022-23 grant, Jacob's House will provide 700 nights of emergency lodging for family members enduring a traumatic medical crisis, preserving their physical, emotional, and financial stability. While simultaneously providing 70 residents, businesses, community based organizations, faith -based communities, and service groups the ability to connect to our community, make a difference in the lives of families experiencing a traumatic ,event, and prove that Temecula's well earned reputation extends to both residents and visitors 'alike. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Like every heaindss, ondly, and henlihcara hosp0lady llorhe like Jotob's House, we were Impaclad by and had to make ehanges In the way we du tluslnass In resppnse to ine COVID-19 9tothil pendomlc, M a unique soclal6en+ioaa provider and ngaource In Tlimecaiti, wq are span And continue 10 provide families expathenctng a tfatrrnaH : VWLal avant with lodging, menls, anaftary rusoauc m. aril umallonal sappoft, Hihvever, She rgautl 01 this psmtemic Impaa wat, exportonc2d In 0ro folloM g weyo. hr 2019 we bnofly (1 112 ri"jilwo 41gd to coasod sctvKee In order Iq work wilh iho CDC. Statu lioallh• and Fkrversldn County Honhh Dolow"onls so wa dould reopen whh Ilse lato8 Piociedunes, pr0ih4pdas and strategies that kept 1wl only der liimlll0.y aofo but also our Temecula v0lunhiara and staff Irian) ccolnncsing the dir,eA.sa. Developed pmnarahlps that provided JrK4W,% Hwism wilh 4A kind services, prodncsa Adlo nr htvan" to rnanm90 the charges needed to aparulo sarety, 311eh as the PuroCloan Company. Tony provlda a hoapilet favgl 1 dioenfacting el north main rind common areas afrar a famRy chodts out. Our occupancy Impact it; based on ptr, matrix, which is 4 AK(rlps House ravens k 369 drays per year -1460 N14J11t maximum lotaf of how "sang nights we can pruvldu DCCdPanGy In q cptandAr year. In 2020 our svrYlru rrccupnncy was r4duud to2a11 niahls booed An fiaepikrl vlsifaflen realriattgn& In 2021 Our ocWponcy was 477 nights. On Invesso at 182% in aewices provided. In 2022 arc goal ✓s 400 n,ghu of occupancy: 110mvor, we have (daehed 500 as 01 WKwAling wish d mtlniks loft in ti calendar year duo W mcreaaa riaods and Mowledgo 0 ruac urces In iemocllla, As pr4viously Ineoliongd, eve lino open In fanliOs who no ad tin, and in doing in we have radoplehl sirnlmgia miiigoring op iraUWxat prune, end pracaall"N to prokaet our auenhi. who Are lacing Cril kftl medical Chilgangua on lheir own. Ewan Ae wa 4kM*ry those Extra aporalinnal CaitA duo to COV10-14, for nva"a'a prolnctkm, wo are alill Ohio to safely pfrnldP IoNing at the hiphnr expectud IA n of occulancy. By w4wkinf with our national aadeoclufloh, Use Heallhmu Hopp,taldy Natwolk, ruprescO g hoollneare "pilailty homes, Hka iftowa House, and 0150 xwvnyina our 7 VAlkxy hU$yltrils. Wit Nwo had to reedjuor our fetch an include n 46% Increase IWm I,Nt yHol`$ servlCa numbers of roo nlghls of kw*ig. The safoly 01 Ilia IriimrkOs we Servo, .And Uxa iafaly or our sinfl, 15 at rho Ioderr0A1 of overylhing we do and every dWision we maim nogbrdfoss Of increased costs. It m ourpdnnty to moat p!u nestle of the familles who depend an us by providing ,I safe, &,hart and welcoming Faomuwwayrrarrx-hole). 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Our goal is to make sure people experiencing a traumatic medical event receive safe, secure lodging. traversing through their loved ones emergency care. Fully funded at the grant request amount, Jacob's House will be able to expand our ability to keep families financially solvent by providing free services to the tune of 700 nights of lodging for the year. Our analysis of Healthcare hospitality home trends, based on engagement between Jacob's House and the 7 hospitals in the Valley that we partner with, shows that we can expect an increase of services needed of approximately 40% (500 nights occupancy to up to 700 nights: based on 4 Jacob's House rooms x 365 nights per year = 1460 total maximum nights that we can provide service). In each case, having a "home away from home" allows the family in need to focus all of their energy on their loved one. With further funds to leverage, Jacob's House will be able to meet the increased demand and expand our services while continuing our partnership with other Temecula CBO's, businesses, faith -based communities, school districts and/or concerned residents, helping mitigate and lighten the burden of these exact families in need due to an emergency medical event. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 w QZ 0 LU I..L N 0 Z O Q � OTC Z0 F— w 0 2 ix LL Z CL Q LL m 1 79 C G7Fn [�' ❑ y C C [7 7. 7. ��7pi �4�y7y I13 y M N m [C� L Al 4i A E E m c ��' y y� c cl �m@mmc cq o'o�"oc�vm n'I8C�m yQ m LO en a C C •Y. 41 ❑ = 4) N y }� Cam" ° m a as❑ y E y y > .G d 7 p 4 p '� E c'U o E �i ayi L) m' wm y� m ci m c o ur E E m m C V r Q�7 p7 tll O7 Y '•�' ❑ •� fV r � �,•k+ p C � ❑ 41 uj ,� � A 7,Z5Iynm �°icroELnm ❑ G 'r} ❑ i0 CV O Y ❑ w C 3 �m r� rronv N w•Ll� G OL C C y C C❑ �1 C rn.�aa �Ec_o_.a 'Em � mcar hca❑ Y l7 y A ❑ pf ❑ ❑ - p m I c�� m c 9— a O) 4 N � U X Ti N N E �a•C v-sr m ❑ -OZ _ @ �� y i E m m0?.L ❑ fl N Ctl •GNP N 7 rya p of ❑ O G7 •y ry Q1 O 'R 9 C��f}7 � 3 u CO Cp 11 a > C C] IC •� � �j 1 R a_ U o m E n0 �❑.� 3 v = �w kQ '0 � �p Lq 4 a.E Sm�� ow2wQ) i��T a _ cu p U w N N C [+�j • y y C_ yp [9 � Zt ❑ T a @� ' > � £ 10 V3 L❑7 61 LU ❑ A 61 N (S7 c [l} fA 7 �]C 6? N C E 'p, ❑ N w w a1 d W [] rnU E a c v m a 2 m g c p ❑ c u�U.� [crop r� o -a ro� DC LOA CO [p _ 37 La p 1�a C N m 01 p, ❑U' E m g A m '� C0 ❑ ur t m _ N OL S9 y CL] NwQ? q7 " C w m ❑ co❑a�E v Rpg�m�3ap� w W 7 Q G y = O c C ❑❑ @ w❑ m M EU S0= a� U aa m4UEtraCi ZC�'3❑c y210 o i Q N y rn E j a mp PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES I EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 193,000 Organization Other grants or funding already awarded for Project/Program, if any $ 14,000 In -Kind match amount or volunteer credit hours estimated amount $ 1931 TOTAL REVENUE $ 257,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance f I Supplies Marketing Services Food ' Other VStaffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET 1 $ $1,850 $3,700 $ 5, 000 $6,400 $31,000 0 $48, 725 $101,585 $198,260 $58,811 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City, To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Jacob's House Inc. Name of Project/Program: FY 2021-2022 Amount of CSF Grant Fund Awarded: $ Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on _ Name of Company Receiptllnvoice z on Receipt or Invoice MUST BE ON OR BETWEEN Amount `2: _ JULY 1. 2021 - JUNE 30. 2022 EXPENDITURE TOTAL $ Ex enaiture _ Description Purpose DESCRIBE THE EXPENDITURE I PURPOSE OF EXPENDITURE EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT If your organization Is awarded a Community Service Funding Grant In FY 2021-2022 by the City of Temecula, then this information is not due until Monday, September 12, 2022 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper bath -up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying recei tslinvoices must be submitted to the City on or before due date: Monday, September 12, 2022. EXPENDITURE REPORT due on or before Monday, September 12, 2022 1. Provide the number of beneficiaries living in 92590, 92591 and 92592 that directly - z benefitted from this program (approximate number of beneficiaries if you don't have a precise , ``• number): 2. Fill out this table (include additional copies if needed to explain all expenditures)^? 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manag is Offic CIF �11N i 2022 Organization: Name of Project/Program: JACOB'S HOUSE INC. r Number of Temecula Residents Served/Engaged: 37 d� �;) Amount of Grant Fund Awarded: Month +Year Grant Received from City: $5000 2021-2�2 - Name of Date (Mo/Day/Yr) Amount Describe... Explain Company on Receipt/invoice on Receipt/Invoice of Expenditure (1) what the expenditure was (2) purpose of the ... how the expenditure Must be dated on or expenditure specifically between July 1, benefitted Temecula 2021 - June 30, 2022 MUST support Project/Program description on Application + Award residents residents it Letter names/addresses of Temecula beneficiaries are available, please attach. Temecula Paid 12/1/2021 $300 Membership provides the It allows us to inform Chamber of residents of Temecula the and engage the Commerce opportunity to represent JH, community in a well leverage relationships, respected platform receive in -kind services and donations 2 NAIC- Paid 12/1/2021 $2766 Up to date insurance This provides Philadelphia Ins. protects the agency, Temecula residents Co. Temecula resident who volunteer that volunteers and guests we have the appropriate coverage to operate safely 3 GotJunk? Paid 12/13/2021 $459 Keeping the JH property Keeping the JH safe, clean & provide property safe, clean emotional renewal for & provide emotional guests renewal for guests 4 Nonprofit Paid 1/4/2021 Software Corp $440 Membership fee database It provides management of guest transparency, services making it easier for agencies, residents and/or supporters can determine data usage 5 Healthcare Paid 11/5/2021 Hospitality $600 Membership fees to our Assures residents, Network national organization donors that we follow national guidelines and are certified by the agency representing healthcare hospitality homes 6 First Team Paid 5/2/2022 Printing $492 JH Brochures To inform, engage our community about JH services 7 Note: Expenditure Total must be equal o EXPENDITURETOTAL: than) awarded arded" greater the Amouant�of Grant Fund Awt (above) provided by the City SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due elate or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: JACOB'S HOUSE INC. MAILING ADDRESS: 31525 JEDEDIAH SMITH ROAD TEMECULA, CA 92592 PHONE: (951) 452-2627 EMAIL: 8MRTILORG PRESIDENT / AUTHORIZED OFFICER: MARTIN BARRERA-MARTINEZ EXECUTIVE DIRECTOR SIGNATURE: _ DATE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 13, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receiptslinvoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" Organization: EXPENDITURE REPORT DATED TOTAL FY 2022-2023 Amount of Grant Fund Awarded: 9 Name of Project/Program: Month & Year FIRST $5,000 check was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No-- or Yes If yes, Amount of Request S Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) v Date on Expenditure Name of Company Receipt/invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION &AWARD LETTER m E on Receipt or Invoice MUST BE ON OR BETWEEN q Z March 20, 2020 - JUNE 30, Amount Description Purpose 7r )A 3 EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. ■ The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME, Jacob's House Inc. MAILING ADDRESS: 31525 Jedediah Smith Road Temecula, CA 92592 PRESIDENT/ AUTHORIZED OFFICER: Martin Barrera- Martinez PHONE: (951� 452-2627 EMAIL: martin@jacobshousetemecula.org Executive Director SIGNATURE: �V1 " DATE: Aug' 25, 2022 MONTH, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PRINT NAME 1.TLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey,Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 11M12ML REVENUE SERVICE P- 0. BOX 2508 CiNC_1*WI, OH 45201 Date Nov 0 3 2008 JACOD I S HOUSE, INC. C/O IQRTIN A WEISS ONE 13ETTERWORLD CIRCLE, SUITE 300 TBM,!ULA, CA 92590 Dear Applicant: DEPARTMMT OF THE TREASURY Employer Identification Number: 26-1183832 DM: 17053106310008 Contact Person: JOANNA YMMY ID# 95078 Contact Telephone Number. (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170 (b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: August 16, 2007 Contribution Deduotibility: Yes Addendum Applies: No We are pleased to inform you that upon review of your application for tax exerrpt status we have determined that you are exempt from Federal income tax under section 501(c}(3) of the Interned 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 pEhlic charity wader the Code section(s) listed in the heading of this letter. Please meat enclosed Publication 4221-PC, Cpmpliance Quide for 501(c)(3) Public Charities, for some helpful information -about your responsibilities as an exempt organization.' Letter 947 (DO/CG) ORS a -file Signature Authorization Fong 8879-EO for an Exempt Organization For oWendar year 2016. or 5=10 yaw b%inning , 2016, and ending .20 Gap&rnnmr or me 1Yeasuy ■ no not send to the IFIS. Keep for yourrecords. Mtamal Revenueswloo Information abaut.Form W79-EO and ha instructions Is at www.1rs.00v11orm88Moo- OMB Na iblfi-i B7a 2016 JACOB'S HOUSE, INC. 26-1183832 Name ano me or omcer SHAWN NELSON PRESIDENT Part I I Type of Return and Return Information (Whole Dollars On[y) Check the box forthe retum 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 Is, 2a, So. 4a, or 6a, below, and the amount on that line for the return being filed with this form was blank, then leave line 1b, 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 I. to Form 990 check here W-® b Total revenue, if any (Farm 99D, Part "ll, column (A), line 12) ........... ........ 1b 195,9.94. 2a Form 990-EZ check here 0-E:1 b Total revenue, if any (Form 990•EZ, line 9).................................... 2b 3a Form 1120•POL check here ■ Q b Total tax (Form 1120•POL, line 22)..,...........................I_ 3b 4a Form 990-PF check here 0-0 b Tax based on Investment income (Forth 990•PF, Part A, line 6) .. 4b tia Form 8865 check here 1/ C] b Balance Due (Form 8808, line 3c) Partli Declaration and Signature Authorization of Officer Under penalties of perjury, I declare that I am an officor of tha above arganlzatinn and that I have examined a copy of ths organizatlon's 2 63 6 electronic return and accompanying schedules and statements and to the best of my knowledge and belief, they are true, correct, and complete. I furlhor declare that the amount in PsA I above fa the amount shown on the copy of the organization's electronic relum. I consent toaliow my Intermediate service provider, transmitter, or electronic rot um a riginato r (ERO) to send the organlzationIs rotum to the IRS and to receive from the IRS (al an acknowledgement Of receipt a reason for rejection of the transmission, (b) the reason for any delay in processing the retum or refund, and (c) the data of any refund. If applicable, I authorize the U.S. Treasury acid its des(gnate d Financial Agent to fnitlate an electronic funds withdrawal (dlrect debit) entry to the ffnaneta] Institution account Indicated In the tax preparation software for payment of the arganlzation's federal taxes owed an this return, and tho financial institution to debit the entry to this account. To revoke a {payment. I must contact tha U.S. Treasury Financial Agent at 1.808-353.4537 no later than 2 business days prior to the payment (settlement) date. I also authorize file linanclal Institutlons involved In the processing of the alectfonic payment of taxes to face Iva confidential information necessary to answer inquiries and resolve Issues related to the payment. I have selected a personal identificatlon number (PIN) as my aignaturo for tho organization's aloctronic rat um and, If applicable, tha a rganiza t ion's consent to electionic funds withdrawal. Officer's PIN: check one box only ® I authorize PRUDHOMME ASSOCIATES CPAS , INC_- to enter my PIN ERO firm name Enter live nu►nbers, but do not enter all zeros as my signature an the organization's tax year 2016 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(fes) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my PIN on the return's disclosure consent screen. 0 As an officer of the organization, I will enter my PIN as my signature on the organization's tax year 2016 electronically flied return. If 1 have Indicated within this ret r that a copy of the return is being filed with a state agencyges) regulating charities as part of the IRS FeW tote program, I will on r an retum's disclosure consent screen. Officer's signature 0- Date 0- Part III Cairtification ancl Authentication ti ERO's EFIN/PIN. Enter your six -digit electronic filing Identification number (EFIN) followed by your five -digit self-selected PIN. 0 7 5 0 912 4 4o not enter all zeros I certify that the above numeric entry is my PIN, which is my signature an the 2016 electronically filed return for the organization indicated above. I confirm that I am submitting this return in accordance with the requirements of Pub.4163, Modernized e•File (MeF) Information for Authorized IRS e-fife Providers for Business Rotuma. ERO'ssignature � Date ® +_ ERO Must Retain This Form - Us Instructions Do Not Submit This Form To the IRS Unless Requested To Do So LHA For Paperwork Reduction Act Notice, see Instructions. Form8879-EO (2018) 121011 09 2fi-19 STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 1 /21 /2020 ESL ID: 5284048908 According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 3013750 Entity Name: JACOB'S HOUSE, INC. ® 1. The entity is in good standing with the Franchise Tax Board, ❑ 2. The entity is not in good standing with the Franchise Tax Board. CI3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. The above information does not necessarily reflect: The entity's status with any other agency of the State of California or other government agency. e If the ontity's powers, rights, and privileges were suspended or forfeited at any time in the past, or the entity did business It, Calirornia at a time when it was not qualified or not registered to do business in California- [) The status or voidability of any contracts nude in California by the entity at a Vine when the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1), o For entities revived under R&TC Section 23305b, any time limitations on the revivor or limitation of the functions that can be performed by the entity. Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 P.M. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persoris with hearing or speech impairments FTS 4263A WEB (REV 02-2019) Form 990 t20 545-0047 Return of Organization Exempt From Income Tax 21 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) _ Department of the treasury ► Do not enter social security numbers on this form as it may be made public, Open to Public Internal Ftcvenua Servko ► Go to wwwJf$.goiWorrn990for Instructions and the latest Information. Inspection A For the 2021 calendar year, or tax year beginning , 2021, and ending 40 r Chock if applicable: C � Employeridenli€€ealion number Addre6schange JACOB'S HOUSE, INC. 2ti-1183832 Name change 31525 JEDEDIAH SMITH RD E Telaphonenumtg Initial return TEMECULA, CA 92592 at (951) 458 8681 Final return/lerminaled Amended return 389 396. G Gross receipts Application pending F Name and address of principal officer: SHAWN NELSON Hfa] IS fhi.s a group return for subetd€na7'e'&.'?rYes NoSAME AS C ABOV)~' H(b) Are all subordinates included? NoTax-exempt status: }{ 501(f ){3) 501c) ( 527I€^No,"attach a list. See Inslrucllo J Website: ► WWW.JACOBSHOUSETEMECULA.DRG N(c) Gawp exemption number ► rll3yiefly lxalion: }( Corporallon 7rus1 Association Other ► L Year of formation: 2007 M State of ttgai domicile: CA mma describe the organiaatton`s mission or most significant activities:` SCHEI2UJ�E_Q_ _�^- - _ ____--- ____-_.�___. ____ _- ..,___,�__,_—_ -..-._-----_---- —. .-.----_--__--.----—.-._.__-----_- 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 1 a) ................... . ............. . .. 3 8 d 4 Number of independent voting members of the governing body (Part VI, line lb).......... 8 4 5 Total number of individuals employed in calendar year 2021 (Part V, line 2a).......... , , , , . , , , . , g -- 2 6 Total number of volunteers (estimate if necessary ) .................................... . ........ d a otal unrelated business revenue from Part VIII, column (C), line 12.......... 7a b Net unrelated business taxable income from Form 990-T, Part I, line 1 I ..................... , , , , , , , , , , , 76 0 4. Prior Year Current Year � B Contributions and grants (Part Vlil, line lh),.. ...., $lq 42q, 231 591. 9 Program service revenue Part VIII, line 2 ( g).............. .......... 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) ............. . . . . . . • , . , .. 1 186. cc 11 Other revenue (Part Vlll. column (A), lines 5, 6d, 8c, 9c, 1 Oc, and T'Te)........ . . . . . . . .97,265. 24 12 Total revenue - add lines 8 throw h i t must 32 527. 97, 265 • g ( equal Part VIII, column (A), line 12)..... , 548, 737. 13 Grants and similar amounts paid (Part IX, column (A), tines t-3)............ . 14 Benefits paid to or for members (Part IX, column (A), line 4)................ 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)...... 83 129. 85, 351 m 16a Professional fundraising fees (Part IX, column (A), line 1le).. . .. . . . . . . .. . . . . . x b Total fundraising expenses (Part IX, column (D), line 25) "' ► 1, 396. 17 Other expenses (Part IX, column (A), lines 1 T a• l Id, 1)1-24e),,, , , , , , , , , , , .10 B 576. 92 Q13 , 18 Total expenses. Add lines 13.17 (must equal Part IX, column (A), line 25)............. 191 705. 177, 374. 19 Revenue less expenses. Subtract line 18 from line 12 .............. 357,032. 151,506. sS "p 20 Total assets (Part X, line 16) Beginning of Current Year End of Year 21 Total liabilities (Part X, line 26). 0 0 144 300. 1,862 zw 22 Net assets or fund balances. Subtract line 21 from line 20.. ... .. .... .... 739, 635 . 891 141 . Part 11 Si 1lature Bloc Undw penalties of perjury. I dotfare that I have ewsmined this return, including accemppanying setwdulas and slolemants, and to the best of my knowledge and belief, it is true, correct, and complete. oeclaration at Wepsrar (other than officer) is based on all information of wh}ch nreparar has any knowledge. Sign Slgnnlurenrafr€eor - Dale Here � MARTIN BARRERA-MARTINEZ EXECUTIVE DIRECTOR pe or print name Roo Print/Type preparers name -,Paid .roux D. NOTTINGHM, CPA 'reparer Firm's name ► NOTTII GHAM & ASSOCIATES Jse Dnly Firm's address ► 43460 RIDGE PARK DR STE 240 TEMECULA, CA 92590 May the IRS discuss this return with the preparer shown above? See instructions.......... . �.+.+ rur rnlrerworK rceauctlon Act Notice, see the separate instructions Check U if PTiN self-rurlpinyod P0016B412 Firm's EIN ► 2D-2D82681 Phone no. 951-296-1698 ... x Yes I I No TEEA0101L 09/22121 Form 990 (2021) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 26 JDS CREATIVE ACADEMY :,I, , 1 :1 h 1 FISCAL YEAR 20= - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 48,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: DigiF■st Temecula 2023 Start Date:.10LLt?A22 End Date: 09130/2023 Physical Address of Project/Program: 28089 Diaz Road, suite D, E, a F, Temecula CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: JDS Greatly* Academy Mailing Address: 39870 Camden Court Temecula, CA 92591 ORGANIZATION AND GEOGRAPHIC: AREA SERVED Name of Applicant Organization: JDS Creative Academy Year Founded: 2014 Website: d@CMOtiveacedem .of ld ihmttemecula.❑ Social Media: 001glFestTemecule Number of Paid Staff: 11 Number of Volunteers: 50 Geographic Area(s) the Organization Serves: CIV ofTernecuia Southwest Rivetaide County, Riverside Coun Geographic Area(s) the Profect/Pro ram Serves: City of Temecula Southwest Riverside County., Riverside County NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Diane Strand Contact Person's Direct Telephone: (961)2964715 Title/Position: Executive Director Contact Person's Email: diano@ldscreativescademy.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 2014 No IF NO. THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 45-5293183 State Identification Number: 3782600 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS)AND STATE (FTB) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: htt ./la sirs. via eosl 2. ® Attach State Entity Status Letter using this link: https://www.ftb.ca,gov/online/self serve entit status letter/index.as 3. A] Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: hit Jlrct.d .ca. pvNerilicationlWeblSearch.as x?facilit =Y City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No © Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No © Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee ❑ Board of Directors x❑ Members -at -Large ❑ NIISSION STATENIENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSIONIGOALS AND OBJECTIVES j The mission of JDSCA Is to advance education and training in the visual, performing, and digital arts: theatre, music, J creative writing, fine art and digital -production art, JDSCA classes and programs fulfill the VAPA requirements, per the California Education Standard for K-17, the Apprenticeships Standards for the State of California and the Title-17 training standards for Inland Regional, providing hzruls•orn tralning to the home school, online school, traditional school, and trade school populations. JDSCA {provides opportunities to gain creative enrichment, self-confidence, leadership, and collaborative skills so that our students can obtain the expertise needed to advance to higher arts education and prosper in a competitive marketplace. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. 00 NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 6 or 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes O IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP DiglFestTemucula In -Kind Economic Development Funding for Special Events OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO ❑ Yes © IF YES, PROVIDE INFORMATION IN TABLE BELOW - AMOUNT MONTH +YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ 2,S00 / year Abbott — Jan. 2021 and Jan. 2022 i " - I $ 5001 year Ranch RV and Self Storage Jan, 2021 and Jan, 2022 $ S00 1 year Cal State University San Marcos I Jan. 2021 and Jan. 2022 $ 1,5001 year Mt, San Jacinto College $ 1,5001 year United Health Services $ 5001 year $ In -Kind $ In -Kind Jan. 2021 and Jan, 2022 Jan. 2021 and Jan, 2022 DCH Jan, 2021 and Jan, 2022 JDS Video & Media, Rosenstein and Associates, Starway Productions, Economic Development Coalition Jan. 2021 and Jan. 2022 KATY, The Vine, Temecula Valley Chamber of Commerce, Visit Jan. 2021 and Jan, 2022 Temecula, Oak Grove Culinary Creations, City of Temecula Community Selvlce Funding - Relnvestmenl In Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAN-1 DESCRIPTION IMPORTANT- RECEIPTS+INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATI ON SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT,PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. JDS Creative Academy NDSCA) will use the Temecula grant to enhance support DiglFest Temecula, the organization's annual digital media festival, conference, and fundralsing event, now In Ks seventh year, DigiFest Temecula is JDS Creative Academy's reinvention of the Temecula Valley International Film and Musical Festival which closed in 2014. DigiFest Temecula Is an annual three-day event celebrating all forms of digital media including, but not limited to. photography, video games, short film and videos, music, music videos, animation, graphic design, websites, and digital art, The event promotes networking, appreciation, knowledge, training and recognition opportunities for students, amateurs, and professionals while continuing to be accessible to all wKh nominal admission and competition tees, 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS EQUIPMEMENT, AND;OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAMJPROJECT, JDS Creative Academy will spend the grant funding on supporting the procurement of high-level speakers as well as bolstering the organization's marketing and advertising efforts. The organization will use the funds to support DigiFest Temecula speaker honorariums, travel, and hotel accommodations. JDS Creative Academy will also use the grant funds to purchase social media ads, Google ads, television commercial air time, and billboa►ds to more effectively Inform those in Southern California about DigiFest Temecula and draw more attendees to the City of Temecula. Additionally, JDS Creative Academy will also put a portion of grant funding towards new equipment such as a lighting control board, a camera, and LED lights which will further improve DigiFest Temecula event experiences. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM?PROJECT IF AWARDED CITY FUNDING, EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. The grant funding specifically benefits all Temecula residents through the DigiFest Temsculs event. The event will bring in tourism which drives revenue to Temecula hotels, sate ries, and businesses as well as bringing in additional tax dollars which will indirectly benefit the entire community of the City of Temecula. Temecula students have historically been the population which has bonefitted the most from DIglFest Temecula since the ovont gives students the opportunity to gain Industry recognition as well as build up a pmtessional network within the Industry, all without having to leave the city of Temecula. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAMS 111,985 people 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 50 volunteers City of Temecula Ccmnuinity Service Funding - Reinvestnw,_nt In Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTI1 UE, D 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Grant funds will elevate DigiFest Temecula, assisting with marketing, advertising, oqulpment, and speaker costs, Resklents of Temecula bonefit by having thn arts highlighted and the city gaining additional tax revenue. TVUSD students benefit from community service work, learning opportunities, and award recognition. Temecula businesses by volunteering and contilbulirrg resources opportunities. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. In 202D and 2021, due to the COVID•19 pandamic. JDS Creative Academy was unable to host an In -person DigiFest Temecula, The organization shortened the event to a virtual, one -day 01glDay event in 2020 which caused the organization to miss out on one of its largest fundraising events, as well as lose money from event deposits. In 2021, the organization returned to its three-day format and prepared a virtual event due to the pandemic still being in offecLThe event still had a lower number of attendees compared to pre pandemic years, This past year, DigiFest Temecula 2022, still was unable to completely recover from the effects oI the COVI0.19 pandemic seeing a lower rate of in•person attendance in ail aspects Including speakers, screenings, and the awards banquet. The pandemic has severely impacted JDS Creative Academy's ability to bring networking and professional development opportunities to the Temecula community. JDS Creative Academy hopes that the funding will bring back in -person attendance which we expect to surpass the highest attendance numbers seen in the past. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The grant funds will be used to expand on JDS Creative Academy's efforts to bring high-level speakers to DigiFest Temecula, as well as expand on the organization's marketing and advertising efforts for the event. The organization aims to use Dig€Fast Temecula as a chance to bring tourism and digital -media Industry exposure opportunities to the City of Temecula. JDS Creative Academy expects the funding will expand in -person attendance. City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not till In shaded areas) r LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 48,000 Amount contributed to the Project/Program by the Applicant $ Organization $1,250 Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount —$ 25,000 TOTAL REVENUE 5' 124 5o LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET $124,250 EXPENSES S 18,000 $ 10,000 $ 2,000 $' 15,0oa — $ 2,000 $ 2,500 $ 15,000 $ 41,250 $ 105,750 $ 105,750 City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual alloration. • The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: TID5 MAILING ADDRESS: acwv& PHONE: 1 EMAIL: 6L ► [.a .' offm r PRESIAUTHORIZED OF ICER l .'RIfJT NAh1�C SIGNATUR y C�e��•�r� ::::A DATE: ON'H, DAY, V[Ar IF DIFFERENT THAN ABOVE, j APPICATION PREPARED BY: `. LG YLQ k .�C-xof.hkve n. , , L-- Trr:_J SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD s F T B`PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/12/2022 ESL ID: 6732335723 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID; 3782660 Entity Name: JDS CREATIVE ACADEMY 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board, 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. El4. We do not have current information about the entity. EJ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 233O5b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) INTERNAL REVENUE SERVICE. P. O. BOX 2508 CINCINNATI, OH 45201 Date: .,OCT 2114 JDS CREATIVE ACADEMY 39870 CAMDEN CT TEMECULA, CA 92591 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 46-5293183 DLN: 17053122345034 Contact Person: J'ASON T SAMMONS ID## 31616 Contact Telephone NwEtbet: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 509 (a) (2) Form 990 Required: Yes Effective Date of Exemption: April 11, 2014 Contribution Deductibility: Yes Addendum Applies: No 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. 2S22 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. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. sincerely, Director, Exempt Organizations Letter 947 Return of Organization Exempt From income Tax OMB Nc, 1545-0047 Form � -— - Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) � 21 Department of the Treasury ► Do not enter social security numbers on this form as it may be made public. Internal Revenue Service ► Go to www.1mgov1Form990 for instructions and the latest information. A For the 2021 calendar year, or tax year beg Innln , 2021, and ending 120 B Check if applicable: C. Name of organiaallon ,3DS CREATIVE ACAL)ENy D Employer identification number ❑ Address change Doing business as 4 6 - 52 9 3 183 ❑ Name change Number and street (or P.O. box if mall is not delivered to street address) Room/suite E Telephone number ❑ Initial return 39870 CAMDEN COURT (951)296-6715 El Final roturn/torminated City or town, state ui piuvinue, country, and ZIP or foreign postal code ❑ Amended return TEMECULA, CA 92591 Q Gross mcarpts $1 18 g 194 ❑ Application pending F Name and address of principal officer: H(a) Is this a group return for subordinates? ❑ Yes © No DIANE STRAND?, 39870 CAMDEN COURT TEMECULA CA 92591 H(b) Are all subordinates included? ❑ Yes ❑ No I Tex -exempt status: ® 501(c)(3) ❑ 501(c) [ ) ,4111 (insert no.) E] 4947(a)(1) or ❑ 527 If "No," attach a list. See instructions. J Website: ► N/A H(a) Group exemption number ► K Form of organlratlom MODrporation ❑ Trust ❑ Association ❑ Other ► L Year of formation: 2 0 151 M State of legal domicile: CA 1 Briefly describe the organ€zation's mission or most significant activities: 1t1 pnvIDi 6gAT10t MD YFAiiIIL., IH M VISUAL flICiflhL p&RP�IIi�G dxi5 --.--,-.-.--••------••- •-----•---- _ 0.1 --�--•---........AP $ FOR AT RISK AND POSTER 1'flLTTII, DgVELQPMENTAL ❑ISABILITIES.- AUTISM, ADULTS.r - . -- - -- - - -- ...-- .......••---.. N 5tW00L, ANI) €tA1H5TR P(}i UTI 5 THRbUG3[OUT THE REGION AHD THE LOCAL C4i4 MITY. ---_WE ARE A TITLB -- Y8.... Willi IHfAVIi REGIONAL CSI7fEIt. 2 Check this box / ❑ if the nrg8�n€ iGin- d€st:ontlnued its operations or disposed of more than 25% of its net assets. 3 Number of voting members of the goveming body (Part VI, line I a) . . . . . . . . , 3 9 Of 4 Number of independent voting members of the governing body (Part VI, ling 1 b) 4 9 5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) . . . . , 5 26 6 Total number of volunteers (estimate if necessary) . . . . . . . . . . . . 6 50 a 7a Total unrelated business revenue from Part VIII, column (C), line 12 . . . . . , . . 7a 7. b Net unrelated business taxable income from Form 990-T, Part 1, line 11 7b 0. Prior Year Current Year 8 Contributions and grants (Part VIII, line 1h) . . . . . . . . . . . . 28,639. 229,135. 9 Program service revenue (Part VIII, line 2g) . . . . . . . . 938,605. 960,3S2. 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) . . . . . . 6. 7 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11 e) . . , 12 Total revenue —add lines 8through 11(must equal PartVill, column( , line 12 967 250. 1 1,89 t94. 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) _6,752, 23 14 Benefits paid to or for members (Part IX, column (A), line 4) . . . . . . 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 562,349. 578 843 . 16a Professional fundraising fees (Part IX, column (A), line 11 e) a b Total fundraising expenses (Part IX, column (D), line 25) ► _ 68, 118 . 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) -. 438 145. 528, 345 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 1,007,244. 1 1077 211. 19 Revenue less expenses, Subtract line 18 from line 12 -39 , 994 . 82,283. ° Beginning of Current Year End of Year q 20 Total assets Part X line 16 . . . . . , ( � ) 218 830, 194 1.54. 21 Total liabilities (Part X, line 26) . , . . . . . . , , . 116,002. 9 053. zu. 22 Net assets or fund balances_ Subtract line 21 from line 20 102 828 . 185 111 . $I nature Block Under penalties of periury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all Information of which preparer has any knowledge. 0 04 Z 2022 Sign Signature of officer Date Here DIANE STRAND PRESIDENT Type or print name and title Paid Print/Type preparer's name Preparer's signature Date Check ❑ if PTIN Preparer MICHAEL E GREENBERG MICHAEL E GREENBERG self-employed IP00200027 Use Only Firm'sname ► MICHML E. GREENBERG, CPA INC. Firm'sEIN ► 46_4574678 Firm'saddress ► 43015 BLACKEII;ER LOOP #102 TEMECULA CA 92590 1 Phoneno. 951235-6255 Ma the IRS discuss this return with the pnarer shown above? See Instructions i] Yes ❑ No For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 07/26122 PRO Form 990 (2021) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 27 LIVE CARE FOUNDATION INC. CITY OF TEMECUI[A FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 I PROJECT/PROGRAM INFORMATION I Amount Requested: $ 50,000 (or as available) MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Temecula Valley Support Project Start Date: Q3-2022 End Date: TBD Physical Address of Project/Program: 43460 Ridge Park Drive, Suite 200-S, Temecula, CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Live Care Foundation, Inc. Mailing Address: 43460 Ridge Park Drive, Suite 200-S, Temecula, CA 92590 I ORGANIZATION AND GEOGRAPHIC AREA SERVED I Name of Applicant Organization Live Care Foundation, Inc. Website: https://LiveCareGrants.org/ Number of Paid Staff: 0 Year Founded: Social Media: N/A Number of Volunteers: Ranges (1-5) Geographic Area(s) the Organization Serves- Mostly Southern California (but can serve broadly) Geographic Area(s) the Proiect/Program Serves: Temecula Valley (or wider if there is a tie to Temecula) NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA Contact Name: Greg Di Cristina Contact Person's Direct Telephone: 951-541-0414 Title/Position: Executive Director Contact Person's Email: Greg@LiveCareGrants.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 12/21/2018 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 32-0587960 State Identification Number: 4221321 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: tt ://a sirs_ ov/a /eos/ 2. ❑ Attach State Entity Status Letter using this link: httl2s://www.ftb.ca.gov/ontine/self serve entity status letter/index.as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: hit :/trct.doi.ca. ovNerifi tion/Webl r ?f ili =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No X❑ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ® Board of Directors Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Live Care Foundation exists to serve our senior community, disabled persons and veterans with care needs. By extension we are also able to help families of our served community who are often bearing the brunt of out- of-pocket cash support for their loved ones' assisted care needs. We offer several options to ease the overall financial responsibilities, and help to assess which options are available and best suited to family needs. Assisted care costs are high and are expected to rise significantly as providers, facilities, and caregivers race to keep up with demand and inflationary costs. Live Care Foundation helps reduce these burdens. We are neither a facility nor a care provider. Instead, we work with certified, licensed, and insured care providers. We do not make grants to individuals, but, instead, support our care -receiving clients by working directly with their care providers to help ease the out -of -pockets costs associated with care delivery. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No © Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP I I OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT, The Temecula Valley Support Project will benefit seniors, disabled persons and veterans with care needs who are based in or around the City of Temecula. Grant support to their care providers directly benefits and addresses the needs of their Temecula -based clientele. The project will also provide relief for Temecula -based families of individuals requiring care in instances where the families are burdened with providing monetary support for the care of their loved ones. Live Care Foundation does not make grants directly to individuals per its IRS -approved bylaws and mission disclosures. Instead, we work with the licensed, certified care organizations to provide the grant support that will directly reduce out-of-pocket costs for Temecula's care recipients and their families. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED j ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Live Care Foundation makes small, targeted and limited grants to licensed and certified assisted care providers. These grants are intended to subsidize the cost of care for Temecula seniors, disabled persons and veterans as well as Temecula -based families who are bearing the costs of providing assisted care services for their loved ones. The organization receives requests for grant assistance, and then conducts and assessment and eligibility evaluation to determine if grant support is warranted. The assessment includes an evaluation of the care provider or facility to ensure State, County and City compliance for delivering assisted care services. Assisted Care Grants are typically awarded in small increments which range but usually don't exceed $500 monthly, and are awarded with 3-6 month minimum support periods. Applicants may reapply for support, but if demand exceeds our budget capabilities then awards are allocated equally among eligible applicants based on need -based criteria and size of applicant pool. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS, The Temecula Valley Support Project will be limited to Temecula -based seniors, disabled persons and veterans with care needs as well as the Temecula -based families of individuals with care needs in cases where the families are tasked with providing monetary support for their loved ones' care services. In all cases, applicants must provide and prove preexisting care support services, and may also be asked to provide proof of prior monetary payments to service and care providers. First time care support cases may also apply, but the burden of proving needs may also include financial statement review and need -based eligibility requirements. There are nearly a dozen in -home care providers that serve scores of Temecula area residents. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 25 - 50 care recip FROM THIS PROJECT/PROGRAM: 50-100 family me 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 1-2 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PRO.IECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. The Temecula Valley Support Project provides support to Temecula -based seniors, disabled persons and veterans with care needs as well as the cost -bearing, Temecula -based families of individuals with care needs. We make grants available to the care providers who provide assisted care services to this community. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. During the brunt of the C-19 pandemic Live Care Foundation's fundraising efforts and results were curtailed owing to regular business disruption across the spectrum of fundraising sources. At the same time, the demand for support spiked and as a result our organization's resources were rapidly depleted, a situation which continues to this day. One of our care support programs provides assistance with burial and funeral costs on needs -based eligibility cases. We were unprepared for the spike in requests for this type of support, and is the most direct impact that C-19 had on Live Care. Currently, we are working to secure more sources of financial support, but, predictably, so are many other charitable organizations who experienced similar situations and conditions. Competition for scarce grant resources is at a high, and we would be very grateful for any amount of f support the City of Temecula may _provide. J rIF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. — City of Temecula funding will be used exclusively for the new Temecula Valley Support Project. This project will limit its support to Temecula -based seniors, disabled persons and veterans with care needs as well as Temecula -based families who currently provide monetary support for their loved ones with assisted care needs. To clarify, while this population are the ultimate beneficiaries of Live Care Foundation support, they are not the direct grantees. Grants are exclusively issued to certified and licensed care -giving organizations. The grants are made on behalf of the intended beneficiaries in order to reduce the amount of direct cost billed to the recipient or his/her family. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) I LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $50,000 (or Community Services Grant (Not to exceed $50,000) (any available) Amount contributed to the Project/Program by the Applicant $ 5,000 Organization Other grants or funding already awarded for Project/Program, if any , $ N/A In -Kind match amount or volunteer credit hours estimated amount $25,000 TOTAL REVENUE $80,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food Other Staffing Expense I MIN IS INtLIGIBLL tO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET $55,000 $0 $ 2,500 $1,500 $ 1,000 $0 $ 50,000 $0 $ 55,000 $ 55,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021,2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds mraiv► d from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date:,September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Name of Project/Program: N/A FY 2021-2022 Amount of $ N/A CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: N/A Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this ProgramlProject (approximate number of beneficiaries if you do not N/A have precise number): a ~ Date on Expenditure E Name of Company Receipt/Invoice Description Purpose ..ion Receipt or Invoice MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE Ji A." 1. 2021 - JUNE 30, 202i 3 5 i - 6 EXPENDITURE TOTAL MUST BE EQUAL TO EXPENDITURE TOTAL - F (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 f FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up informatton to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [if you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursedfor the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED — Organization: Live Care Foundation, Inc. TOTAL FY 2022-2023 Amount of Grant Fund Awarded: $ Name of Project/Program: Temecula Valley Support Project Month & Year FIRST $5,000 check was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report Is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) Date on a Name of Company I Receipt/invoice E on Receipt or Invoice MUST BE ON OR BETWEEN Z March 20, 2020 - JUNE 30, 2024 F- - EXPENDITURE TOTAL Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount I Description I Purpose EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. Every Community Service Funding application is considered individually and on its own merit. Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of I emecula. o Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. o Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Live Care Foundation, Inc. MAILING ADDRESS: 43460 Ridge Park Dr., Suite 200-S Temecula, CA 92590 PRESIDENT / AUTHORIZED OFFICER: Greg Di Cristina PHONE: (951 ) 541-0414 EMAIL: Greg@LiveCareGrants.org Executive Director SIGNATURE: / DATE: ��� IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 _J STATE OF CALIFORNIA FRANCHISE TAX BOARD FTB PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 7/2/2022 ESL ID: 4339927033 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 4221321 Entity Name: LIVE CARE FOUNDATION, INC. 0 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 0 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights. and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: :711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: J 11 N A 201 LIVE CARE FOUNDATION INC CIO GREGORY DI CRISTINA 32863 LEVI CT TEMECULA, CA 92592-1482 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 32-0587960 DLN: 17053060 3U2U29 Contact Person: LISA A RONAN IDN 17305 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170(b)(1)(A)(vi) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: December 21, 2018 Contribution Deductibility: Yes Addendum Applies: No We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. It we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 PA LIVE CARE FOUNDATION INC Sincerely, Director, Exempt Organizations Rulings and Agreements Letter 947 r� n O C OP.-► m u 410 IA a° a F J N U: 00 yd u O E i+ O 0 0" LL u C ` A O R C � ;! E r ++ U 1 C N i G) E N a_ c o �� s d r TZ' o «m N p N V� pc G O W may^ Oz N 3� N i o a C o N 10 N Y � y ToL NYN L YN `aa � rla aN, Qy � a+ coa�iv gaEE 00 oaaid b to m 1= N p N d u N m C LL c '+m .i N � c v O N ` d O LL AIL .y Ln io U [• XN INN YI WM m0 JJ FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 28 MAKE-AmWISH ORANGE COUNTY INLAND EMPIRE INC. C11`1r OF T11,1NI UCUI.:'tt FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAMS APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 20,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Wish Granting in the City of Temecula Start Date: 9/1/22 End Date: 8/31/23 Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Make -A -Wish Orange County and the Inland Empire Mailing Address: 3230 El Camino Real STE 100 Irvine, CA 92602 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Make -A -Wish OCIE Website: wish.ocie.org Number of Paid Staff: 21 Year Founded: 1983 Social Media: https://www.facebook.com/MakeAWishOCIE Number of Volunteers: 550 Geographic Area(s) the Organization Serves: Riverside, San Bernardino and Orange Counties Geographic Area(s) the Project/Program Serves: City of Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Gloria Jetter Crockett Title/Position: President and CEO Contact Person's Direct Telephone: (714) 573-9474 x 214 Contact Person's Email: gcrockett@ocie.wish.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 1983 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0036556 State Identification Number: 8315236986 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1- E Attach IRS Deductibility Status using this link: htt ://a s. irs. ovla /oos/ 2. EjJ Attach State Entity Status Letter using this link: httos://www.ftbrCa.igovtonfine/self serve entity status letter/index.as 3. V Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: h i ://rct.dai.ca. ov/Verification/Web/Search.as x?facilit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No © Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors N Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION —I BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Our mission is to grant life -changing wishes for children with critical illnesses between the ages of 2'/2 -18 in Riverside, San Bemardino and Orange counties. Currently there are 528 local children with critical illnesses waiting for their wishes to be granted. These children need the strength to fight against their illness, and Make -A -Wish is committed to ensuring no child waits one unnecessary day for their wish to be granted. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP $ $ _ I $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? * No ❑x Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. *All unrestricted funds raised by Make -A -Wish OCIE goes to support wish granting in all 3 counties. Funds from this community service grant will be used to grant wishes in the City of Temecula. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT, Make -A -Wish OCIE is committed to further expanding its wish granting capacity in Riverside and San Bernardino counties. Funding for this project will allow us to reduce the number of children waiting for their wish. by granting wishes in the City of Temecula. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Grant funding will be used to fund expenses directly associated with granting the waiting wishes of Temecula wish children. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Currently there are 9 local Temecula children with critical illnesses waiting for their wishes to be granted. Funding for this project will allow us to grant a minimum of 2 wishes for children in the City of Temecula [3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 27 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 18 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. Currently there are 9 local Temecula children with critical illnesses waiting for their wishes to be granted. These funds will allow Make -A -Wish to grant a minimum of 2 wishes in Temecula and reduce the number of children with critical illnesses waiting for their wishes to be granted. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Over the past two years, our wish granting program has been significantly impacted by COVID-19, as over 70% of the wishes we grant involve some form of public transportation andfor large gatherings. Given the health concerns for our immuno-compromised families, many wishes were put on hold during the pandemic. With many travel wishes, which generate some of the largest annual expenses for the organization, on hold during 2020-2021 and a portion of 2022, our overall wish expenses decreased significantly, and ultimately led to a temporary reduction in our functional program ratio. In order for us to continue our mission and maximize our community impact, our chapter reduced its fundraising costs and was also able to receive Paycheck Protection program (PPP) loan forgiveness. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Make -A -Wish OCIE is in the midst of a 5-year Strategic Plan (FY21-FY25). As part of this effort, Make -A -Wish has plans to grant 450 wishes per year by 2025 and is committed to ensuring no child in the City of Temecula waits one unnecessary day for their wish to be granted. This effort will require significant funding, and Make -A -Wish is committed to raising significant funds through a diverse series of events across our three counties, enhanced youth fundraising efforts with local schools, and establishing key relationships with local companies and organizations to provide critical funds and in -kind resources to help maximize our wish granting efforts. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $20,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $50,000 14 Organization Other grants or funding already awarded for Project/Program, if any $0 In -Kind match amount or volunteer credit hours estimated amount $20,000 TOTAL REVENUE $90,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/Insurance $ Supplies $ Marketing $ Services $ Food Other Direct wish expenses $ 90,000 Staffing Expense I THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $ TOTAL BUDGET $ $90,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Make -A -Wish Orange County and the Inland Empire MAILING ADDRESS: 3230 El Camino Real Ste 100 Irvine, CA 92602 PRESIDENT / AUTHOR17kD OFFICER: Gloria Jetter Crockett PRINT NAME SIGNATURE: x IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Clarissa Morales PHONE: (714) 573-9474 EMAIL: cmorales@ocie.wish.org President and CEO TITLE DATE: MONTH, DAY, YEAR Development Manager PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 13 of 13 Internal Revenue Service District Director Department of the Treasury Date: Noy p 1 1984 Make -A -Wish Foundation of Orange County, Inc. 833 Dover Drive Newport Beach, CA 92663 Dear Applicant: 4CEIVED NOV 199 Employer Identification Number: 33-0036556 Accounting Period Ending: December 31 Form 990 Required: W Yes ❑ No Person to Contact: L. Bakion (RH) Contact Telephone Number: (213) 688-4889 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. We have further determined that you are not a private foundation within the meaning of section 509(a) of the Code, because you are an organization described in section 509(a)(1) and 170(b)(1)(A)(•vi). If your sources of support, or your purposes, character, or method of operation change, please let us know so we can consider the effect of the change on your exempt status and foundation status. Also, you should inform us of all changes in your name or address. As of January 1, 1984, you are liable for taxes under the Federal Insurance Contributions Act(social security taxes) on remuneration of $100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Since you are not a private foundation, you are not subject to the excise taxes under Chapter 42 of the Code. However, you are not automatically exempt from other Federal excise taxes. If you have any questions about excise, employment, or other Federal taxes, please let us know. 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. The box checked in the heading of this letter shows whether you must file Form 990, Return of Organization Exempt from Income Tax. If Yes is checked, you are required to file Form 990 only if your 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 your annual accounting period. The law imposes a penalty of $10 a day, up to a maximum of $5,000, when a return is filed late, unless there is reasonable cause for the delay. (over) P.O. Box 2350, Los Angeles, CA 90063 Letter 947(DO) (Rev.10-83) You are not required to file Federal income tax returns unless you are subject the tax on Wrj%lated business income under sectioir 511 of the Code. If you are subject to this tax. you must file an income tax return on Form 990-T, Exemrt Organization Business Income Pax Return. In this letter. we are not determining whether any of your present or proposed activities are unrelated trade or business as defined in section 513 of the Code. You need an employer identification number even if you have no employees. If an employer identification number was not entered on your application, a number will be assigned to you and you will be advised of it. Please use that number on all returns YOU file and in all correspondence with the Internal Revenue Service. Because this letter co4d`help resolve any questions about your exempt status and foundation status, you should keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter. Sincerely yours, to( '� C-�t �- t�c� District Director STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/8/2022 ESL ID: 5438109377 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1169838 Entity Name: MAKE -A -WISH FOUNDATION OF ORANGE COUNTY AND THE INLAND EMPIRE, INC. ® 1. The entity is in good standing with the Franchise Tax Board. EJ 2. The entity is not in good standing with the Franchise Tax Board. ® 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d, 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) ** PUBLIC DISCLOSURE COPY ** Return of Organization Exempt From Income Tax 01AFS No, 16d5.OD1! Form 990 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) (Rev. January 2020) 2019 Department of the Treasury I ► Do not enter social security numbers on this form as it may be made public. Open to Public lnfwnal Aevanue seryica Go to www.irs.gov/Form99O for Instructions and the latest information. InspecVon A For the 2019 calendar year, or tax year beginning SEP 1 2019 and andina AUG 31, 2020 S Chock if C Name of organization applloahlo: MAKE -A -WISH FOUNDATION OF ORANGE COUNTY �cpl AND THE INLAND EMPIRE, INC. �Name charl Doina business as O eulwn Number and street (or P.O. box if mail is not delivered to street address) 1:1Fnol r3230 EL CAMINO REAL termin- ated City or town, state or province, country, and ZIP or foreign postal code ��oAn flrn � "d IRVINE. CA 92602 =VW.A F Name and address of principal officer: GLORIA SETTER CROCKETT pondmp SAME AS C ABOVE J Websitil OCIE.WISH.GRG D Employer identification number 33-0036556 Room/suite E Telephone number 00 714-573-9474 43 Gross ril 5,213,481. H(a) Is this a group return for subordinates? __ DYes 91 No H(b) Are all subordinates Included? L�j Yes [_1 No r 527 If "No," attach a list. (see instructions) K Form of ortgarkaliow L:K] Corporation J_J Trust [ I Association J I Other ► J L Year of formation' 1983 I m Siate of lanai domidle' CA 1 Briefly describe the organization's mission or most significant activities: TOGETHER, WE CREATE v LIFE -CHANGING WISHES FOR CHILDREN WITH CRITICAL ILLNESSES, A 2 Check this box ► = if the organization discontinued its operations or disposed of more than 25% of its net assets. c3 Number of voting members of the governing body (Part VI, line 1a) 3 23 23 c9 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 ee (4 5 Total number of individuals employed in calendar year 2019 (Part V, line 21 5 35 ;,E - --• . - _ 6 Total number of volunteers estimate if necessary) 6 700 C, a7 a Total unrelated business revenue from Part VIII, column (C), line 12 7a b Net unrelated business taxable income from Form 990-T line 39 17b 0. Prior Year Current Year 4, 224, 901. 3, 763, 197, y 8 Contributions and grants (Part Vlll, line 1h) 188, 400, 79,921. v9 Program service revenue (Part VIII, line 2g) 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) 129,868. 106,133. cc 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -24 807, , -49, 856. 4,518.362. 3,899,395. 12 Total revenue • add IInas 0 itlrorf h 11 must ual Part VIII column fin 12 13 Grants and similar amounts paid (Part IX, column (A), lines 1.3) 2,259,595. 1,309,159. 0. tl. 14 Benefits paid to or for members (Part IX, column (A), line 4) 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5.10) .. - 1,780,039. 1.558.555. 0. 0. 16a Professional fundraising fees Part IX, column (A), line 11 e b Total fundraising expenses (Part IX, column (1)), line 25) Jim-1,000,516. 1, 038, 465, 1,101. 654, 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) 5,078, 099. 3, 969, 368. _ 18 Total expenses. Add lines 13.17 (must equal Part IX, column (A), line 25) 19 FievenwIII ex mSubtractline18fromOne12 -559,737. -69,973. Beginning of current Year End of Year 2,904,150. 2,775,036. 20 Total assets (Part X, line 16) ......, 852, 303. 740 1156 21 Total liabilities (Part X, line 26) .. 2 051 847 , 2, 034, 921. r 22 Net assets or fund balances. Subtract line 21 from line Pit .................. Ill a 11 I p1a1106LIrp 47III Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true correct and Corn leie. declaration of pnorer other than afffcer is based on all information of which preparer has any knowledge. Sign Signature of officer Date Here GLORIA JETTER CROCKETT, PRESIDENT & CEO Type or print name W fide Print/Type preparer's name Preparer's signature /f� q Date check Q PTIN Paid '.HRISTINE KAWECKI 1i4.'f^ f Ot7�22/2U21 sag-ProIE Eti Preparer Firm's name III DELOITTE TAX LLP Firm's EIN bb, 86-1065772 Use Only Firm's address 0. Two JERICHO PLAZA JERICHO, NY 11753 Plfnnn nn 516-918-7000 ,ft the IRS discuss this retum with the ereporer shown above? see instructions . .......--_-.. LLJS No 932001 01-20-20 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 9W (2019) TAX RETURN FILING INSTRUCTIONS FORM 990 "" FORM 990 PUBLIC DISCLOSURE COPY " FOR THE YEAR ENDING AUGUST 31, 2020 PREPARED FOR: MAKE -A -WISH FOUNDATION OF ORANGE COUNTY AND THE INLAND EMPIRE, INC. 3230 EL CAMINO REAL NO, 100 IRVINE, CA 92602 PREPARED BY: DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO, NY 11753 AMOUNT DUE OR REFUND: NOT APPLICABLE MAKE CHECK PAYABLE TO: NOT APPLICABLE MAIL TAX RETURN AND CHECK (IF APPLICABLE) TO: NOT APPLICABLE RETURN MUST BE MAILED ON OR BEFORE: NOT APPLICABLE SPECIAL INSTRUCTIONS: THIS COPY OF THE RETURN IS PROVIDED ONLY FOR PUBLIC DISCLOSURE PURPOSES. ANY CONFIDENTIAL INFORMATION REGARDING LARGE DONORS HAS BEEN REMOVED. FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 29 MICHELLEYS PLACE CANCER RESOURCE CENTER CITY OF ZTMECYTLA FISCAL, YEAR 2022 M 2023 COMMUNITY SERVICE FUNDING M REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Cancer Support Services Project/Program Title: Start Dater End Date: i� .a3 Physical Address of Project/ Program: 41669 Winchester Rd. Temecula CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Michelle's Place Cancer Resource Center Mailing Address: 41669 Winchester Rd Temecula, CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Michelle's Place Cancer Organization: Resource Center Website: www.micheliesplace.org Number of Paid Staff. 10 m Year Founded: 2001 Social Media: @pinkribbonmp Number of Volunteers: 121 Geographic Area(s) the Organization Serves: Riverside County, North San Diego County Geographic Area(s) the Pr jecttl?ro ram Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE ExcLus Vj ELY USED TO SERVE TEMECULA. Contact Name: Kim Gerrish Title/Position: Executive Director Contact Person's Direct Telephone: 951-699-5455 Contact Person's Email: kim michellesplace.or 9 NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 2001 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0951216 State Identification Number: 2267780 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: htt2:l1ap-0s.irs.q vlappleasl 2. ® Attach State Entity Status Letter using this link: htt s:/� //www,Ftb.ca.00vlonline/self serve entity stater�lgtter/index.asa 3. 1 Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: Ilr a. v e ifi t1vnlWetal5earch.as x7f,-Ilitv=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions vaiued over $500 including any business transactions, negotiations, investments, or interests In real property with a Temecula City Council Member during the past 12 months? No ■o Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No [■J Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations. � y Executive Committee ❑ Board of Directors ❑ Members -at -Large [kj MISSION STATEMENT OF ORGANIZATION -- 1 BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Empowering individuals and families impacted by cancer through education and support services. Michelle's Place is a full service cancer resource center providing free resources for families dealing with cancer. r FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA's AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes N IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Pink Ribbon Asst. Program $ 2,000 6/1/20 CMD CSF Cancer Support Services 1/29/21 CSF CSF 1 $5,000 $ 5,000 Cancer Support Services 1/2022 Purple Ribbon Assistance $1,000 6/2022 CMD CSF Purple Ribbon Assistance $1,000 6/2022 CMD CSF OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ❑ Yes 0 IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH +YEAR RECEIVED NAME OF ENITY FUNDING RECEfVED $ 10,000 Riverside County Transportation Comission 7/22 $ 10,000 CDBG - Murrieta 12/21 $ 10,000 5,000 Is 10,000 $ 25,000 $ 24,500 $ 45,000 CDBG - Menifee _ 6/22 San Manuel Band of Mission Indians 9/22 Inland Empire Community Foundation 7/21 Stater Bros. Charities 4/21 Kaiser Permanente 12/21 Inland Empire Health Plan 1/22 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROD , CTIPROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT The cancer support services program provides free resources for cancer patients, education on prevention and early detection, patient navigation, temporary financial assistance, transportation to medical appointments, and support to families dealing with cancer. Michelle's Place hosts 23 different programs and support groups over 50 times a month for cancer patients and their families. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EGIUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The Center currently relies on donated items for the cooking program, art expression and husbands hangout groups. Funding through this grant will enable Michelle's Place to purchase supplies for these classes and allow for more attendees. They will also be used to purchase items for the chemo kits and mastectomy kits. Funds will also be used to provide temporary financial assistance to people in active cancer treatment that are struggling to feed their families. Funds will also be used to provide transportation to medical appointments, fund MRI's and lymphedema supplies not covered by insurance. Funding will support a 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAMIPROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Michelle's Place is the only cancer resource center in the County and is located in the City of Temecula. Residents can access the Center and receive a variety of support Monday through Friday. From July 2021 to June 30, 2022, Michelle's Place helped 318 Temecula cancer patients with 2,126 free services. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 425 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECTIPROGRAM: 121 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECTIPROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT -- SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS The Temecula Community Service Funding - Reinvestment in Temecula grant will! provide over 400 Temecula residents and their families facing cancer with navigation, psychosocial support, temporary financial assistance, transportation, and education on early detection and prevention. No one will face cancer alone in Temecula. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. The Covid-19 pandemic limited Michelle's Place ability to serve Temecula because of the many restrictions. Cancer patients could not access support groups or classes during the pandemic, leaving them feeling less supported. Michelle's Place implemented zoom for many classes and groups to reach more of those affected. During the Pandemic, many cancer patients struggled financially. The need for financial resources was significant. The increased need added a financial burden to Michelle's Place. Transportation to medical appointments also became a huge need but was unavailable due to the restrictions on the transportation company. Today, the cost of fuel has created new restrictions on the program. We are only 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Funding will expand the current programs for Temecula residents at Michelle's Place. We will be able to provide more transportation, have more people in classes and programs, ensure families get financial assistance and we will be able to highlight the programs and groups available in the Center through a new Program Calendar. This funding will enhance the program experience as well as serve all who need help while going through cancer in Temecula. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) i LINE ITEMS FOR PROJECT/PROGRAM REVENUES _I EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM f Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 23,000 Organization Other grants or funding already awarded for Project/Program, if any $ 26,600 San Manuel Tribe of Mission Indians IECF HUD - Food Insecurity RCTC IEHP In -Kind match amount or volunteer credit hours estimated amount $ 12,000 TOTAL REVENUE $ 111,600 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Michelle's Place Program Calendar Facilities/Rent/Insurance Supplies Chemo kits - 159 x $75 = 11,925 Transport Art Supplies - $500 per month (24 clients) p $ 3,125 $ $ 17, 925 Marketing Printing and duplicating, educational materials on cancer related topics. p Services Transportation - 40 rides x $125 = 5,000 $1 125 $ 5,000 Food Grocery gift cards - 30 families x $350 = 10,500 Other Mastectomy kits - 25 x $50 = 1,250 Husbands Hancout - 3 support events x $250 $ 10,500 $ 2 000 , Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, HOWEVER PLEASE INCLUDE. _ $ 1 925 , TOTAL EXPENSES TOTAL BUDGET $ $ 1$111,600 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 2V22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2 021 -2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the Funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. I. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table,) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization. Michelle's Place Cancer Resource Center FY 2021.2022 Amount of $ CSF Grant Fund Awarded: Name of Project/Program: Cancer Support Services Month & Year CSF Grant Received from City: Number of Beneficiaries I-iving in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): c Name of Com an Date on Expenditure r `w p y Receipt/invoice on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose QE JULY 1, 2021 . JUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE 2 3 4 $ 5 $ 6 $ EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT, City Of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in _ _ FY2022-2023 by the City of Temecula. follow these instrurtinnc_ I€ your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in PY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30. 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any Funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the a pp rove dlawarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no laler than June 30, 2024. to demonstrate grant funds were spent in accordance wlth the Application, (if you were awarded less than $6,000, submit Expenditure Report for that amount.) S. If awarded grant funds exceeding $5,000. A) Follow 41.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed far the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than ,tune 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Michelle's Place Cancer Name of Project/Program: Cancer Support Services Resource Center o TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: S was received from City: I. Is this Exponditure Report Is to provide documentation for first $5,000 awarded and received? Yes or No_ (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the city 3. Is this Expenditure Report Is submitted to request reimbursement of funds? No or Yes It yes, Amount of Request 5 Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) m i aZ Name of Company on Receipt or Invoice Date on Receipt/lnvoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, 2024 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Eli EXPENDITURE TOTAL $ Amount + Description Purpose I EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. 1/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Michelle's Place Cancer Resource Center MAILING ADDRESS: 41669 Winchester Rd Temecula, CA 92590 PRESIDENT / AUTHORIZED OFFICER: Kim Gerrish PRINT NAME SIGNATURE: 11 G� aAA�G IF DIFFERENTTHAN ABOVE, APPICATION PREPARED BY: ,,M NA U PHONE: c 95 y 699-5455 EMAIL: kim a@michellesplace.org Executive Director DATE: 9/9/2022 TITLE NiONTI-I, DAY.'([ -AR SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Browfi@TeMeCUIeCA.gov (951) 694-6413 Betsy.Lowrey@7a-remeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD �T g PO BOX 942857 SACRAMENTO CA 94257.0540 Entity Status Letter Data- 5/29/2020 ESL ID: 1897482817 According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 2267780 Entity Name: MICHELLE'S PLACE CANCER RESOURCE CENTER 0 1. The entity is in good standing with the Franchise Tax Board. u 2. The entity is not in good standing with the Franchise Tax Board. LRJ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d El4. We do not have current information about the entity. The above information does not necessarily reflect: • The entity's status with any other agency of the State of California or other government agency. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or the entity did business in California at a time when it was not qualified or not registered to do business in California: o The status or voidability of any contracts made in California by the entity at a time when the entity was suspended ar forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). o For entities revived under R&TC Section 23305b, any time limitations on the revivor or limitation of the functions that can be performed by the entity. Connect With Us Web: ftb.ca.gov Phone; 800.852,5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 02-2019) Q HELPB MENU `Me- > Tax Exempt Organization Search > Michelles Place Breast Cancer Resource Center < Back to Searchexults Michelles Place Breast Cancer Resource Center EIN: 33-0951216 1 Temecula, CA, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in l termining deductibility of their contributions, On Publication T8 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2020 Form 990 Organization Name: Michelles Place Cancer Resource Center EIN: 33-0951216 Tax Period: 202012 Return ID: 2657067 Filing Type: E Return Type: 990 Copy of Return: 2020 Form 990 Filing I Tax Year 2019 Form 990 Tax Year 2016 Form 990 Page Last Reviewed or Updated: 20-November-2020 04 Share $ Print Form 990 oNte No. 1545 0047 Return of Organization Exempt From Income Tax - 2021 Undersectlon 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) f r1 bnnnl of the Treaxrrry � Do not enter social secailly numbers on Ihls font as It may bem ile public. Open to Public fnSernaf Revenue Samce ► Go to nrww.fra.gov1Farm980for instructions and the latest information. inspection A For the 2021 calendar year, or tax year beginning 2021, and ending .20 B Check fapplicabla: C f) Employer identification number AtIdfCSAchange MICHELLE' S PLACE 33-0951216 Name change CANCER RESOURCE CENTER TelophoAn number Imbal return 41669 WINCHESTER RD. STE 101 951-699-5455 Foal r@turOlermi0aled TEMECULA, CA 92590 hh ILnende;i return G Gos5receipts •7 1,169,118. Apphcabon pending F Name and address of principal officer: MARILYN R. WATSON RM 15 rtus a group rrtmen for subwonates' HYes 6 No SAME AS C ABOVE Nfb) Are all subordinates included? Yes No If'No,' anach a list. See mstouclions I Ta<•ex mpl status: X 50I(c)(3) 501(c) ( )+ (insert m.) I 14947(a,'(I)or 11527 J Website: ► WWW, MICHELLESPLAi DRG H(d) Group a%cmphorr number K Form of prpenrtahca: X Carprnaben Trull Assdciahan O her L Year of formation: 2000 1 M state or legal domicile: CA 1 l rlerfy describe the organizations mission or most slgndreant achvt4es:EMPOWERING INDIVIDUALS AND FAMILES IMPACTED BX CNER THROU6F1 DUCATY4NwANb 5[3PPflRT SERVxC � _ --.-- - --- - - --------------------------------------------------------------- 2 Check this box - ❑ rF fhe organitallon discontinued its operations or disposed of more than 25% of its net assets -- — <5 3 Number of voting members of the governing body (Part Vf, fine ia) ... 3 12 °a 4 Number of independent voting members of the governing body (Part VI, lime 1 b)........... 4 8 Y ....., 5 Total number of indivltluals employed in calendar year 2021 (Part V, line 2a),.....,.,...... ...... -„, $ 12 .< 6 Total number of business revenue from Part VIII, column (C), line 6 165 volunteers (estimate If necessary), . , , ....... q 7a Total unrelated business r lie 12............ 7a 25 024. b Net unrelated business taxable income from Form 990•T, Part I, line 11 .............. 7b 24,024. Prior Year Current Year m 8 Contributions and grants (Part VIII, line In). .......................- 576 224. 523, 564. 9 Program service revenue (Part VIII, line 2g) , .... ... .. . > 10 Investment income (Part VIII, column (A), lines 3, 4, an d cc 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, , 1 c, I ... ............ 383 255. 4fl3 452. 12 Total revenue — add lines 8 through f I (must equal F , coumn (A), line 12), . 962,134. 929 850. 13 Grants and similar amounts paid (Part IX, column (A), iines 1.3)..-....-.....-.... -. 14 Benefits paid to or for members (Part IX, column (A), line 4) ........... .. . . 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) _... 473,043. 518, 679. m 16a Professional fundraising fees (Pail IX, column (A), line IIe)..... ........ ... m b Total fundraising expenses Part IX, column D , line 25 w g p ( () 1 _ 83, 720._ 17 Other expenses (Part IX, column (A), lines 11a-11 d, 11 11`-24e). . . ........ . . .. 258,957. 253 924, 18 Total expenses, Add lines 13-17 (must equal Part IX, column (A), line 25)_ ....-. .. 732, 000. 772 603. _ 19 Revenue less expenses. Subtract line 18 from line 12 ................. ........... ... 230 134. 157 247. E 6 Beginning of Current Year End of Year 21 Total liabilities Part X, line 26 ......... ..... 3, 352 533. 3,813,088. 1 20 Total assets (Part X, line 16) ( ).........--..................-... � 2,352,533. 2,279r188. x 22 Net assets or fund balances. Subtract line21 from line 20,,.__.................... 1, 362, 781. 1, 533, 900. Part II Si na re oc under pena%os of perjury, I declare that I have examined this reltim, indi;dlno Xco-npnnyino schedules and st0mit' 5, and to the best of my knowledge and belie!, d is !rue, correct, and complete. Declaration of preparer Collier Than officer) is based on all mfo•mabron of vows preparer has any knowledge. Sign 5,jy,61ureOre1hcer -- oale Here ` KIMBERLY GERRIS14 EXECUTIVE DIRECTOR yno or pr.nt name am line PrinllType preparc,'s name Preplrrr5 sianeluro Dale Check U if PTIN Paid LESLIE A. DOPE€TY CPA LESLIE A. DOHERTY, CPA sdf•empuyrd IP0044929L Pre})arer Fnm's name ► LESLIE A DOHERTY & COMPANY, PC Use Qnly Firm'saddress 41880 KALMIA ST STE 170 Firm'sEIN 1 20-2082661 MUR€ ZETA CA 92562 Phone no. (}51� 698-2260 f,4ay the IRS discuss this return with the preparer shown above? See instructions ..... ............................... -- JXJ Yes I I No BAA For Paperwork Reduction Act Notice, see the separate instructions. TEEA011311- 091220 Form 990 (2021) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 30 MILIVET CITY OF TFAMCUTA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 10, L7 C) MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: y Q -Je rA &3 r 1 WyA acc c-1 u,n r Start Date: t t End Date: Physical Address of Project/Program: ,,r r INCLUDE IF DIFFERENT HAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Mailing Address: 0' for - rYX A c ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: M, L- Year Founded: .. O t 1Q Website: ,,,� �y„ ,,�,�, (�,.�- �,�� Social Media: Number of Paid Staff: C Number of Volunteers: Geographic Area(s) the Organization Serves: i Q Geographic Area(s) the Proiect/Proaram Serves: A t J Q)iyef , NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Q c► v e n t-1 ; e, 3 Title/Position: C E a Contact Person's Direct Telephone:95-/ 901- 96Ft1 Contact Person's Email: CP rN r %; NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes [Date of Incorporation as a Nonprofit: --1n1,Sn 2-0 1 (p No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: -51- 18,-i I �l to 3 State Identification Number: J 3 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. [R Attach IRS Deductibility Status using this link: htt Ha s.irs. gov/app 2. [$ Attach State Entity Status Letter using this link: httl)s://www.ftb.ca-ciov/online/self serve entity status letter/index.as 3. t Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt :l�t.doi-c ovNerificatiorVWeblSearch.aspx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No DS Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ' Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. 1 m"t'J k 4 11I h SC: C ►1�✓� P 1`G 1 �v �� c `.z t� L �1 2 v 1 /tJ� ri' C sn��f ( Y- -� -} I`t. CU,tiM�-�: _ ``'�i 0'_"r q. 1WY Pf'U vi N i ✓L" r11 11 l J ry� � 'tom n�S $� VP (ArJj� `�c Vc IV\ 4- A P C c, r A l y (� .. v c c l N J n rO Yam` + G Y -4 �,, �/ C, ✓Z J y S-il-- a-e P SS C,,o l L7 s +i e -4 (P-7 -r- yr v ivs -r(� C L:"v,r�u 'k � Y, FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No x Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT MONTH +YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP AMOUNT I FUNDING RECEIVED OR S�ONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ❑ Yes"K IF YES, PROVIDE INFORMATION IN TABLE BELOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT - I I) d e -1r : A .J L. i � ► ,r•+ rt 1 S '. �] �'- /1 �_ D .' %J r� r7. ✓✓� � �� : ��j 11 1 � C� � eil S S�� J Tom' n ��^', �,s rA-��.��J .✓�c�prars S 1--� L � 1l J � � � � ✓1 Q 1- T J-4- [a �'�a.l. .lo .� r t ..e •1 .rti. �7 r•'a .. 1 H C ._ J]h... .._1. _%.. _ . I n _ l f y. _ � 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. G s � ..-� � r1� c� i ✓\J �„� ;1 \ 4�aS� �_, i -} � �cl c'� i �•-+ a-.. ��.�.. �q ✓� 1A c � •�-e /- S I "\ P r 2 vYl , ii' _ ; 1, h �' b Cris S P ✓► / �, ,,ti.; \u -,A ,�.: \� �_\S G b c. c h �. �v c_o✓�-� • �-� +-- ti U cl; ---VD Ve 6 a GL t[ 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. ^� `Jb o `'r VQ-�2 �r.3s A S'�✓ v�rS 'c'Scr�, �n -F� C' o f TD N. P c c t P, c,•S -i`� H C c �- w�L J f s e -% r ��;.D�,.,,CC--..j---i.,.�,.,� `� i �,�/� 1-� c, � � S ©�., f p ✓ li -•�' ,. ,.v,, L � Q it , ,,,,� ,•� ,_,- �, �}-[ r V P /-I tiJj 4S C:,( A " 1a.-�- �� S f1 I� r.�.�� e. S p� ,� l c "� . ►%� c r� ✓� -�(� , P o-f.re v� 'r(�wY�I.IA �In Tp.�t [wl� � � .s �r�� !''ufr�r°-�.4 VA r^ CC14 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BE FROM THIS PROJECT/PROGRAM: U 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: t City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. TYN. \V Z'� � : U .� � CLQ S � ice. -ii C &. \ S -, Q 1, A f11 r^ 1 ll �N �C C-L "C A, +' c� ��y� I J�� ��r f Av�N -1 �'� l !� + c�• r�-� l ` I f' s. �'k-D- 0 I/ , -i - 1 A 1j A i W7 � J s : J +" ✓\ C e- , J j f'c1_M ( ,S'l-1. �'•�. � ya 1a c,. z l, -1 i r ✓� C� e iv, e ,� C c i C-� J S' '. -I c- nC-Q- IQ' ry ^ f,r�c� -i I2 Ti7rhPCc.i�r1 L/e-I Cai I lrla ry c_1 k�,`tiP�(� l /a �%�liJ i (�r1G' Irt'S C1 �Y ( C r 7 C.✓� i L --+' �` 1 y.-1NC4 lr�L �c1i h L"lAk 'e L) c&S C.� �.-�; �� j �+ '3'r- /• A . ,1C to k-"i 42-- 0Cp f- r - - 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. i Lv J,Ct - I r-A PAt-,Aer-i('� C✓ P c:. ecJ .,-ssf/e- C / o� i✓) V r r —,6 f- c (A k •r^ S os ki c 1 ' i N n-^a-•nJ ve nr Q. e- k. y,O,tit Lv-Js •'` -rS �;"r nJ etc'• Lr � � -}�� � ' ..:, n r-I1 i c � J i �QJ CaiO'.iO�I/ ��`r} KGVl✓1 of ^ Pc� 1 ^ C o r✓, e. V e , I C4 -p, C P � {-v C�A.v n�C1 -S J- J�iN� 1�1Cr2( r a 7 ^ 1 Qr Cis 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. � �r`c ��� � �� '� � -� rn ,�► � 1 r► �,--� �,.s.r, s� :.� c;z. S „(� � � r^f- G..•� J iCU,] S c:✓.cl ,v.l,lc !1 ,emu c�_`� ` S ,.,�o pi,lL-.:> c � S ...: �- L... �l s -/ /Y! n k�7��1 � i Y� 1 v �'+2-�[') ..Ll,.r,Jy'i _ l� C�% L 1 � f r'l,W r j ��� C L� � ., � c` _ �hi •J nJ ,-}�+ f 1 v`•-� J'C l_�� 1``ci.J'� .�L' r 6/2 ('� lily-1 �, Cj' rL � f r City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES 1 EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) " C) Amount contributed to the Project/Program by the Applicant $ Organization Other grants or funding already awarded for Project/Program, if any $ 1 O , r'-Z� In -Kind match amount or volunteer credit hours estimated amount $ 1p+ o TOTAL REVENUE $ gU► 0-77 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ J DOC> Facilities/Rent/Insurance $ 191 t M 0 Supplies $ Marketing $ Services $ _ Food Other $ e nn (D t w V Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ O TOTAL EXPENSES $ TOTAL BUDGET . n-C) $ �D 613-D City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: ■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. ■ Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds, The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: (—Y\ t���la5al MAILING ADDRESS: p r<GVti 'r .• w 104 91tir9 PHONE: (911) e p EMAIL: PRESIDENT / AUTHORIZED OFFICER: ROev SIGNATURE: f DATE: _•_ IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: WOW NA611 IM SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 of the Treasury raDepartment Internal Revenue Service Tax Exempt and Government Date: Entities PO Box 2508 august 20, 2021 >DQ Cincinnati, OH 4520i Employer ID number: 37-1841663 Form 990 required: 990, YES MILVET Person to contact: ° r R.A%7EN L I IILDEN Name: S Lenard ID number: 0203196 30777 RANCHO CALIFORNIA .RD 8925? 1 TFNTF.CULA, CA 925,39 Dear Sir or Madam. - We're responding to your request dated August 16, 2011. about ,your tax-exempt status. Wo issued you a determination Ictter in December 2016, recognizing you as tax-exempt under Internal Revenue Codc (IR(-') Section 501(013). We also show you're not a Private loundation as defined under IRC Section 509(a) hecause you're dcscrihed in IRC Section 509(a)(2). Donors can dedu,a contributions they make to you as provided in IRC Section 17f1. You're also qualified to recei'Ve tax-deductible bequests, le`��acies, devises, transfers, or gifts under IRCSections 21355, 2 106. and 2522. In the heading, we indicated whether you must file an annual information return. lt'you're required to I& a return. Y'ou must li]e one of the following by the 15th day of the 51h month after the end of your annual accounting period. • Form 1990, Return ot'Organizattion Exettapt 17ront Inctrrne Tax . For"' t)t]0-EZ, Snort Form Reta.lrn 01'()rganization Exempt Frorn Incotnc Tax • Form 990-N, Electronic Notice: (e-Poslcard) Im Tax -Exempt Organizations Not Required to File Form 990 or borne 990LZ . Form 990-PF, Return ul'Private 1,oundation or 5ec:iun 4947,,u1( 1) Trusl `treated as Privire Fsjundution According to IRC Section 6033(j), ifyota don`t file a required annual intiamt;tlion return or notice liar 3 Ceanseculit c }carsa, e'I1 revoke your tax-exe:tnpt status on the due date of the 3rd required return or notice. You can fact IRS forms or publications you need from our websitc at w w.irs.gw 4ornts-pubs or by calling 800-1 AX- FOR-M (M10-829-3676), If yuu have questions, call 1107-829-5500 between M a.m. and 5 p,m.. local time. Mouday through Friday (Alaska and IfaWaii li�llow Pacific time). Thank you for your cooperation. Sincerely. Slephen A. Martin Director, F.zcntpt Organizations Ruling~ and Agreements Later 4168 (Rev. 09-2020) Cetatog Number 66666G INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. 0. BOX 2508 CINCINNATI, OH 45201 Employer Identification Number: Date: D E C 2 3 2.016 37-1841663 DLN: 26053756003026 VALLEY RESOURCE CENTER Contact Person: 42097 DAHLIA WAY CUSTOMER SERVICE ID# 31954 TEMECULA, CA 92591-0000 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 509 (a) (2) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: October 28, 2016 Contribution Deductibility: Yes Addendum Applies: No Dear Applicant: We're pleased to tell -you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records_ organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 -z- VALLEY RESOURCE CENTER Sincerely, Jeffrey I. Cooper Director, Exempt Organizations Rulings and Agreements Letter 947 STATE OF CALIFORNIA FRANCHISE TAX BOARD 78) PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/22/2022 ESL ID: 8590949861 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 3958913 Entity Name: MILVET 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information • This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). • The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Fonn �����Z Short Form OMB No. 1545-0047 Return of Organization Exempt From Income Tax 2021 Under section 501(c), 527, or 4947(a)(i) of the Internal Revenue Code (except private foundations) ► Do not enter social security numbers on this form, as it may be made public. • • ' • • Department of the Treasury • tntemal Revenue Service ► Go to www.1rs.gov1Form990EZ for instructions and the latest information. A For the 2021 calendar year, or tax year beginning 01/0112021 and ending 1213112021 8 Check If applicable: 0 Name of organization D Employer identification number ❑ Address change MILVET 37.1841663 ❑ Name change Number and street (or P.O. box It mail is not delivered to street address) suite E Te!ephono number ❑ Initial return 30777 Rancho California Rd 892521 Final return/terminated 951-384.0110 Amended return City or town, state or province, country, and ZIP or fomeipn postal code F Group Exemption Applicallen p"dWg Temecula, CA 92589 Number ► G Accounting Method: r Cash D Accrual Other (specify) ► H Check ► 0 if the organization is not Website: No, www,mlivet.or required to attach Schedule B J Tax-exempt status (check only one) — ID 501 c ❑ 501 c(insert ncLj ❑ 4947 a 1 or ❑ 527 (Form 990). K Form of organization: ❑✓ Corporation ❑ Trust ❑ Association ❑ Other L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or If total assets (Part II, column (B)) are $500,000 or more, file Form 990 instead of Form 990-EZ . . . . . ► g 134,735 Revenue, Expenses, and Changes In Net Assets or Fund Balances (see the instructions for Part 1) Check if the organization used Schedule O to respond to any question in this Part I . . p 1 Contributions, gifts, grants, and similar amounts received . . . . . . . . . 1 134,735 2 Program service revenue including government fees and contracts . . . . . . 2 0 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . 3 0 4 Investment income . . . . . . . . . . . . . . . . . . . . . 4 0 5a Gross amount from sale of assets other than inventory . . . . 5a 0 b Less: cost or other basis and sales expenses . . . I 5b 1 0 c Gain or (loss) from sale of assets other than inventory (subtract line 5b from line 5a) 5c 0 6 Gaming and fundraising events: a Gross income from gaming (attach Schedule G if greater than $15,000) . . . . . . . . . . . . . . . . .I I Ba 0 b Gross income from fundraising events (not including $ 0 of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) . 6b 0 c Less: direct expenses from gaming and fundraising events . 6c 0 d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) . . . . . . . . . . . . . . . 6d 0 7a Gross sales of inventory, less returns and allowances . . . . 7a 0 b Less: cost of goods sold . . . . . . . . . . . . . 7b 0 c Gross profit or (loss) from sales of inventory (subtract line 7b from line 7a) 7c 0 8 Other revenue (describe in Schedule O) . 8 0 9 Total revenue. Add lines 1, 2, 3, 4, 5c, Ball, 7c, and 8 . ► 9 134 735 10 Grants and similar amounts paid (list in Schedule O) . . . . . . . . . . 10 0 11 Benefits paid to or for members . . . . . . . , . . , . 11 0 12 Salaries, other compensation, and employee benefits . . . 12 0 w 13 Professional fees and other payments to independent contractors . 13 � a 14 Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . . . . . 14 46,831,723 15 Printing, publications, postage, and shipping . . . . . . • . . . . . . . . 15 2, 723 654 16 Other expenses (describe in Schedule O) .5ee schedule O Statement 1 16 97 028 17 Total ex uses. Acid lines 10 throe h 16 . ► 17 134 236 H 18 Excess or (deficit) for the year (subtract line 17 from line 9) 18 499 H 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end -of -year figure reported on prior year's return) . . . . . . . . . . . . . . 19 15,000 Z 20 Other changes in net assets or fund balances (explain in Schedule O) . 20 0 21 Net assets or fund balances at end of year. Combine lines 18 through 20 ■ 21 15,499 For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 106421 Form 990-EZ (2o21) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 31 MOTHERHOOD STEPS CITY OF TEMECULA. FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 F- PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Rental assistance and financial program 01/2023 12/2023 Project/Program Title: Start Date: End Date: Physical Address of Project/Program, 44731 Corte Gutierrez Temecula, CA 92592 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Nikia Ellis Mailing Address: 44731 Corte Gutierrez Temecula, CA 92592 j ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Motherhood Steps Website: moth erhoodsteps.org Number of Paid Staff: Year Founded: 2021 Social Media: Motherhood steps Number of Volunteers: 3 Geographic Area(s) the Organization Serves: Temecula CA Geographic Area(s) the Prolect/Program Serves: Temecula CA NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Nikia Ellis Title/Position: President 858-922-5133 motherhoodsteps2021 @gmail Contact Person's Direct Telephone: Contact Person's Email: NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 10/29/2021 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 87-3493543 State Identification Number: 4805679 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1, X❑ Attach IRS Deductibility Status using this link: hM:ll�DsJrs.ctov/app/eos/ 2. ® Attach State Entity Status Letter using this link: https://www.ftb.ca.gov/onlinelself serve entitV status letterlindex.as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http;/lrct.doi.ca _govNerification/Web/Search.asox?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Motherhood Steps is dedicated to assiting families in reaching self sufficency by providing an array of resources to further enhance stability within communities. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No 2 Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Target $ 250 06/08/2022 Gift Card $ $ $ I $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The program will aid in housing attainment and sustainability. We porvide necessary assistance to nurture independence an ability to grow and strive in the city of Temecula. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Housing is fundamental in stability and families being able to provide efficiently for their children to grow in safe and nurturing environments. With the funding we will aid in paying the deposit for rentals then assist with rent with guidance of budgeting to make them financially aware of paying rent and other household obligations, so they are still living independently in a safe, clean, and stable environment together as a family. We will be providing books for fiancial, budgeting and credit class. We also have created a financil assistant power point for our class we will be providing to clients. we will be needing paper, ink file folders and marketing brochures we also will be marketing on our website. 1 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. R EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. The residents will not have to relocate out of the city and still feel successful knowing they have a place to call home. It is even more stressful having to make such a big move leaving a city you already have roots in or have begun to root. The grant will help give families the relief they need while keeping Temecula thriving with the love and hope of its citizens. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 1-15 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 3 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. If awarded the grant, our organization will aid Ternecula families with housing attainment and sustainability to nurture the health and stability of daily living. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Motherhood Steps was born in 2021, still amidst the pandemic. It was painfully evident of the effects of the Temecula citizens. Increasing in rapid numbers, more and more families have begun facing the seriousness of homelessness. We want to fill that need but with tight budgets of other families trying to stay above water themselves, donations have been low only allowing us to serve families with basic needs such as food and diapering needs. With this grant we will be able to relieve much needed recipients of the burden of possibly living on the streets by helping them attain and maintain housing. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Being awarded this grant will give us ample opportunity to assist those in financial hardships associated with housing.Our program is still in its infant stage and with proper funding we can grow into fulfilling our vision of bringing stability within the community. Providing rental assistance coupled with budgeting courses is our approach to guide citizens from homelessness towards a self-sufficient lifestyle. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 50,000 { Amount contributed to the Project/Program by the Applicant $ Organization 0 Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 43,200 TOTAL REVENUE $ 95,700 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ 0 Facilities/Rent/Insurance $ 0 Supplies $ 1,036 Marketing $ 417 Services $ 48,547 Food 0 Other _ $ 0 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ HOWEVER PLEASE INCLUDE, O $ 50,000 TOTAL EXPENSES TOTAL BUDGET $ $ 50,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS' FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT *IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 I Organization: Name of Project/Program: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month $ Year CSF Grant Received from City: Number of Beneficiaries Living In 92590, 92591, 92592 that Directly Benefltted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Ex enditure Name of Company Date on I E ;, p y Receiptlinvoice E on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose a2 JULY 1, 2021 - JUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE i 6 I EXPENDITURE TOTAL I EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City, To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/Invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment In Temecula" Organization: EXPENDITURE REPORT DATED Name of Project/Program: TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report Is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received E of the total FY 2022-23 Grant Fund awarded by the Clty 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living In 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) Date on E Name of Company Receipt/Invoice u E on Receipt or Invoice MUST BE ON OR BETWEEN go March 20, 2020 - JUNE 30, Q z 2024 EXPENDITURE TOTAL Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount I Description EXPENDITURE TOTAL Purpose City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Motherhood Steps MAILING ADDRESS: 44731 Corte Gutierrez Temecula, CA 92592 PRESIDENT/AUTHORIZED OFFICER: Nikia Ellis SIGNATURE: N-.� IF DIFFERENTTHAN ABOVE, APPICATION PREPARED BY: PHONE: (8g) _922-5133 EMAIL: DATE: 08/22/2022 N!()N1 H, _:1AY Y[A.2 SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD (,FT B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/22/2022 ESL ID: 8239891442 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 4805679 Entity Name: MOTHERHOOD STEPS ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) of the Treasury jrjDepartment Internal Revenue Service Date: 02/16/2022 Tax Exempt and Government Entities rIDQ P.O. Box 2508 Employer ID number: Cincinnati, OH 45201 87-3493543 Person to contact: Name: Customer Service ID number: 31954 Telephone:877-829-5500 MOTHERHOOD STEPS Accounting period ending: 44731 CORTE GUTIERREZ December 31 TEMECULA, CA 92592 Public charity status: 509(a)(2) Form 9901990-EZ 1990-N required: Yes Effective date of exemption: October 29, 2021 Contribution deductibility: Yes Addendum applies: No DLN: 26053749002581 Dear Applicant: We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Sincerely, -a rc 4 . ` z ,tti_ Stephen A. Martin Director, Exempt Organizations Rulings and Agreements Letter 947 (Rev. 2-2020) Catalog Number 35152P I� i �'I i'.E'. . i I •iE ' �I .,,1 ', , i '. ; I .. I 'E � i •:I . I , , - Organization Name: MOTHERHOOD STEPS IRS FEIN: Entity Type: Public Benefit SOS/FTB Corporate/Organization Number: 4805679 Registry Status: Not Registered Renewal Due/Exp. Date: RCT Registration Number: Issue Date: Record Type: Charity Registration Effective Date: Date of Last Renewal; DBA: a g Ad d res.,-v Street: 44731 CORTE GUTIERREZ Street Line 2: City, State Zip: TEMECULA CA 92592 o ,,^ ke No Related Documents nuall Renewal Data No Annual Renewal Data Related ��.,::g s ratg0ns & Event ie s, Arl No Related Records From: Nikia Ellis <motherhoodsteps2021@gmail.com> Sent: Friday, September 9, 2022 11:59 AM To: Stacey Brown Subject: 990 form letter CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Hello I'm Nikia Ellis the President of motherhood steps noprofit organization We did not file a 990 form this year this will be our first full year serving the community. If you have any questions please contact me. Thank you From: Nikia Ellis <motherhoodsteps202l@gmai[.com> Sent: Thursday, September 8, 2022 8:34 PM To: Stacey Brown Subject: Application corrections Attachments: 01-Policy-and-Application-2022-2023-74-FILABLE (1).pdf CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Good evening I was able to correct the first page of the application. I read the funded one very carefully and I am not being funded by any other entity for this program I have received $250 gift card to help a mother in need in June of this year but it was not for this program. Can you let me know if I still need to fill that out thank you. FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 32 MY SISTER'S KEEPER SUCCESS INSTITUE INC. CITY OF TEMECUTA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 1 2, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 35,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Math Genius Program - Math Project/Program Title: Tutoring Start Date: Jan 2023 End Date: Dec 202: Physical Address of Project/Program: Local Schools Participating in TVUSD INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: My Sister's Keeper Success Institute, Inc. Mailing Address: 41765 Rider Way Temecula, CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant My Sister's Keeper Success pp Institute, Inc. 2017 Organization: Year Founded: Website: www.msksi.com Social Media: @msksiinc (FB, Twitter, IG) Number of Paid Staff: 0 Number of Volunteers: 15 Geographic Area(s) the Organization Serves: SW Riverside County Geographic Area(s) the Project/Program Serves: Temecula, CA NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Kristen Newsome Title/Position: Executive Director Contact Person's Direct Telephone: 760-613-1062 Contact Person's Email: kristennewsome@tusks NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 5-15-17 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 82-1665289 State Identification Number: C4025912 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑■ Attach IRS Deductibility Status using this link: http://apps.irs.gov/app/eos/ 2. M Attach State Entity Status Letter using this link: https://www.ftb.ca.govtonline/self serve entity status letter/index.as 3. N Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http:t/rat.doj.ca.govlVerificationfWeb/Sepreh.asox?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No C7 Yes ❑ IF YES, BRIEFLY DESCRIBE: i Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No I11 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ■0 Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES, Mission: We inspire girls and young women and those who are historically the most underrepresented in STEM and business ownership to become confident, bold world changers through STEAM & Career Mentoring and Personal Development Programs. Our programs support students to: Develop leadership skills Build their confidence Practice problem solving Build critical thinking skills Build their communication skills Gain an interest in pursuing STEM and/or entrepreneurship Increase their knowledge about STEM and/or entrepreneurship and how to pursue those careers FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 I_ FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No Ir Yes ❑ IF YES, PROVIDE BELOW. f NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT !I FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP i i I $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ■ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT Y MONTH + YEAR NAME OF ENITY RECEIVED FUNDING RECEIVED $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT -RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Math Genius Program is an Afterschool Expanded Learning Opportunity that will be instrumental in supporting Temecula's most vulnerable students whose 'CAASPP assessments are currently less than proficient in Math, to increase their proficiency. This is an expansion of the current online program that will be piloted to families in TVUSD and can include multiple children per household. The program combines mentoring and tutoring, as well as SEL coaching, extends instructional learning time, accelerates progress to close learning gaps, establishes community learning hubs, gives access to additional academic 12 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Grant funding will be spent to establish a pilot math tutoring hub at participating TVUSD middle and high schools. Purchases will include the following for each tutoring hub: 1. Training for tutors/participating teachers �2, Family coaching and curriculum materials 3. Insurance 4. Online curriculum (at home) 5. Meals/Snacks 6. LPriatina 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Mathematics is a foundation of STEM learning and includes content and thinking that can be used as tools for tackling integrative STEM problems. Expanding this program in Temecula schools will create a consistent hub of support in the community and provide necessary tutoring, mentoring, and support to improve student outcomes and interest, so that performance gaps are addressed and an increased population of students can widen their opportunities to participate in STEM related careers and higher education, which will ultimately create a stronger, more highly skilled and prepared workforce in Temecula. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 500+ I FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 1�0 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 14 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. MGP will support Temecula's most vulnerable students to gain proficiency in math. Grant funding will be spent to establish two math tutoring hubs and provide online curriculum and training accessible to households. This creates a consistent hub of support in the community and improves the workforce readiness of Temecula residents. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. COVID-19 impacted our ability to serve the Temecula community because of the reduction in our volunteer staff, strained operating budgets and extreme competition for charitable funding for nonprofits, which directly impacts our ability to expand services. Many families have also experienced economic and personal hardships that impacted their ability to afford extracurricular programs. 'Inflationary concerns further exacerbate the issue and our nonprofit organization has to do more to address growing needs of students emerging from a pandemic, with less revenue to cover costs to perform services, and decreased staff. Space rental prices are increasing, gas costs are prohibitive for some parents to continue with in person programminq not hosted at their child's school. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. With receipt of grant funding, we will expand our program beyond 100% virtual participation to a hybrid program with 2 community hubs at a participating Temecula schools that will include both online instruction, in -person mentoring and tutoring, and family support services and coaching to ensure parents are partnering in their child's success. Funds will support duplicating the program at two locations with virtual programs and parent coaching support. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET ado not fill In shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES I EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 35,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 25,000 Organization I � Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 42,400 TOTAL REVENUE $ 102,400 LIST OF EXPENSES FOR PROJECT/PROGRAM Online family curriculum, ipads, hotspots, f Tools/Equipment portable speakers, Zoom upgrade Facilities/Rent/Insurance Supplies Printing, mini whiteboards, markers, paper, etc. Marketing Peachjar Marketing to TVUSD Services Tutor/Teacher Training & Parent Coaching Food Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; ' HOWEVER PLEASE INCLUDE. TOTAL EXPENSES I TOTAL BUDGET $102,400 $45, 800 $ 1,000 $ 3,200 $ 15000 $ 81000 $ 91000 $ 11000 $0 $69,000 $69,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately, • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement, • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: My Sister's Keeper Success Institute, Inc. MAILING ADDRESS: 41765 Rider Wy _ PHONE: (951 ) 290-8442 Temecula, CA 92590 EMAIL: kristennewsome@msksi.com PRESIDENT/AUTHORIZED OFFICER: Kristen Newsome Executive Director 'WNT NAME TITLE SIGNATURE: DATE: 9/5/2022 P/10N I, H, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: iNl NAM,' TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B y' PO BOX 942857 `111� SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/7/2022 ESL ID:2683468917 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 4025912 Entity Name: MY SISTER'S KEEPER SUCCESS INSTITUTE, INC. FZ1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d, 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information • This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). • The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m, weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 DEPARTMENT OF THE TREASURY Date. MAY o 1201E MY SISTERS KEEPER SUCCESS INSTITUTE INC 35130 GOLDTHREAD LANE MURRIETA, CA 92563 Dear Applicant: Employer Identification Number: 82-1665289 DLN: 17053363310037 Contact Person: MRS. JOHNSON ID# 31287 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170(b) (1) (A) (vi) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: May 15, 2017 Contribution Deductibility: Yes Addendum Applies: No We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. we determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 -1- MY SISTERS KEEPER SUCCESS INSTITUTE Sincerely, Director, Exempt Organizations Rulings and Agreements Letter 947 Form 990-EZ Short Form OMB No. 1545-0047 Return of Organization Exempt From Income Tax 2021 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) ► Do not enter social security numbers on this form, as it may be made • ' ' ' Department of the Treasury Intemal Revenue Service public. ► uv Go to ww.f►s gov/Form990EZ for instructions and the latest information. A For the 2021 calendar year, or tax year beginning January 1 , 2021, and ending December 31 , 20 21 e check if applicable: C Name of organization a ❑ Employer identification number ❑ Address change IMy Sister's Keeper Success Institute, Inc. 821665289 ❑ Name change Number and street for P.O. box if mail is not delivered to street address) Roontisuae E Telephone number Initial reium Final retum/teanlnated 33175 Temecula Pkwy A8038 951-290-8442 Amended return City or town, state or province, country, and ZIP or foreign postal code F Group Exemption Appllcxllon pending Temecula, CA 92592 Number No, IM G Accounting Method: Lj Cash LIJ Accrual her (specify) ► H Check ► ❑ if the organization is not I Website: ► www.msksi.com required to attach Schedule B Im J Tax-exempt status (check only one) — E] Sot c C],501 c -4 Vnsert no. ❑ 4947(a)(11 or 171597 (Form 990). K Form of organization: 0 Corporation ❑ Trust ❑ Association ❑ Other L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B)) are $600,000 or more, file Fonn 990 Instead of Forst 990-F-z . . . . . . . . . . . . ► $ Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the Instructions for Part 1) Check If the oraaniaation used Schedule O to respond to anv ouestion in this Part I _ _ rl ® 1 Contributions, gifts, grants, and similar amounts received . . . . . . . . . . . . . 1 25,341 ® ® 2 Program service revenue including government fees and contracts . . . . . . . 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . 2 2,561 3 ® 4 Investment income . . . . . . . . . . . . . . . . . . . . 4 5a Gross amount from sale of assets other than inventory 5a b Less: cost or other basis and sales expenses . . . . 5b c Gain or (loss) from sale of assets other than inventory (subtract line 5b from line 5a) 5c 6 Gaming and fundraising events: C a Gross income from gaming (attach Schedule G if greater than $15,000) . . . . . . . . . . . . . . . . . . . . 6a b Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1) (attach Schedule G If the sum of such gross income and contributions exceeds $15,000) . 6b c Less: direct expenses from gaming and fundraising events . . 6C d Net income or (loss) from gaming and fundraising events (add lines 6a and 61b and subtract line 6c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lid 7a Gross sales of inventory, less returns and allowances . . . . 7a b Less: cost of goods sold . . . . . . . . . . . . . 7b c Gross profit or (loss) from sales of inventory (subtract line 7b from line 7a) 7c 8 Other revenue (describe in Schedule O) . . . . . . . . . . . . . . . . . . . 8 1,296 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 . ► 9 29,19E 10 Grants and similar amounts paid (list in Schedule O) . . . . . . . . . . . . . . 10 11 Benefits paid to or for members . . . . . . . . . . . . . . . . . . . . . 11 v, x14 w 12 Salaries, other compensation, and employee benefits m . . . . . . . 13 Professional fees and other payments to independent contractors m . . . . . . Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . . . . . . 15 Printing, publications, postage, and shipping . . . . . . . . . . . . . . . . . 12 13 900 14 1,884 15 690 16 Other expenses (describe in Schedule O) m . . . . . . . . . . . . . . 16T 14,528 17 Total a enses. Add lines 10 through 16 . ► 17 18,002 a 18 Excess or (deficit) for the year (subtract line 17 from line 9) . . . . . . . . . . . . 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end -of -year figure reported on prior year's return) . . . . . . . . . . . . . . . 18 11,196 19 19,485 z20 Other changes in net assets or fund balances (explain in Schedule O) . . . . . . . 21 Net assets or fund balances at end of year. Combine lines 18 through 20 . ► 20 21 30,691 For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 106421 Form 990-EZ (2021) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 33 NATIONAL CHARITY LEAGUE TEMECULA VALLEY CHAPTER CFFY OF TEMECULA FISCAL, YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION 1 Amount Requested: $ Project/Program Title: 4000 Warrior Bags Physical Address of Project/Program: MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Start Date: 8/1/22 End Date: 3/31/23 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: National Charity League Inc. Temecula Valley Chapter Mailing Address: PO BOX 891381 Temecula, CA 92589 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant 1925 - National Organization: National Charity League Inc. Year Founded: 2013 - Temecula Chapter Website: https://members.nationalcharityleague.org Social Media: __@pcltemeculavalley Number of Paid Staff: 0 Number of Volunteers: 250 - Temecula Valley Chapter Geographic Area(s) the Organization Serves: Numerous Local philanthropies in Temecula Geographic Area(s) the ProjectlProgram Serves: Temecula, CA NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Diana Arban Title/Position: Grade Level Advisor Class of 2023 Contact Person's Direct Telephone: 858-382-3766 dianaarban@gmail.com Person's Email: @9mail.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes X❑ Date of Incorporation as a Nonprofit: 2015 No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 46-2834204 State Identification Number: C3577161 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: http //apps.irs.gov/a ieos/ 2. [3 Attach State Entity Status Letter using this link: https://Www ftb.ca,govlonline/self serve entity status letter/index.asp 3. 0 Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http//rct.clgj ca-govlVerification/Web/Searc;li.�ispx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 l APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with i any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. National Charity Leagues mission statement is "Fostering the mother -daughter relationship through an ongoing commitment to philanthropy, culture and leadership." Mothers and daughters build on their relationship through volunteering in Temecula, helping others. It also allows them to be exposed to different cultures and teaching not only the daughters but also mothers about leadership, how to be a leader. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ® IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Preventing Perlod Poverty - NCL Class of 2022 $ 2500 December 2021 Community Service Fundi Senior Project Program $ $ $ $ $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT � MONTH +YEAR NAME OF ENITY RECEIVED FUNDING RECEIVED 4 $ $ $ $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT Project Warrior Bags is the name for mastectomy kits we will be creating to help support Michelle's Place. Michelle's Place was in need of care kits to give to their clients who had recently undergone mastectomies, so our senior class decided to take on the project to help them. The care kit includes handmade tote bags, heart pillows, rice packs for heating pads, seatbelt covers, drain pockets and bookmarks,and inspirational notes. In addition to the handmade items, the bags will include journals, grip socks, and chap stick. We plan on providing Michelle's place with 150 warrior bags. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT Materials needed to make the handmade items: • fabric- heart pillows, tote bags, rice packs, drain pockets, seat belt covers • filling for pillows • rice • velcro • belt material for tote bag straps • batting for seat belt cover • bookmark paper and printing • paper for inspiration cards • printing costs for book marks • thread for sewing Will purchase the following items to put into the bags Journals. Purple pens. Grippy socks, Burts Bees chapstick, 62 inches long, and %2 inches wide satin ribbon 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Temecula Residents who have just had a mastectomy and are connected with Michelle's Place will benefit from this project, as the care kit that we are creating is meant to help make the women more comfortable after having this surgery. We will coordinate with Michelle's Place to ensure and document that the mastectomy kits will be given to Temecula Residents. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 150 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 50 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECTIPROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS The senior year class of 2023 of the Temecula Chapter of the National Charity League will be providing Michelle's Place with 150 mastectomy kits. The mastectomy kits are filled with handmade and purchased items that provide comfort and support to women post -surgery. 5 IF APPLYING FOR MORE THAN $6,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES 11 LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 4000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 1000 Organization _ Other grants or funding already awarded for Project/Program, if any $ 0 L_ I In -Kind match amount or volunteer credit hours estimated amount TOTAL REVENUE $ LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/Insurance $ Supplies $ 5000 Marketing $ Services $ Food Other $ Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ $ TOTAL EXPENSES $ 5000 TOTAL BUDGET $ 5000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. I If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent, If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 ��innal chancy �eaPue 'remecula Valley Preventing Period Poverty/Rose Again Organization: �1iu,ur Name of Project/Program: -- Foundation FY 2021-2022 Amount of $ 2500 CSF Grant Fund Awarded: _ I Month & Year CSF Grant Received from December 2021 City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): 100 ! Date on_ Expenditure Name of Company Receipt/invoice E on Receipt or Invoice MUST BE ON OR BETWEEN A u mount Description Purpose Q= JULY 1, 2021 -JUNE 30, zozz DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE NCL INC 1 Temecula Valley December 2021 Purchasing Feminine Products $ 2500 Providing 100 Temecula Foster and emancipated Chapter — - -- — -- women with 3 months of —fgmirstne-produicts — 2 Coordinated with Rose Again Foundation. i 3 4 5 Is EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024, In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1,A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursedfor the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Name of Project/Program: TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report Is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City i 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) _ C Date on Expenditure iName of Company Receipt/Invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER o E on Receipt or Invoice MUST BE ON OR BETWEEN Z oa2rch 20, 2020-JUNE 30, Amount Description Purpose EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: National Charity League Temecula Valley Chapter PO Box 891381 Temecula CA 92589 MAILING ADDRESS: PHONE: ( 858) 382-3766 EMAIL: dianaarban@gmail.com PRESIDENT / AUTHORIZED OFFICER: 1J 6,2_D _L_V_v_e � 016)\J 66 PRINT NAME TITI G SIGNATURE: " DATE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Diana Arban 6�-lt - 22 MONTH, DAY, YEAR Grade Level Advisor Class of 2023 PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 22, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA F T B FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/27/2022 ESL ID: 8456733290 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 3577161 Entity Name: NATIONAL CHARITY LEAGUE, INC., TEMECULA VALLEY CHAPTER 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone- 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Prudhomme Associates CPA, Inc. 43460 Ridge Park Drive, Suite 220 Temecula, CA 92590 (951) 676-3131 (951) 676-4141 (fax) November 12, 2021 National Charity League, Inc. Temecula Valley Chapter Po Box 891381 Temecula, CA 92589 Dear Mercedes: Enclosed is the organization's 2020 Exempt Organization return. The state Exempt Organization return and Annual Report are also enclosed. Specific filing instructions are as follows. FORM 990-EZ RETURN: This return has been prepared for electronic filing. If you wish to have it transmitted electronically to the IRS, please sign, date, and return Form 8879-EO to our office. We will then submit the electronic return to the IRS. Do not mail a paper copy of the return to the IRS. CALIFORNIA FORM 199 RETURN: The California Form 199 return has been prepared for electronic filing. If you wish to have it transmitted electronically to the FTB, please sign, date and return Form 8453-EO to our office. We will then submit the electronic return to the FTB. Do not mail the paper copy of the return to the FTB. No payment is required. CALIFORNIA FORM RRF-1: The California Form RRF-1 should be mailed on or before April 18, 2022 to: Registry of Charitable Trusts P.O. Box 903447 Sacramento, CA 94203-4470 Enclose a check or money order for $25.00, payable to Department of Justice. The report should be signed and dated by the authorized individual(s). Copies of all the returns are enclosed for your files. We suggest that you retain these copies indefinitely. Sincerely, Gregory J. Prudhomme,CPA TAX RETURN FILING INSTRUCTIONS FORM 990-EZ FOR THE YEAR ENDING May 31, 2021 Prepared for National Charity League, Inc. Temecula Valley Chapter Po Box 891381 Temecula, CA 92589 Prepared by f Prudhomme Associates Cpas, Inc. 43460 Ridge Park Drive, Suite 220 Temecula, CA 92590 Amount due or refund Make check payable to Mail tax return and check (if applicable) to Return must mailed on or before Special Instructions aaosai a4-01-2a Not applicable Not applicable Not applicable Not applicable This return has been prepared for electronic filing. If you wish to have it transmitted electronically to the IRS, please sign, date, and return Form 8879-EO to our office. We will then submit the electronic return to the IRS. Do not mail a paper copy of the return to the IRS. Prepared for Prepared by dated by Amount of tax Overpayment nIanc a Ilwun payable to 2020 TAX RETURN FILING INSTRUCTIONS CALIFORNIA FORM 199 FOR THE YEAR ENDING May 31, 2021 National Charity League, Inc. Temecula Valley Chapter Po Box 891381 Temecula, CA 92589 Prudhomme Associates CPAS, Inc. 43460 Ridge Park Drive, Suite 220 Temecula, CA 92590 no Not Applicable Total tax $ 0.0 0 Less: payments and credits $ 0.00 Plus: other amount $ • 0 0 Plus: interest and penalties $ 0 .. 0 0 No pmt required $ .... Credited to your estlmated tax 0.00 Other amounts 0 Q D Refunded to you $ ............................. Q 0 Not applicable snail tax return This return has been prepared for electronic filing. If you and check (if wish to have it transmitted electronically to the FTB, please applicable)to contact our office. We will then submit the electronic return to the FTB. Do not mail the paper copy of the return to the FTB. Return must be mailed Not Applicable orbeforea Special Instructions 000084 04-01-20 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: DEC 09 ZU'j NATIONAL CHARITY LEAGUE INC TEMECULA VALLEY CHAPTER C/O JULIET GROSSMAN PO BOX 891300 TEMECULA, CA 92589-1300 Dear Applicant: DEPARTMENT OF THE TREASURY Employer identification Number: 46-2834204 DLN: 17053235363013 Contact Person: MB. GAISER ID# 31609 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: May 31 Public Charity Status: 509(a)(2) Form 990 Required: Yes Effective Date of Exemption: June 3, 2013 Contribution Deductibility: Yes Addendum Applies: NO 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 statue, 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. I; - .. � r ; . r•:r ..:r r,. . !. I.I . I ..f. . 1`.r i, . Registrant Details Organization .Name: NAI•IUNAL C:HARI'I Y LLAUUli, INC..' EMLCULA VALLEY CHAPTER IRS FEIN,. 462834204 Entity Type: Public B011Ch[ SO5/1'I'13 Cm -porn te/Organization Number: 3577161 Registry Status: CutTent Renewal Due/Exp. Date: 10/15/2022 RC'T Registration Number: CT0214184 Issue Date: 12119/2014 Record "1)•pe: Charity Registration Effective Date: 12/1912014 Date of Last Renewal: 3/29/2022 ORA: Mading Address Street: PO BOX 891381 Street Line 2: City, State zip: TEMECULA CA 92589-1381 Filings & Correspondence 11 i g Documents Foundin.- Documents �T _ �Tj,�itiltiOn rCtlL'l' Confirmation of Registration Letier �IYt=wa1 Filing — 2021 onewal Filing 2020 gnewal Filing 2019 �1lewttl Filing 2018 R-1 2017 �l�ftF-1 2016 RRF-I RF-1 2� l5 2015 RRF- I 2015 IRS Form 990-N ^ 2014 RRF jma t'orm:ZY&LIN Zu14 2014 IRSForm 990-N J� �y Annual Renewa Data Status of Filing: Accepted Accounting Period Begin Date: 6/ 1/2013 Amounting Period End Date: 5/31/2014 Filing Received Date: 1/12/2015 Farm RRF-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason; IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing; Accepted Accounting Period Begin Date: 611 i2014 kccounting Period End Dale: 5/31 /2015 Filing Received Date; 10/ 16 2015 Form RRF-I Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff, S1alns of Filing: Acccptcd Accounting Period Begin Date: 6r1-2015 Accounting Period End Date: 5/31/2016 Filing Received Date: 10/19;2016 Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff': Staiux of Filing: Accepted Accounting Period Begin Date: 6/1/2016 .Accounting Period End Date: 5/31/2017 Filing Received Date: 10/16 2017 Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Rejecl/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: status of Filing: Accepted Accounting Period Begin Date: 6/1/2017 Accounting Period End Date: 513 1/2018 Filing Received Date: 12/14•201 S Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/incomplete Reason: IRS Form 990 Reject/incomplete Reason: Notes Fran Registry Staff': Status 01' Filing: Accepted Accounting Period Begin Date: 6/ l 2019 Accounting Period End Date: 5/31i2019 Filing Received Date: 10/2)4;2019 Form RRF-I Reject/Incomplete Reason: Form CT-1'R-I Reject/incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff'. Status of Filing: Accepted Accounting Period Begin Date: 6/1/2019 Accounting Period End Date: S/31/2020 Filing Received Date: 10/ 19,'2020 Form RRF-I RC1ect/Incomplete Reason: Forin CT TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason- Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date; 611 /2030 Accounting Period End Date: W11/2021 Filing Received Date: I1-22/2021 Form RRF-I Reject/Incomplete Reason: Form CT-TR-I Reject/incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: j�'�( �/.�w r� y. A e4 },. _ .. .,: WA No t-!.r•.:. ,:, �,i • :i No Related Records FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 34 NAVY LEAGUE OF THE UNITED STATES, INLAND EMPIRE (NJROTC) CrFY OF TEM ECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN' PROGRAM APPLICATION r; (Please Print or Type) DUE ON OR BEFORE: MOND", SEPTEMBER 12, PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000.00 .SF-oI ..t MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Navy League NJROTC/Sea Cadet 11/1/22 11/1/23 Project/Program Title: Start Date: _ End Date: Physical Address of Project/Program: Chaparral High School, 27215 Nicolas Rd, Temecul INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: NLUS Inland Empire Council Mailing Address: PO BOX 361 Temecula, CA 92593-0361 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Navy League of the U.S. Organization: Inland Empire Council Website: https://www.navyleague.org/ Number of Paid Staff: 0 o Year Founded: 2015 Social Media: facebook.com/InlandEmpireNLU�c Number of Volunteers: 316 Members Geographic Area(s) the Organization Serves: Inland Empire, North San Diego County, LA, Long Be, Geographic Area(s) the Proiect/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: William Lauper Title/Position: Council V.P. Contact Person's Direct Telephone: 6198402846 Contact Person's Email: lauperwm@gmail.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes N Date of Incorporation as a Nonprofit: 12/24/2 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 47-4336297 State Identification Number: 3856223 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑■ Attach IRS Deductibility Status using this link: h4p://apps.irs.ctovlapp/eos/ 2. pp Attach State Entity Status Letter using this link: https:/Iwww.ftb.ca.gov/online/self serve entity status letterlindex.asp 3. 0 Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: ihtip:lfret.diva.porn/VerificationANeb/Search.aspx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No {N] Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors lmf Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSIONIGOALS AND OBJECTIVES The Navy League of the United States, founded in 1902 with the support of President Theodore Roosevelt, is a nonprofit civilian, educational and advocacy organization that supports America's sea services: the Navy, Marine Corps, Coast Guard and U.S.-flag Merchant Marine. As part of its mission focus, the Navy League of the United States: Enhances the morale of sea service personnel and their families through national and council level programs. Is a powerful voice to educate the public and Congress of importance to our nation's defense, well-being and economic prosperity. Supports youth through programs, that expose young people to the values of our sea services. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No 0 Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW AMOUNT RECEIVED MONTH + YEAR NAME OF ENITY FUNDING RECEIVED $ 1000.00 Navy League of the United States STEM 3/2022 $ 1000.00 Navy League of the United States STEM 5/2021 $ $ 3 $ $ fj $ I City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. This funding will support STEM activities for Temecula Navy JROTC and Sea Cadets, as well as students from feeder TVUSD middle schools. These activities include SeaPerch (underwater robotics), CyberPatriot (National Youth CyberSecurity Competition), and Drone Soccer (drone/sUAS). A portion of the funding will support the founding of a Sea Cadet unit here in Temecula (others located at March ARB, Camp Pendleton, and Escondido. These programs will support Temecula's youth from ages 10-18, many of whom are from military families. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. $25,564 will fund two Drone Soccer Classroom Bundles. One bundle will be provided to Mr. Davisson at Bella Vista Middle School and one will go to Chaparral High School (CHS) NJROTC. $2237 will fund ten SeaPerch kits and three tool kits for Bella Vista and Day Middle Schools. $2000 will fund trophies for the Chaparral NJROTC hosted SeaPerch Challenge. $18,000 will fund 12 laptops to support CyberPatriot competitions and CyberCamps. CHS and Bella Vista Middle School currently compete in CyberPatriot and collaborate with training. The remaining $4199 will help fund uniforms for a new Sea Cadet program in Temecula. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. This program and associated funding will support the Sea Services Youth programs located in the City of Temecula and other interested TVUSD Middle School students who are interested in JROTC or Sea Cadets. Chaparral High School NJROTC conducts thousands of hours of community service in Temecula, including the presentation of Colors at the State of the City Address, State of the District Address, school functions, and veterans events. 3b -ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 200 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 10 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. This program supports STEM training and competitions for Temecula NJROTC and Sea Cadets and feeder middle schools to include SeaPerch (underwater robotics), CyberPatriot (cyber security), and Drone Soccer (drones/sUAS). Success is determined by increased youth participation and interest in STEM. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. The COVID-19 pandemic forced the cancellation of our annual fundraiser/benefit night at Europa Village Winery as well as other fundraising opportunities. 1 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. (1) Funds will support the founding of a Sea Cadet program in Temecula. Sea Cadets is a volunteer run leadership program for teenagers. The program relies upon volunteers and donors for their uniforms and activities. (2) The Inland Empire Council has been organizing and running the Southern California SeaPerch Challenge since 2016. The intent is to host the 2023 competition at Chaparral High School. This is a regional qualifier for the International SeaPerch Challenge. The Inland Empire Council also sponsors local CyberPatriot (cyber security) teams and summer camps. These funds will allow the Council to expand those offerings to others in the district. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES 4 LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 1000.00 Organization i Other grants or funding already awarded for Project/Program, if any $ 1000.00 In -Kind match amount or volunteer credit hours estimated amount $ 10000 Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food Other TOTAL REVENUE $ 52000 LIST OF EXPENSES FOR PROJECT/PROGRAM 12 Laptops for CyberPatriot competitions, 2 x Drone Soccer Bundle. 3 x SeaPerch Tool kits 10 x SeaPerch underwater robotics kits @ $179.00 each. Trophies for SeaPerch Uniforms and startup costs for new Sea Cadet program in Temecula. Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. 0 TOTAL EXPENSES TOTAL BUDGET $62000 $44011 $3790 $4199 $0 $52000 $52000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT *IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent If the funds were not spent in accordance with the approvedlawarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Navy League of the U.S. Name of Project/Program: Navy League NJROTC/Sea Inland Emplre Council o Ca- a support FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): C m E 2.2 E QZ EPA W7 10 I&I Date on Name of Company Receipt/Invoice on Receipt or Invoice MUST BE ON OR BETWEEN Amount JULY 1, 2021 - JUNE 30, 2022 Description Purpose DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation Including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. (if you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Navy League of the U.S. Name of Project/Program: Navy League NJROTC/Sea Inland Empire Council a Cadet support 0 TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: _ 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the city 3. Is this Expenditure Report Is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92690, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise numb r) EName of Company Eon Receipt or Invoice Q Z 2 3 Date on Receipt/Invoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, 2024 Expenditure MUST SUPPORT PROJECTIPROGRAM IN APPLICATION & AWARD LETTER EXPENDITURE TOTAL $ Amount I Description EXPENDITURE TOTAL Purpose City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. Every Community Service Funding application is considered individually and on its own merit. Awards will be given to organizations and activities that directly benefit the residents of Temecula. Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. n The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula, • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Navy League of the U.S. Inland Empire Council MAILING ADDRESS: PO Box 361 Temecula, CA 92593-0361 PHONE: ( 619 ) 840-2846 EMAIL: lauperwm@gmaii.com PRESIDENT/ AUTHORIZED Drf=1CFi: Ronald Barham, President SIGNATURE: TE: 9/11 /2022 IF DIFFERENT THAN ABOVE, William Lauper, Vice President APPICATION PREPARED BY: p n SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 s : r NAVY LEAGUE of the United States January 27, 2016 Navy League of the United States Inland Empire Council P.O. Box 361 Temecula, CA 92593 Dear Council President, We have received all of the materials from your council that are necessary to participate in the Group Tax Exemption Program (that is, as an organization exempt from federal income tax under sections 501(a) and 501(c)(3) of the Internal Revenue Code) which was approved by the Internal Revenue Service (IRS) on November 6, 1990, The council has been added to the list of participating subordinate councils. A four -digit group exemption number (GEN) 3276 was assigned by the IRS Service Center in Philadelphia on January 14, 1991. This number must be used in order to identify the Group Exemption when corresponding with the IRS. Do not confuse it with your council's Employer Identification Number (EIN). The local council's EIN is the number that should be used on all correspondence with the IRS and also given to your vendors and contributors as identifying the council as tax-exempt. A copy of the IRS letter recognizing the Group Exemption, and the letter assigning the GEN are both attached. This letter provides you with important information about the Group Exemption granted to the Navy League of the United States (Navy League) and its subordinate councils. RIGHTS A significant benefit of being included in the Navy League's Group Tax Exemption Program is that your council may receive contributions deductible by the donor as provided for in section 170 of the IRS Code. Additionally, bequests, legacies, devises, transfers, or gifts to or for your council's use are generally deductible for federal estate and gift tax purposes under sections 2055, 2106, and 2522 of the Code. Should you encounter a situation where a potential donor, state agency, or vendor requests proof that your council is a member of the Group Exemption, you may send them this letter from the Navy League and a copy of the Group Determination Letter from the IRS. 2300 Wilson Boulevard, Suite 200 • Arlington, VA 22201.703-528-1775 • 703-528-2333 Fax • www.navyleague.org Navy • Marine Corps • Coast Guard • U.S.-Flag Merchant Marine Group Tax Exemption Letter Page 2 RESPONSIBILITIES Your council (though now exempt as a member of the Group Exemption) is still required to file an annual information Return of Organization Exempt from Income Tax (Form 990EZ or 990), by May 15, if its gross receipts exceed $50,000 annually. Moreover, if your council conducts any activities that give rise to unrelated business income tax, the council must file an Exempt Organization Business Income Tax Return (Form 990-T). PLEASE NOTE: LEGISLATION NOW REQUIRES ALL NON -PROFITS (regardless of gross annual income) STARTING IN TAX YEAR 2007 TO FILE AN INFORMATION RETURN WITH THE IRS. More information can be obtained about the E-Postcard Form 990N at www.irs.novkharities . This form is also due by May 15"' of each year. As you may know, the law imposes a penalty of $10 a day (with a maximum penalty of the lesser of 5 percent of your council's gross receipts for the year in question or $5,000) when a return is filed late or incomplete, unless there is a reasonable cause for the delay. Please be advised that even if your council does not meet the $50,000 filing minimum for a 990E7, if you receive a Form 990 from the IRS, you should reply to the request. This will allow the IRS to update its records regarding whether or not your council should be sent a Form 990 in future years. As you are probably also aware, your council is liable for FICA (social security) taxes on remuneration of $100 or more paid to any council employee during a calendar year. However, your council is not liable for the FUTA (federal unemployment) tax. In addition to your filing responsibilities with regard to the IRS, your council must promptly provide the Navy League with information regarding any changes in the following areas so that the Navy League is able to fulfill its responsibilities under the Group Exemption: 1. Any material changes in the purposes, character or method of operation of your council; and /or 2. Any changes in the name or mailing address of your council. And finally, the council must also register with the state and local authorities as a charitable organization to meet all state and local ordinances because it solicits funds from the public. Please call this office, at the Navy League, if you have any questions about the rights and responsibilities of your council as a member of the Navy League Group Tax Exemption Program. Sincerely, Ryan Donaldson, Esq. Corporate Council, Senior Director of Contracts and Finance INTERNAL REVENUE SERVICE MTRICT DIRECTOR 31 HOPKINS PLAZA BALTIMOREr NO 21201 Date, NOV D 6 1990 NAVY LEAGUE OF THE UNITED STATES 2300 N I L S O N B L V D ARLINGTON? VA 2221E Dear Applicant, DEPARTMENT OF THE TREASURY Employer Identification Number', 53-0116710 Contact Person; msS A: ASKINS Contact TFlephone Number-, (301) 962-9923 Addendum Applies: Yes We have considered your application for a arou,P exemption letter reco-l- nizing vour subordinates as exempt from Federal income tax under section 501(a) of the Internal Revenue Code as organizations of the type described in Section 501(c)(03). Our records show that you were recognized as exempt from Federal income tax under section 501(c)(03) of the Code. Your execution letter remains in effect. Based on the information supplied, we recognize vour subordinates whose names aP-par on the list you submitted as exempt from Federal income tax under section 501(c)(03) of the Code. Additionallvr we have classified the organizations You operates supervises or controls and which are covered by vour notificatioro to ust as organizations that are not private foundations because they are organizations of the tvpe described in section 509(a)(2) of the Code, Donors may deduct contributions to vour subordinates as Pravided in section 170 of the Code. Bequestsy legaciesr devlses9 transferst or Sifts to vour subordinates or for their use are deductible for Federal estate and gift tax purposes if they meet the applicable Provisions of section 2055? 2106? and 2522 of the Code. Your subordinates whose gross receipts each near are normally more than $25?000 are each required to file Form 990? Return of Organization Exempt. From Income Tax? by the 15th day of the fifth month after the end of their annual ar.countinq period. If you perfert you may file a croup return for those sub- ordinates that authorize you in writing to include them in that return, If you are required to file Form 990 for vour own activities? you most file a separate return and may not be included an env group return that vo,i file for your sub- ordinates. The law imposes a penalty of $10 a day when a return is filed later unless there is reasonable cause for the delay. However? the maximum Penalty imposed cannot exceed 15YO00 or 5 percent of gross receipts for the vearr whichever is less. This penalty may also be char3ed if a return is not completer so vour subordinates ahould make sure their returns are complete before filing them. Please advise your subordinates that, if thev receive a Form 990 package in the mails they should file the return ever, if their gross Letter 1.1t9(D0/CC) STATE OF CALIFORNIA FRANCHISE TAX BOARD FTB PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/10/2022 ESL ID: 7552962182 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 3856223 Entity Name: NAVY LEAGUE OF THE UNITED STATES, INLAND EMPIRE COUNCIL ❑X 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. EJ 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) 4 Secretary of State n w 6 *. -t Certificate of Status un I, SHIRLEY N. WEBER, PH.D., California Secretary of State, hereby certify: Entity Name: NAVY LEAGUE OF THE UNITED STATES, INLAND EMPIRE COUNCIL Entity No.: 3856223 Registration Date: 12/24/2015 Entity Type: Nonprofit Corporation - CA - Public Benefit Formed In: CALIFORNIA Status: Active The above referenced entity is active on the Secretary of State's records and is authorized to exercise all its powers, rights and privileges in California. This certificate relates to the status of the entity on the Secretary of State's records as of the date of this certificate and does not reflect documents that are pending review or other events that may impact status No information is available from this office regarding the financial condition, status of licenses, if any, business activities or practices of the entity. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of September 10, 2022. SHIRLEY N. WEBER, PH.D. Secretary of State Certificate No.: 044014728 To verify the issuance of this Certificate, use the Certificate No. above with the Secretary of State Certification Verification Search available at bizfileOnline.sos.ca.gov. Navy League Of The United States Inland Empire Council EIN: 47-4336297 1 Temecula, CA, United States Farm 990-N (e-Pnstcard) Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations t receive less than $50,000 fall into this category. Tax Year 2021 Form 990-N (e-Postcard) Tax Period: 2021 (01 /01 /2021 - 12/31 /2021) Tax EIN: Yeai 47-4336297 Legal Name (Doing Business as): Navy League Of The United States Inland Empire Council Mailing Address: 3249 Marengo Avenue Altadena, CA 91001 United States Principal Officer's Name and Address: William Lauper 31596 Flintridge Way Altadena, CA 91001 United States Gross receipts not greater than: $50,000 Organization has terminated: No Organization Name: NAVY LEAGUE OF -FTIE UNITED STATES, INLAND EMPIRE COUNCIL IRS FEIN: 474336297 Entity Type: Public Benefit SOS/FTB Corporate/Organization Number: 3856223 Registry Status: CUITent Renewal Due/Exp. Date: 5/15/2023 RCT Registration Number: CT0241528 Issue Date: 9/7/2016 Record Type: Charity Registration Effective Date: 9,7/2016 Date of Last Renewal: 7/13/2022 DBA: Street: 3249 MARENGO AVF Street Line 2: City, State Zip: ALT.AI)ENA CA 91001 Firs[ Notige to J�- gisler First Notice to RegistcT �- f1inUn11izlit111 UTReg61ralicw„LOW Confimaarion oi'Rcgistrolion Lcttcr jkagvv�� [�, Lli; _ 2021 Online 2019 I urtu L"h"t'1t-I 2019 I AI : z[ Y19 �2019 - MisCeilancotts DoetnllCllts Miscellaneous Documents I'U1111(Ill}g D0(;w11S11l% _ Founding Documents 2016 — — 2017 [)thine Renewal Subrttissioa 2019 i. tr�l�al l iling 2020 status of Filing: Accepted Accounling Period Begin Date: Il1/2016 Accounting Period End Date: 12/.;1 /2016 Filing Received Date: 8/4/2017 Form RRF-1 Reject/Incomplete Reason: Form C"f=1'R-] Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes Front Registry Staff: Status of Filing: J Accepted Accounting Period Begin Date: 1/1/2017 Acenuuting Period End Date: 12/31 2017 Filing Received Date: li 1112019 Form RRF-1 Reject/Incomplete Reason: Form C"I'=riz-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Noteti From Registry Staff: Maros of Filing: E-Accepted Accounting Period Begin Date: I11 /2018 Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/]ncomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Received Date: u RRF-1 Reject/Incomplete Reason: a CT-T R-1 Reject/Incomplete Reason: Form 990 Reject/Incompletc Reason: i From Registry Staff: tits of Filing: punting Period Begin Date: ountine Period End Date: (Filing Received Date: Form RRF-1 Reject/incomplete Reason: (Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/incomplete Reason: Form CT-TR-I. Reject/Incomplete Reason: IRS Form 990 Reject/incomplete Reason: Notes From Registry Staff: 12/31 /2018 1 /9/2019 E-Accepted I'1/2019 121/31/2019 I /31/2020 Accepted 1 / 1/2020 12/312020 2,: 8/2021 Accepted — I/l/2021 12/31/2021 2/ 10/2022 No Related Records -+ -i- NAVY LEAGUE OF THE UNITED STATES This graup exemption letter supersedes all urior determination letters of the following organizations: 1. Fart Lauderdale Council 2� Lonq Beach Council U. Miami Council 4, Oak Harbor Council 5, San Fernando Council b. Oakland Cauncil 7. CO -MAR Waves Council The Central organization will be responsible for notifying each of the above listed subordinates that its individual exemption letter is superseded, Letter 211?(00/CG) 11 Internal Revenue Service 11601 Roosevelt Blvd. Philadelphia, PA 19255 Emp . 28 �4do a Q__ __ hear Officer or Trustee: Refer Reply �to! q P: IP : EOUC Date: EIN: Croup Exemption Numbcr: -.L1. L? The four -digit Group Exemption Number (GEN) as shown above has been assigned to your organization— This number is not to be confused with the nine -digit Employer Identification Number (EIN) previously assigned to your organization. Form 990 (Return or Organization Exempt from Income Tax) and instructions require each central organization and its subordinates to show their group exemption number (GEN) in Part I, Item 18(b), of Form 990 in addition to their EIN. Please advise any of your subordinates that are required to file an annual information return. Form 990, to place your group exemption number on their return. Thank you for your help in this matter. Sincerely yours Mary nne Slater Chief, Entity Section III -2- NAVY LEAGUE OF THE UNITED STATES receipts do not exceed the $25r000 minimum, If not required to °ilex a subor- dinate should simply attach the label provided, check the box in the headinq to indicate that its annual gross receipts are normally $25000 or less, and sign the return, This will ai'1 —us to update our records to show that the subordi- nate is riot required to file and to delete that subordinate from the list of organizations that will receive Form 990 packages in future years. Your subordin2tes are riot required to file Federal income ta:: returns unless sub iect to the ta- an unrelated business income under section 511 of the Code, Each Organization subject to this tax must file Form 990-T, Exempt Organization Business Income Tax Return, Iri this letter we are not. determining whether any of your subordinates present or proposed activities are unrelated trade or business as defined in section 513 of the Code, As of danuary 1, 1989r each of your subordinates is liable for taxes ender the Federal Insurance Contributions Act (social security takes) on remunera- tion of $100 or more they pav to each of their emplovees during a calendar near, Your subordinates are not liable for the tax imposed under Federal Unemployment Tax Act (FUTA). Each near, at least 90 days before the end of vour annual accountinq per- iodr please send the items listed below to the Int+rrial Revenue Service Center at the address shown below. 1, A statement describing anv changes durin,a the year in the purposes, character, or method of operation of your su�bordinatesi 2+ A list showing the names, mailinq addresses (including Postal ZIP codes)v actual addresses if different, and employer identification numbers of subordinates that since vour previous report! a, Changed names or address, b, Were deleted from your roster: or c, Were added to your roster, 3. For subordinates to be added, attach: a. A statement that the information on which vour Present aroup exemption letter is based applies to the new subordinates; b. A statement that each has given you 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 priyate foundation as defined in section 509(a) of the Code if the group exemption letter covers organizations described in section 501(c)(3)a e, The street address of each subordinate whose mailing address is a P. 0, Bo;;; and f, The information required by Revenue Procedure 75-50r 1975-2 C,B, 587r for each subordinate that is a school claiming e>temption under seetinn 501(c)(3), Also include any other information necessary to establish that the school is complvina with the requirements of Revenue Rulinq 71- W ? t971-2 C,8 230, Letter 2419(DO/CC) -3- NAVY LEAGUE OF THE UNITED STATES This is the 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 applicablev a--srtatement that your group exemption roster did not change since your Previous report, If the heading of this letter indicates than an addendum applies► the enclosed addendum is an integral Part of this letter, B'fraute 'this letter -could-Ive-lp resolve any questi-a-ns about your exe-mpt status and foundation status► you should keep it in your permanent records. We have sent a copy of this letter to your representative as indicated in your power of attorney, If you have any questions? please contact the person whose name and telephone number are shown in the heading of this letter, Enclosure(s)i Addendum Sincerely ,yours? 0istri dketoi Letter 2419(DQ/CG) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 35 NEIGHBORHOOD HEALTHCARE CI 1w1- OF'rFM FIX111A FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) l _ DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 s PROJECT/PROGRAM INFORMATION Amount Requested: $ $50,000 MAXIMUM ALLOWABLE: $50.000 PER ORGANIZATION Project/Program Title: NHC Great Starts Program _ Start Date: 12/112022 End Date:11/30/2023 Physical Address of Project/Program: 41840 Enterprise Circle N, Temecula, CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Neighborhood Healthcare Mailing Address: 425 N Date St Escondido, Ca 92025 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Neighborhood Healthcare Website: www.nhcare org Number of Paid Staff. 1,030 Year Founded: 1969 Social Media: M_".fam-book.com/Nei-Qhbc)rho-QdHealthcare _ - Number of Volunteers: 183 Geographic Area(s) the Orr anization Serves: San Diego and Riverside Counties Geographic Area(s) the Proie_cUEEggram Serves: City of Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLL SIVELY USED TO SERVE TEMECULA. Contact Name:. Ellen Clark Title/Position: Grant Writer Contact Person's Direct Telephone: 760-429-4917 _ Contact Person's Email: Ellen. Clark@nhcare org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes © Date of Incorporation as a Nonprofit: 7/1/1973 No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 95-2796316 State Identification Number: 0667935 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. D Attach IRS Deductibility Status using this link: http:/lappsJrs.0ovlanpleosl 2. 0 Attach State Entity Status Letter using this link: https:l(www.fthca.q„ovlonlinelself serve entity status letterlindex aso 3. El Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.dol.ca.g2v_/Veri{icationfWeb/Se@rCh.agpE2faciliLy=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 — APPLICATION AUTHORIZATION — Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ❑x Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑x Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: %'Aitz 1YVs-t;n4 Or-, OA - W-2o ZZ Executive Committee ❑ Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Our mission is to improve the health and happiness of the communities we serve by providing hlgh•quality healthcare to all, regardless of s€tuation or circumstance We betieve IhaI cam munity health is about more than just vaccines and checkups, it's about giving people the resources they need to Ilve their best lives Our wsion is a community whereeveryone is healthy and happy In working to make this a reaIit we are never satis red with good enough. Our purpose is to improve community health through acoess to better health care, FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No Q Yes ❑ IF YES, PROVIDE BELOW, NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP i OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY 1 Ell FUNDING RECEIVED I City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. This program will support Neighborhood's efforts toward prenatal and baby health and wellness through education, advertising, community outreach, and providing baby care items to needy families. Neighborhood primarily cares for Individuals with low incomes and limited access to resources Included in the program are two baby wellness events adjacent to our Temecula Heaith Centers. These events will be open to the community. Information on prenatal and baby wellness will be available as will premium items and some supplies, and families will be offered help with Medi-Cal and CalFresh registration. Self -care kits encouraging new baby care will be provided to new moms, and newborns will receive a onesie and burp cloth at their first check-up. Educalionai articles on baby wellness before and post birth and geographically directed digital marketing campaigns, using targeted locations such WIC. will provide education to a targeted segment of the Temecula cormunity. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, ANDIOR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. j Funds, if granted, will be used to directly support the Temecula residents through the distribution of matemal and infant care items and in support of educational messaging to the community. Plans to purchase: 70 Infant Car Seats 100 Playpens 120 High Chairs 100 Strollers 150 Packages of Diapers (size N-3) 300 Packages of Wipes 150 New Mother Kits 150 Welcome Baby Kits Miscelaneous Promotional Items Brochures Advertising and Marketing 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. This program is specifically targeted to Neighborhood patients seeking care at our Temecula and Temecula Parkway Health Centers and local community members. Events will be held locally and all baby items will be distributed locally either at the Health Centers or adjacent community events. Advertising for the events will be through flyers at local venues including WIC offices, and digital advertising targeted to the community. By providing baby essentials, Neighborhood's staff will have the opportunity to provide new and expectant parents with the information they nee to make informed decisions on their baby's health and wellbeing. Individuals without medical insurance can ask questions about heir newborn's eligibiltiy for Medi-Cal and obtain the help they need to register their child. We anticipate that more than 500 Temecula Residents will directly benefit from this program, plus 1,030,000 impressions through advertising, social media, and other marketing activities. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 500 0 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Neighborhood plans to provide low-income parents of newborns in Temecula with physical and informational tools to help keep their babies well and happy. We will reach individuals through targeted educational advertising messages, community outreach, and directly to our patients. Tangible infant care items will be limited to one per family. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. In response to COVID-19, Neighborhood rapidly tansitioned to providing telehealth visits after stay-at-home order temporarily disrupted care, resulting in revenue decline. At the height of the pandemic, 85% of patient visits were by phone or video. Medicaid {Medi-Gal}, the primary insurance for patlents, was sfow in determining reimbursement for telehealth visits, causing a further revenue decline. With COVID as a catalyst. Neighborhood also took a proactive approach to care for vulnerable patients with complex and chronic medical condidions ulilizing a moble care team to provide essential health services as an extension of the healthcare facility. As a result of unimplayment due to COVID, the percentage of uninsured patients also increased to 15% in 2020 and 2021, from 7% in 2019. Due to our ability to accomodate patients remotely, fundraising efforts to cover uninsured patients, COVID Grants and Provider Relief Funds, we have been able to sustain financial stability- 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Funds, if granted, will provide as vehicle for Neighborhood's Women's Health team to reach out to the Temecula Community with critical information on prenatal and infant care that can positively effect the wellbeing of the child for hislher lifetime. Neighborhood has provided infant supplies to our patients in the past, and funding will allow us to continue distribution to our patients. Funds also allow us to extend this program and provide important maternal and infant wellness messaging to the community. It will also allow us to provide diapers to families in need for the first time. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 + Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 11,oao Organization Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 0 TOTAL REVENUE $ 61,040 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services $ o $ 5,549 $ 8,850 $ 15,000 $ 0 Food 0 Other $ 26,150 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ 5,as1 HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $ 61,040 TOTAL BUDGET $ $ 61,040 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: ■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. d Awards will be given to organizations and activities that directly benefit the residents of Temecula. Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The dwarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. ■ The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. ■ If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Neighborhood Healthcare F41AILING ADDRESS: 425 N Date St Escondido, CA 92025 PRESIDENT / AUTHORIZED OFFICER: Dr. Rakesh Patel SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Ellen Clark PHONE: ( 760 ) 520-8375 EMAIL: RakeshPQnhcare.org Chief Executive Officer DATE: September 12. 2022 SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: 5tacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Neighborhood Healthcare, HBOCS00285 HRSA-11-017; Attachment 12 Internal Revenue Service Date: August 3, 2002 Neighborhood Healthcare 425 N Date St Escondido, CA 92025 Dear Sir or Madam; Department of the Treasury P. O. Box 2508 Cincinnati, OH 45201 Person to Contact: Steve Brown 31-07422 Customer Service Representative Toll Free Telephone Number; 6;08 a.m. to 8:30 p.m. EST 877-829-5500 Fax Number: --------------5�1-3=263=3756-- - --------. ____ .— Federal Identification Number: 95-2796316 This is in response to the amendment to your organization's Articles of Incorporation filed with the state on March 18, 2002. We have updated our records to reflect the 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 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 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 year Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FU T A). 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 :o.your organization or for its use are deductible for federal es -,ate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Neighborhood Healthcare, HSOCS00285 HRSA-11-017; Attachment 12 -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, TE/GE Customer Account Services Q HELPO MENU Home > Tax Exempt Organization Search > Neighborhood Healthcare < Back to Search Rest Neighborhood Healthcare EIN: 95-2796316 1 Escondido, CA, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2020 Form 990 Tax Year 2020 Form 990T Tax Year 2019 Form 990T Tax Year 2019 Form 990 Tax Year 2019 Form 990T Tax Year 2018 Form 990 Tax Year 2018 Form 990T > Tax Year 2017 Form 990 Tax Year 2017 Form 990T Tax Year 2016 Form 990 Page Last Reviewed or Updated: 20-November-2020 I f* Share it STATE OF CALIFORNIA FRANCHISE TAX BOARD F T 13 PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/12/2022 ESL ID: 5578808527 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 0667935 Entity Name: NEIGHBORHOOD HEALTHCARE 0 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board, 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. El4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Return of Organization Exempt From Income Tax OMf1No 15,15-00el Farm � R_ Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 20 Department of the Treasury ► Do not enter social security numbers on this form as it may be made public. Intemal f Icvcnue sarv,ce T ► Go 10 www_irs.gov/FormgW for instructions and the latest Information. , - A For the 2020 calendar year, nrlax year h innl 0710112020 and ending 001301120211 e C+xietr(afsptic¢nfa: CfvamaW 2dl" NEIGHBORHOOD HEALTHCARE �•----• NEIGHBORHOOD --- --- -. - - _-._. ____ _ _ D Employer identification number n Arlc+reas utrenge Uo n bune9s as _ 95-27_9_631_6 _ Flame r-hpnily Nurnber and sheet (or P 0, box if main is not del vered to sheet address; �9oom/swta E ieleull number- rl IntSinl return 425 N Date SUCil Y 760.737.6934 L►rrp1 rehirnita-rhndtey City or town state or province, coLo!ry, and ZIP or foreign postal code ❑ Amended return Es"ndld CA F0Z G Gross recently $Lj tz�,onste Appfcahonpoodng FIand address ofprnopalofficor: LisaDaigle File) fFliaa:ua:r:ae.•°osi�c•ei^at�;!{�YOa �pje 425.- Date SlrQttl, EgCOuditlD, CA B2Qis _ I Are all subordinales included, r] Yes ❑ No I rax•oxempl status J SOi — �'_, jf} I i(insert no.) 4947(a,(1) nr� 57J "Vo,' attach a list See instructions L_l u [a! of J Webaite: ► wwwnheare.org— . r�T Ftjnf ilmup4w¢mpbon number K Farm of ur 4jll L• fCwvolatwn ❑ •'rust .Q,Assdciation •1 Other ► L Year of formation: .�•IJrllif19i�1 1973 M slate of lgeyl dcrr•icilu: CA. -- — - — 1 Briefly describe the organization's mission or most significant activities: Neighborhood Healthcare is committed toprovlding quality health care and promoting wellness to everyone In our communities, focusin on those most in need, - ---- ....9- _-.- ...--------- -.-.".. ••.--... 2 Check this box No- (_] if the organization discontinued its operations or disposed of more than 25% of its net assets. 3 Number of voting fnembers of the governing body (Part VI, line 1 a) . . . 3 -a 4 Number of indepondent voting members of the governing body (Part VI, line 1 b) 4 �1E 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) -5 - till 6 Total number of volunteers (estimate if necessary) , , . , , , , . , • , , . - ass a 7a Total unrelated business revenue from Part VIII, column (C), line 12 . . . 7a �� b Net unrelated business taxable income from Form 990-T,_Part 1, line 11 91,771 - --..-. --- �-- _ 7b Prior Year Current Year m 8 Con?,^tutions and grants (Part VIII, line 1h) . 10.f%30.308 1B,954,BSS 9 Program servicD revenue (Part Vlll, line 29) . . , , . BB.71s.3e4 107,28v,155 v 10 Investment income (Part Vlll, column (A), lines 3. 4, and 7d} 531 644 1,118,970 11 Other revenue (Part Vi11, roltimn (A), Iines 5, 6d, 8c. 9c, 10c, and 110) 614.4731 97e 4t3 12 Total revenue --add lines 8 through 11 (must aqual Part VIII, column (A), line 12) 101.769,810. 127,012,211 13 Grants and slmitar amounts pad (part IX, column (A), lines 7-3) . --- a o 14 Benefits paid to or for members (Part IX, column (A), line 4) d o 15 Salaries, other compensation, employee benefits (Part Of, column (A), tines 5-10) 60.040,235 66,146,597 "r 16a Professional fund►alsing fees (Part Ix, column (A), line 11e) . 0 _ o b Total Iundralsing expenses (Part IX, column (0), ling 25) ■ 346,0uu _ 17 Other expenses (Part IX, column (A), lines 11 a-1 1d, 11f--24e) 28,691,153 — 36,798,115 18 Total expanses. Add lines 13-17 (must equal Part IX, column (A), line 26) 88,939.388 102.244,713 19 Revenue less expenses. Subtract line I from line 12 _ 12,850,422 24,067,498 Beginning of Current Year End of Year 20 Total assets (Part X, line 16) 76,551,787 105 405,269 $ 21 Total liabilities (Part X, line 26) 16,676,15 17,S3a 528528 i d 22 Net assets or fund balances. $ubtrW line 21 from line 20 5g,g7g,1a3 B7,g7{ 741 $i 114 i e 81aak Under penalties of perl„ry, I declare that I have examined this return. Including accompanying I{r ,,!pules a9d slaWntlill and to !ne best of my xiiowlcd,go and dellel It o trae, correct, and mpipl ar~ of prenarec (Oyler thdn olficpr is based on all ir1:`or. — ) nation of wh ch prapautrrras any knowledge Sign ` Synalum to arlrem � -- -1Dat Date, Here Use Dai le, CFO Type ur print Warne and tole Pr r.1/Type preparer's name fylep9rgr'S ,ignature lu ate 'T arer IN Paid l it PrepJeremy Were. - — sa I amp:oyed P00642659 Use Only Fam y ulme ■ GI IW LLP - - - --- ---- — -- f-irm's LIN—► 47.2771555 Firms adaresa ► 7797 N First Street Suite 15, Fresno, CA 93720 _ Pht �¢,___ 558548.64ga May the IRS discuss this return with the preparer shown above? See instructions _ Yes-EJ NO For Paperwork Reduction Act Notice, see the separate instructions. cat No 112H?Y Form 990 (2020) neighborhood HEALTHCARE September 12, 2022 City of Temecula Community Service Funding Attn: City Manager's Office 41000 Main St. Temecula, CA 92590 Dear Aaron and Community Service Funding Committee Members, Thank you for this opportunity to apply for funds through the City's Reinvestment in Temecula Community Service Funding. And for all you do in support of the residents and businesses in Temecula. Attached is a copy of our proposal requesting $50,000 in funds for Neighborhood Healthcare's Great Starts Program. Funds, if granted would be used for maternal and infant care education and the distribution of infant care items to the Temecula Community through our Health Centers and Community Outreach Events. Please Let me know if you need additional information or have any questions. Thank you for your consideration. Sincerely, Ellen Clark Grant Writer ellen nh reLorg 760-520-8650 Neighborhood Healthcare - Ray M. Dickinson Wellness Center 425 N Date St-eet, Escondido, CA 92025 1 D: (760) 520.3300 1 nhcare.org FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 36 OAKGROVE CENTER CITYOF TI+7MECUL& FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Culinary Creations Program Project/Program Title: Start Date: 11/1/22 End Date: 10/31/23 Physical Address of Project/Program: 41923 2nd St #104, Temecula, CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Oak Grove Center Mailing Address: 24275 Jefferson Avenue Murrieta, CA 92562 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Oak Grove Center Organization: Website: www.oakgrovecenter.org Number of Paid Staff: 272 Year Founded: 1992 Social Media: facebook.com/OakGroveCenter Number of Volunteers: 60 Geographic Area(s) the Organization Serves: Mostly Riverside County, but students throughout CA Geographic Area(s) the Prolect/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA, Contact Name: Tammy Wilson Title/Position: Chief Executive Officer Contact Person's Direct Telephone: 951-677-5599 Contact Person's Email: tammyw@oakgrovecen ter.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes 0 Date of Incorporation as a Nonprofit: 9/24/92 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0470446 State Identification Number: 1574925 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. H Attach IRS Deductibility Status using this link: http://apr)s.irs_gov/ap2/eos/ 2. © Attach State Entity Status Letter using this link: hftM.,Itwww.ftb.ca.gov/onlinelself serve entity status letter/index.as 3. K Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: ht# ://rct. of ca. ov verification/Web/Search.a ?facilit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 I APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No S Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑■ Board of Directors ❑ Members -at -Large ❑ I MISSION STATEMENT OF ORGANIZATION I BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. J The mission of Oak Grove Center is to rebuild the lives of at -risk children and their families through educating, healing, restoring relationships, building character and instilling hope. Oak Grove Center specializes in serving California's most at -risk and vulnerable children and their families with the widest spectrum of services including residential, educational treatment, and day programming. In addition, we operate Oak Grove Center's Culinary Creations Bakery in Temecula, which provides our youth vocational training and hands-on programming as they actively participate in a working bakery. In addition, Oak Grove acts as a Workability site for students in high school programs in Temecula. At Oak Grove Center our vision is to see broken lives healed and hope restored. We are empowering success and transforming lives. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No E Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO E Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT RECEIVED MONTH + YEAR NAME OF ENITY FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT Culinary Creations is a unique vocational program designed to build vocational and culinary skills, as well as provided jobs for at -risk, vulnerable and/or special needs and disabled youth and TMI (Toward Maximum Independence) young adults through a retail store in Temecula. While core services seek to restore challenging circumstances and move youth from crisis to stability, Oak Grove Center's unique approach of supportive programs sets our agency apart. Culinary Creations provides hands-on vocational training to youth including customer service, culinary expertise, barista skills, inventory management, catering services and more. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Funds will be spent on the operating costs of the Bakery, including rent, utilities, food (for preparation), marketing, mileage, supplies (including baking and kitchen supplies, takeout containers, bags, etc.) and telephone expenses. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. While we expect to serve 120 youth through this program during the grant period, 70 will be Temecula residents. These Temecula youth will engage in hands-on vocational training at the Culinary Creations Bakery and/or on our main campus in Murrieta. 315 ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS At -risk, vulnerable Temecula youth participating in wraparound services will engage in hands-on vocational training programming in the Culinary Creations Program. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. The Covid-19 pandemic certainly has impacted profitability of the bakery. Our desire is to create a self-sustaining enterprise that hosts our vocational programming and internships for youth, but 2021 did not accomplish that. Raising grants and accepting donations for the program will help offset costs as the Bakery continues to serve and develops a stronger customer base, while providing vocational training. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The request from the City of Temecula will continue an existing program, serving 70 Temecula students throughout the grant period. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) ` LINE ITEMS FOR PROJECT/PROGRAM i REVENUES 1 EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed 550,000) Amount contributed to the Project/Program by the Applicant $ 66,838 Organization Other grants or funding already awarded for Project/Program, if any $ 375,373 Sales and donations In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 492,211 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food Other Staffing Expense $299 $ 65,474 $1017790 $381 $0 _ $0 $ 25, 894 i THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ 298 373 HOWEVER PLEASE INCLUDE. , TOTAL EXPENSES $492,211 TOTAL BUDGET $492,211 $492,211 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022, In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to cnnduct an audit and/nr require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receiptslin voices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn. City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Oak Grove Center Name of Project/Program: Culinary Creations Program FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): C Date on E Name of Company Receipt/invoice E i on Receipt or Invoice MUST BE ON OR BETWEEN Amount JULY 1, 2021 - JUNE 30, 2022 <Z 3 G13 6 I I$ Expenditure Description I Purpose DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City, To substantiate that grant funds from the City are spent appropriately, proper back-up rinr_.umentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000- Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent In accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 Liniess the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds, 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Oak Grove Center Name of Project/Program: Culinary Creations Program TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ _ was received from City: 1. Is this Expenditure Report Is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number)__ Date on Expenditure E Name of Company Receipt/invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION &AWARD LETTER on Receipt or Invoice MUST BE ON OR BETWEEN a = I March 20, 2020 -DUNE 30, Amount Description Purpose 2024 I EXPENDITURE TOTAL $ ExPENDrrURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula, ■ Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. /we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Oak Grove Center 0 MAILING ADDRESS: 24275 Jefferson Avenue PHONE: ( 951 ) 677-5599 Murrieta, CA 92562 EMAIL: tammyw@oakgrovecenter.org PRESIDENT/AUTHORIZED OFFICER: Tammy Wilson, Chief Executive Officer PRINT NAME SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Tommy W 0 01FT PRINT NAMF TTLF DATE: September 12, 2022 MONT!-I, LAY. YEAR CG) SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELPB MENU = Home > Tax Exempt Organization Search > Oak Grove Institute Foundation Inc. < ch Resu Oak Grove Institute Foundation Inc. EI N: 33-0470446 1 M u rrieta, CA, United States Other Names Publication 78 Data e Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) 8 Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2019 Form 990 Tax Year 2018 Form 990 Tax Year 2017 Form 990 Tax Year 2016 Form 990 Page Last Reviewed or Updated: 20-November-2020 r# Share $ Print Internal Revenue Service Date: March 23, 2005 OAK GROVE INSTITUTE FOUNDATION INC % THOMAS LESTER 24276 JEFFERSON MURRIETA CA 92562-7286 Dear Sir or Madam: Department of the Treasury P. 0. Sox 2508 Cincinnati, 01; 45201 Person to Contact: Ms. Regina Parker 31-07403 Customer Service Specialist Toll Free Telephone Number: 8:30 a.m. to 5:30 p.m. ET 877-829-5500 Fax Number: 613-263-3756 Federal Identification Number: 33-0470446 This Is in response to your request of March 23, 2005, regarding your organization's tax- exempt status. In September 1992 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 Internal Revenue Code. Our records Indicate that your organization is also classified as a public charity under section 509(a)(2) 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 quallfled to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2108 or 2622 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, len) Janna K. Skufca, Director, TEIGE Customer Account Services STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/8/2022 ESL ID: 7230475266 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 1574925 Entity Name: OAK GROVE INSTITUTE FOUNDATION, INC. 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3, The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information • This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). • The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) State of California Department of Justice Office of the Attorney General HOME I AROUT 211 : MEDIA CAREERS REGULATIONS RESOURCES � PROGRAMS CONTACT Entity type: Corporate RegistrantJ�ilil�11!11 Details Class as registered mith the Secretary of State oi- based on founding & registration documents. Organization Name: OAK GROVE INSTITUTE FOUNDATION, INC. IRS FEIN: 330470446 Entity Type: Public Benefit SOS/FTB Corporate/Organization Number: 1574925 Registry Status: Current - Awaiting Reporting Renewal Due/Exp. Date: 5/15/2022 Rur Registration Number: 082134 Issue Date: 12/31/2005 Rerurd Type: Charity Registration Effective Date: 12/31/2005 Wte of Last Renewal: 3/25/2022 DBA: r • Address Street: 24275 JEFFERSON AVE Street Line 2: City, State Zip: MURRIETA CA 92562 Filings & Correspondence iOUI][Ij1tP�. [aOCilftt( its Founding Documents I3Rl - 12008 2008 RRF- I IRS Form 99D M 2008 IRS Form 990 �$�I 2U[S7 - 2007 RRF-1 R .�'t7an 2007 IRS Form 990 RE --I 2M 2006 RRF- I I$$ EQtm 99120DG 2006 IRS Form 990 RRF-I 2005 2005 RRF-I IRS Form 99UM 2005 IRS Form 990 RRF-1 2004 2004 RRF-I 2004 IRS Form 990 RRE 20Q3 2003 RRF-1 IRS Form 29fl 2003 2003 IRS Form 990 E RF- I m 2002 RRF-I IRS Form 9902M 2002 IRS Form 990 ERE-JIQU 2001 RRF-1 RRF- I M 2009 RRF-1 IRS Farm 920_2od9 2009IRS Form 990 ForM 990 2011 2011 IRS Form 990 LqT-- UQU 2011 RRF-I RRF-1 20 I 0 2010 RRF-1 IRS Form 9902 l d 2010 IRS Form 990 $fig 2019 ,\enewaI Filing 2018 RRF_I = 2012 RRF-1 IRS Form 99Q 20 12 2012 IRS Fonn 990 ME 2013 2013 RRF-1 IRS Form 990 2013 2013 IRS Form 990 ERL L2WA 2014 RRF-1 IRS Porn' 290 2014 2014 IRS Form 990 201 RRF- I 2015 RRF-1 2015_IRS For 990 2015IRS Form 990 2M Form RRF- I Click on Document Type at the left to open PDF 2916_IRS Fol Itt 990 series Click on Document Type at the left to open PDF Renewal_ Filing 2017 Renewal Ping 2020 Annual Renewal Data Status of Filing: Accepted Accounting Period Begin Date: 1/1/2010 Accounting Period End Date: 12/31/2010 Filing Received Date: 11/14/2011 Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: 1/l/2011 Accounting Period End Date: 12/31/2011 Filing Received Date: 8/20/2012 Form RRF-1 Reject/Incomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: I/I/2012 Accounting Period End Date: 12/31/2012 Filing Received Date: 11/18/2013 Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: I/l/2013 Accounting Period End Date: 12/31/2013 Filing Received Date: 9/3/2014 Form RRF-I Reject/Incomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: 1/l/2014 Accounting Period End Date: 12/31/2014 Filing Received Date: 10/19/2015 Form RRF-1 Reject/Incomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: of Filing: sting Period Begin Date: Ming Period End Date: Filing: Received Date: Form RRF-J Reject/Incomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/lncomplete Reason: Notes From Registry Staff: Status of Filing: Accou sting Period Begin Date: ^Icconmmv Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Forst CT TR-1 RejectA ncom plete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Lorna CT-TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT TR-1 Reject/] ncom plete Reason: IRS Form 990 Reject/Incomplete Reason: Votes From Registry Staff: Accepted 1/1/2015 12/31/2015 7/26/2016 Accepted 1/1/2016 12/31 /2016 9/7/2017 Accepted 1/1/2017 12/31/2017 9/ 18/2018 Accepted I/I/2018 12/31/2018 11 /19/2019 Accepted I/l/2o19 12/31/2019 1 / 15/2021 Accepted 1 / 1 /2020 12/31 /2020 11/23/2021 No Related Records Return of Organization Exempt From Income Tax r;rlAI, M, J5.'on I, Form 99O Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 2020 Department of the Treasury ► Do not enter social security numbers on this form as it may be made public. Open to Public Into.n&Fla"nuo serviix- Go to wwwJrs.gov/Forri for instructions and the latest information. Inspection A For the 2020 calendar year, or tax year beginning and ending 9 Ch4wk rr InC Name of organization D Employer identification number ,grtrileni. E]=09'° Oak Grove Institute Foundation, Inc. n va Doing business as 3 3- 0 4 7 0 4 4 6 E�Ih}li�l rebJm Number and street (or P.O. box if mail is not delivered to street address) Roor ite E Telephone nilmhp.r [JHinni 24275 Jefferson Avenue 051) 677-5599 termin- ated City or town, state or province, country, and ZIP or foreign postal code G Grossrnncyreo $ 17,722,800. Arruurdnd rn=aril Murrieta, CA 92562 H(a) Is this a group return E71t �plicn F Name and address of `.L' officer:amara. Wilson pnnrNn{f principal for subordinates? -- •, 0 Yes IM No same as C above H(b) Ara all subordinates included %E:1 Yes E] NO t Tax—exempt status: LK I 501(c)(3 501(c) ( ) (insert no.) 4947(;I)(1) or _ 527 If "No," attach a list, See instructions J Website: ■ www . od grovecenter • org I H o Group exam tion number ■ L Forrn of Or afsixaliorr: _,Xr,_ Corporation Trust Association Other■ L Year of formation: 19$ M State of le al domicile: CA Clad I Crrint Mi u 1 Briefly describe the organization's mission or most significant activities: Education an res x entia M facilities for children with neurologicalproblems, earning C iu 2 Check this box ► LJ if the organization discontinued its operations or disposed of more than 25% of its not assets. 3 Number of voting members of the governing body (Part VI, line 1a) 3 14 f7 a ............... _ 4 Number of independent voting members of the governing body (Part VI, line 1 b) „• 4 14 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) 5 6 Total number of volunteers (estimate if necessary) ......... _ _..... .............. 6 110 7 a Total unrelated business revenue from Part VIII, column (C), line 12 7a 0. 0. b Not unrelated business taxable income from Form 990-T Part I, line 11 7b Prior Year Current Year v 8 Contributions and grants (Part VIII, line 1h) 11,079,166 . 7,915, 743 . 9 Program service revenue (Part VIII, line 2q) 81660, 883 . , , 173 . m 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) _ , 122 -97 252, 7 0 . 6, 280 . 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 1 Oc, and 11 e) 12 'Total revenue - add lines a Ihrou h 11 must ii Part VIII, column line 12' . 19, 9 8 9 ,171. 17, 043, 7 4 . 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 650, 628 . 517, 546 . 14 Benefits paid to or for members (Part IX, column (A), line 4) 0 . 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5 10) •., •, 14,487,459. 14,517,356. wa 16a Professional fundraising fees (Part IX, column (A), line 11 e) 0 . 0 . x • ............. b Total fundraising expenses (Part IX, column (D), line 25) ► 241,808 . W 17 Other expenses (Part IX, column (A), lines 11a-1 id, 11 f-24e) .- - _ _ 3,819,074 . 3,461,236 • 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) • • _ , , 18,957,161. 18,496,138 19 Revenue less expenses. Suistiracl this 18 from line 12 1,032,010. , 5 3 , 4 . 17 mac Beginning of Current Year End of Year 27,247,092. 2 5 2 5 14 7. NA 20 Total assets (Part X, line 16) 21 Total liabilities (Part X, line 26) 7 15 zLL 22 Net assets oT fund balances. Subtract line 21 from line 20......................................1 2 3. 7 7 0 , 9 3 $ • 2 2 , 1. rare rr 1 %7rVeraaurIlls 0SUVIK Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the hest of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than Officer) is based on all information of which preparer has any knowledge. Sign Signature of officer Data Here Tamara Wilson, CEO type orprrn name and title TIN Print/Type preparer's name Preparer's signature Uate check Paid Sean E. Cain, CPA I I I Ireu-+okay 01612986 Preparer Firm'sname 11, Harrington Group, CPAs, LLP Firm'sEIN 6, 9 5-4557617 Use Only Firm'saddress p, 2 34 East Colorado Blvd. , :Tu to M150 Pasadena, CA 91101 Phone no. ( 6 2 6 ) 403-6801 IN the IRS discuss this return with the are amr shuwr! above? ee Instructions ..... ...... X. Yes 1. 1 No 0320e1 12-23-20 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2020) See Schedule 0 for Organization Mission Statement Continuation FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 37 dba PROJECT TOUCH GOD"S FAN CLUB r CITY OF TEMECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TE `, CUL9111 PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 202P,(* FA PROJECT/PROGRAM INFORMATION -.,,,,., ; Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Emergency Gas/Food/Shelter Start Date: 7-1-2022 End Date: 6-30-201 Physical Address of Project/Program: 29760 Rancho California Road, Temecula, CA 92591 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Project Touch, Mailing Address: 30141 Antelope Road, D103, Menifee, CA 92584 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Ood's Fan Club dba Project TOUCH Year Founded: 2003 Website: www.projecttouchonline.com Social Media: projecttouch Number of Paid Staff: 1 Number of Volunteers: 45 Geographic Area(s) the Organization Serves: Temecula Geographic Area(s) the Proiect/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Anne Unmacht Title/Position: Executive Director Contact Person's Direct Telephone: 909-821-7890 Contact Person's Email: anne@projecttouchonline.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 09-03-2003 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 73-1681483 State Identification Number: 2553261 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: http://apps.irs.gov/agpleos/ 2. ® Attach State Entity Status Letter using this link: hftps://www.ftb.ca.gov/ontine/self serve entity status letterlindex.as 3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.do'.ca.rloviVe.riticationtWebISearch.afpx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 I APPLICATION AUTHORIZATION I Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBERS NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ J MISSION STATEMENT OF ORGANIZATION I BRIEFLY DESCRIBE THE ORGANIZATION'S MISSIONIGOALS AND OBJECTIVES. M[Ail b.1300S VAN CW11 OWI PROD EC t TOUCI I IjTit��Uulc1 Our lJruly Cerrqunrs I lgwe7 wivs) Working Iegolhor wi Ihul air colnmuniliou lapolher w lh dol an bus!rtoss arganizalions to riffOCllgyip�0vdr[pn#1 lnxnit OM 10s% Wd d%leW o efa, n1oRledi of twinveons Rrevenf on 8"Xii 21 F'reloct KKfGli WA Luar, "%kViN hvoW tw prowili" IN Miming CJnlnl 90mm 1)21 rfpy WnerUu11Gy 5l1ollnr S4r trpfn011095"4115 9d Lon lytsl 10o1w, 5 911 W6 WW011 nytdr*ildran loll Lin shollarod dic la ahn uav al hoe, 1hismousing;s imilaCle 24xl, fully stocked with alul hINM9 aglF plljgr +15WI1ZIAI5fur fyR111111F, ?} Syt7prN11W Gp119iI1nlrM1 hgllblll(1. 23'.: h4d CApilGty fqr rypvmlrJppTAus/ltefilMRgq rt10p1@IS, Nrtfman J11qwwnen, vr7tNb115 and sunlofs omanGpal[xl fa7lar ynUlh, iIVJIxi!ng 45-5�iL91r}e1r911 If r�pfgnonMmwm Iva namJilnylot"r if NTd pin nmrtgnl homing: vq tIxx 2 Sl tIMrnxilnl s!Iu1rSH111sf]ImG E1 AyitnrlCeIrnWfilarllwrdYtpfr11Ap7 ahippA f+xtnuws hGflRfn antl Ilny ollulr amorgmn y naods, suet as inlanl nhcos For mellNrs Wllh hamb7s; 5 FSrq¢ SRxw1 •prf vol'o a10< ea plullrios muf [upll wo kx c1111n111: s} RpEc iu e6 e1rrn%-n rl[nI1rJlrod sns xmw 01 PF7t7JF C7 TfMCf 1 regpnluls Iq Irwrfhodf u1 c+hs mmllmly In ry n 7c1 collars la impgrWnl gpyerr rrx rrt wxl %pciad Ixrnafns, 'J fHvjfeO filfuYlunl Th!ill SIoiU• effurs rhgnlx Ihq gppwrlu1111y L7 pnIIW p nu In enAhd•jplr Uil lung, in addition IV proYtling a re4anll0 Ogrcu for FALj4Ll TQVf H FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION's CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA's AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT, DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 El W M E o U O ; v � 'Q U N Q W cn F- O L 4M m 6 ° c o ry 3 (D m Co — 0 L �v > E L) L a O3cn h ts aa Ei E E "o U) tea` W o> w o` E m 0) U E L cm 0 E y a W g 93 aa �!! 5 ❑ w€Z6� Z E a �E' a Q m'��n d,pcp v/ Z. N MVid0 U P Q �' 7 2 C- a s 0 E`!c a u�Ewcc om -155 3 �� a Ec y N VJ E0Z`° ECDOvi N� °� C U) n Z cJ E W rn-- E of z 6 E i Emv CD—0 Q O�>'je OO ❑TL�pF"C [� �dgT% � -auP N Ry Ci 0 nV�c Zq w (U ",68'9c'Ts m_ ET M S 0 -1,4 % °gy C N U o dz ' o U, ° c� 4D � 70 U)ui ���Z? Q LL 0UJ ����A �� C�'C to Q4LryO W W W W W wmZ ~ � m F ❑ Q ❑ U) zQ0 Q (n Z �U WWz m W Fes-+ DW CO W z<z W d UZQ r� Q V/ ��Z OWz H2L.L Z N I- Z _ ¢F- �—' W U) 0 2 I- Z F- - (n 0 � 00 U)Q2 aZ❑ 2 00 wQw O W O W w Z cr- aQaO. m DZ) FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ICJ IF YES. PROVIDE BELOW NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED 2021 NAME OF CITY GRANT OR SPONSORSHIP $ 1,000 Council Member $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJEC11PROGRAM IN THIS APPLICATION? No ❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT NAME OF ENITY MONTH + YEAR RECEIVED FUNDING RECEIVED I $ 45,000 Wells Fargo Foundation $ 10,000 Riverside County-ARPA $ 10,000 Riverside County -CID Funds $ 150,000 Business Sponsorships $ 150,000 In -kind donations -food, etc. net proceeds from Divine Discount Thrift Store $ 50,000 $ 125,000 Fundraising events $ 400,000 Proqram fees 2020,2021,2022 2021 2020, 2021 annual annual annual annual annual City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT" GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Temecula grant funding will support the following: 1 j gas cards and/or bus/airline tickets to reunite families together and seek and keep employment in order to gain self-sufficiency; 2) food cards to buy groceries for 21-days emergency shelter and for clients to shop for specific fond and necessities for infants, children, diabetics and other medical conditions; 3) rental assistance for Temecula residents that entered 21-day emergency stay program and now have to move to transitional housing but have not received government benefits yet nor have any income; 4) rental assistance to Temecula residents that currently rent in Temecula and have fallen behind or at risk of homelessness, a form of homeless prevention. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT Gas Cards Bus Passes Airline Tickets Food from local grocery stores to stock pantries of 21-day emergency stay program Food gift cards from local grocery stores for clients to get food and necessities for infants, children, seniors, veterans, diabetics and those with other medical conditions. Rental assistance to Temecula clients residing within zip codes: 1) as a form of homeless prevention to clients that have fallen behind in rent; 2) for clients currently in 21-day emergency stay program who now need to transfer to PT supportive transitional housing but have not received government benefits yet nor have income; 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING, EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Grant funding will specifically benefit Temecula residents by the following- ' homeless/unsheltered clients specifically referred by the City of Temecula Police and Taskforce_ ' clients that have entered program on their own that reside in the required zipcodes. clients that reside In the apartments, homes or duplexes located in City of Temecula; Benefits; Gas cards will help clients either keep their employment or conduct job search to gain employment which leads to self-sufhoienc Bus passes will help clients get to work if they don't have a car and/or be reunited with their families Airline tickets will hells clients become reunited with their families Food cards for clients who have entered program on (heir own that resided in the required zipcodes' Food cards for clients that reside in apartments, homes or duplexes located in the City of 'remecula Funding for food needed for 21-day emergency stay program Rental assistance for clients moving from 21-day emergency stay program to transitional housing. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: M1 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 45 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. Request funding for gas cards, bus passes and airline tickets to be used for family reunification and/or employment or job search, food cards to fill 21-day stay units and for clients to shop at local grocery stores, rental assistance for clients transferring to transitional housing from Tcmcculn. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY, YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. COVID-19 PANDEMIC: The pandemic affected the clients of Project TOUCH by increasing the need for masks, wipes, cleaning supplies, and food as many fell ill to COVID and rooms had to be i cleaned as much as possible and interactions between clients kept small. More rooms were needed for emergency shelter and motel vouchers. Although Project TOUCH is a sustainable agency through grants, donations and sponsorships, it was not able to hold it's annual fundraising golf tournament for two years in a row. Volunteers declined due to fear of spread of COVID, but in -kind donations from churches, business and civic agencies kept supplies stocked, even though there were supply chain shortages. INFLATIONARY CONCERNS: With the pandemic handled, though there are new variants coming out all the lime, gas prices rising, food shortages and supply delay, rental properties raising rents and not willing to lease housing for homeless so they can get higher rents from public, Project TOUCH is concerned about funding needed to keep clients working and working towards self-sufficiency, if they cannot afford gas for cars or bus passes. Food donations are decreasing as more donors and civic agencies have less to spare while it is of the utmost concern to be able to afford food to feed the families and children in our 245 bed capacity agency. More Temecula residents are entering PT 21-day emergency stay program because they have fallen behind on rent/ mortgage due to unemployment or not having the funds to afford rising rent, food and gas costs. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM, Continue Existing Program: Funds will assist in continuing existing programs of providing Project TOUCH clients with gas cards and bus passes to either be reunited with family or keep OF gain employment; allow Project Touch to buy food for emergency 21-day stay units and purchase food gift cards for clients of PT to be able to shop at local Temecula grocery stores; supplement rental assistance program for PT clients moving from emergency 21-day stay units to transitional Housing because public social benefits are not available yet nor does client have income and/or a job. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 i PROJECT/PROGRAM BUDGET (do not fill in shaded areas) j LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES 1 LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 50000 Amount contributed to the Project/Program by the Applicant $ Organization 400,000 Other grants or funding already awarded for Project/Program, if any $ 15,000 In -Kind match amount or volunteer credit hours estimated amount $ 175,000 TOTAL REVENUE $ 640,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/Insurance $ Supplies $ Marketing $ Services 21 days stay, transitional housing for Temecula homeless $ 315,000 anti mshPj1jrP_li,_virtims aLdomp.ifir—viaiP_ricP Food food purchased for 21 day stay units, food cards to local grocery 5IQre5 for clients 50,000 Other gas cards for employment and medical appointments, bus passes, and $ 100,000 airline tickets_ foramjlxreunifica1iQ1L Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ HOWEVER PLEASE INCLUDE. In -kind Volunteer 7s,000 $ TOTAL EXPENSES $ $ TOTAL BUDGET 640,000 640,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 , PREVIOUS` FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT I*IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE If your organization was awarded a Community Service Funding Grant in FY 2021-2022 �! (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding, City of Temecula reserves the right to rnnrlurt an audit and/or rPquira additinnal hank -up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2, Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attm City Manager's Office — CSF Organization: EXPENDITURE REPORT due on or before September 12, 2022 not app1ic�)hlc FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Name of Project/Program: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Name of Company .. on Receipt or Invoice 4 0 Date on Receipt/Invoice Amount MUST BE ON OR BETWEEN JULY 1, 2021 - JUNE 30, 2022 :5 Expenditure Description Purpose DESCRIBE THE EXPENDITURE I PURPOSE OF EXPENDITURE EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. ■ Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. ■ Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. ■ The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete, I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: God's Fan Club dba Project TOUCH MAILING ADDRESS: 30141 Antelope Road, D103 Menifee, CA 92584 PRESIDENT / AUTHORIZED OFFICER: Anne Unmacht PRINT NAME PHONE:(909) 821-7890 EMAIL: anne@projecttouchonline.com Executive Director TITLE SIGNATURE: _ l I� - DATE:^ T'o�d2�. MONTH, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PRINT NAME SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD B PO BOX 942657 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 7/17/2022 ESL ID: 7808627684 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 2553261 Entity Name: GOD'S FAN CLUB A NON-PROFIT ORGANIZATION FRI1. The entity is in good standing with the Franchise Tax Board. El 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) CQ HELPO MENU Home > Tax Exempt Organization Search > Gods Fan Club < Rack to Search Results Gods Fan Club EIN: 73-1681483 1 Menifee, CA, United States Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Form 990-IV (e-Postcard)o Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. Tax Year 2008 Form 990-N (e-Postcard) Copies of Returns (990,990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2019 Form 990 Tax Year 2018 Form 990 Tax Year 2017 Form 990 Tax Year 2016 Form 990 Tax Year 2015 Form 990 Page Last Reviewed or Updated: 20-November-2020 & Share 1 9 Print Form 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) ticp� ,ent of thrf 7rowary ► Do not enter social security numbers an this form as it may be node pulilic. Interne! Revenue service ► Go to www.0s.gov1Form990 for instructions and the latest information. A Forthe 2020 calendar year, or tax year beginning B Check if applicable: G Address change GOD'S FAN CLUB Name change 30141 ANTELOPE RD D-103 Initial return MENIFEE, CA 92584 Final ratan/ errninaied Amended return Application penning F Name and address of principal officer: ANNE UNMACHT Same As C Above Tax-exempt status: }( 50i(c3} 5o1(c) ( ) (insert no.) 4! J Website: ► ro ecttouchonl.Ine.com K Form of urijoisizaliort: R Corporation 11 Trust Association11 Other' 2MR4 t I rr.rna Mmj , 2020. and ending OMB No. 1W-00,11 2020 Open to Public Inspection 120 D Employer IdentIfication number 73-1681483 E Telephone number 951-677-9661 G Gross receipts $ 1 0 60, 782. H(a) Is Ilrb a group return for subordinates? Yes No Htb) Are all subordinates included? Yes No If "No," adach a list See mstruc.lionc or 527 ll Group exemption number ► (_ Year of formation: 2003 M State of legal domicile: CA 1 Briefly ae_scribe_the Organization's mission or most significant sctivillBRIDGING INDIVIDUAL AND COLLECTIVE a HODIES OF FAITH WITHIN OUR'COMMUNITIES TOGETHER WITH CIVIL_ AND BUSINESS �_��� ORGANIZATIONS Wkkff6ME_HONfELES$NESS a15 ESTABLISH EFFECTIVE METHOL]S QF HOMELESS E -TO -- - -_- __----__ _ _ _ 0 _PR_E_V_EN_T_I_ON_. 2 Check this box ►— if the organization discontinued its operations or disposed of more than 25—% of its net assets. _ — — — — _ _ 0 3 Number of voting members of the governing body (Part VI, line la) ................................... 3 5 'd 4 Number of independent voting members of the governing body (Part A, line 1 b).......... . . . . . . .. . ... 4 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) ....................... , . 5 1 2. 6 Total number of volunteers (estimate if necessary)............. , ................ . ................. - .. 6 32 a 7a Total unrelated business revenue from Part VIII, column (C), line 12............................ 7a 0, b Net unrelated business taxable income from Form 990-T, Part I, line 11 ..... , .. , 7b 0. Prior Year Current Year 8 Contributions and grants (Part VIII, line Ih)...................... ...... 9 Program service revenue (Part VIII, line 2g) ............ ..... ,. 505 363, 507 900. 324 726. 429 390. -88. 219. 10 Investment income (Part VIII, column (A), lines 3, 4, an �. ............. 59 198. 79,427. f> 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 1 C. �1 ............... 12 Total revenue — add lines 8 through 11 (must equal P co umn (A), line 12).. 889,199. 1 016 931157 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3)... —. .. . . ....... 20,254. 363 719. 14 Benefits paid to or for members (Part IX, column (A), line 4) ..................... N 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) . 19,280. 23,787. 16a Professional fundraising fees (Part IX, column (A), line I Ie)............ ....... b Total fundraising expenses (Part IX, column (D), line 25) ► 528.459. 556 101, 17 Other expenses (Part IX, column (A), lines 1la-11d, llf-24e).......... ,...... ..... 18 Total expenses, Add lines 13-17 (must equal Part IX, column (A), line 25) .......,, 767,993, 943 607. 19 Revenue less expenses. Subtract line 18 from line 12 .... _............. .... 121 206. 73,329. Beginning of Current Year End of Year 20 Total assets (Part X, line 16)......-„ ..... I-- _... -. 2,486,904. 3,237,730. 21 Total liabilities (Part X, line 26) ........ . ................ - ..-.... 1 596 092. 2,273,589. 890 812.1 4,141. z,] 22 Net assets or fund balances. Subtract line 21 from line 20......................... rare n I �t naxure tsioeK Under penalties of perjury. I declare that I have oxamined this return, iTICILP rrg accwrpanymg schedules and stntaments, and to the best of my knowledge and belief, it is true, correct, and Complete. Declaration of preparer (ouwr than officer) ir. III on all infonimtmn of whklipreparer has any anowomfao. Sign algmlhire el olfIrAr Dole Here ' ANNE UNMACHT President Type ar pant rarrle and litle PTint/Type preparer's name Preparers signature Dale Check ifTPTINC0Paid Elizabeth Ni ro CPA Elizabeth Ni ro CPASelf-empteved 0222251 Preparer -irnrs name ► NIGRO & NIGRO PC Use Only Firm'saddress ' 25220 Hancock Ave Ste 400 Firm'sI1N' 30-0636241 MURRIETAr CA 92562 Phone 951698-8783 May the IRS discuss this return with the preparer shown above? See instructions ...................... .. . ...... ... JXJ Yes I I No BAA For Paperwork Reduction Act Notice, see the separate instructions. TEEA01011_ 011190 Form 990 (2020) Form 990 (2020) GOD' S FAN CLUB 73-1681483 Page 2 I�arF III Statement of Program Service Accomplishments Check if Schedule 0 contains a response or note to any line in this Part III .................... ............................ 1 Briefly describe the organization's mission: BRIDGING —INDIVIDUAL _AND_ _CO_LL_EC_T_I_VE_ BODIES —OF —FAITH WIIT_H_I_N_0_U_R_CO_MMUNIT_I_E_S_T_O_GE_T_H_ER _ - WITH CIVIL AND BUSINESS ORGANIZATIONS -TO OVERCOME HOMELESSNESS AND ESTABLISH �� EFFECTIVE_METHGDS OF HOMELESS-PREVENTION_________W__W_________________ Did the organization undertake any significant program services during the year which were not listed on the prior Form990 or 990-EZ?........................................................................ ............. Yes FRI No If "Yes," describe these new scrvices on Schedule 0. Did the organization cease conducting, or make significant changes in how it conducts, any program services? Yes FX1 No If "Yes," describe these changes on Schedule 0. Describe the orgganization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 50I(c)(3) and 501(c)(4) organizations are required to repert the amount of grants and allocations to others, the total expenses. and revenue, it any, for eaO program service reported. 4a (Code: ) (Expenses $ 747,483, including grants of $ 363■ 719. ) (Revenue $ } TRANSITIONAL PROGRAM — WE PROVIDE SHARED AND HOMELESS PREVENTION HOUSING WITH 230 BEDS. WE PROVIDE A WIDE ARRAY OF SERVICES WHICH INCLUDES _ EMERGENCY, _TRANSITIONAL _ _ _ ------------------- _ AND _ _PERMANENT S_U_PP_O_R_T_H_OUSI_N_G_W_HICH _AS_S_I_ST_S_ _FA_M_I_LI_E_S, _SINGLE MOTHERS, _SENIOR _ _ _— _CIT_IZENSr_DISABLED PERSONS, _VE_T_E_RANS_A_N_D_S_I_N_GL_E _MEN AND_WOM_E_N_I_N_S_0_U_TH_W_E_ST_R_IV_ER_SI_DE__ COUNTY. IN THE WINTER MONTHS THE NUMBER HOUSED INCREASES UP TO 255 BEDS.— OTHER - ---------------------------------------------------------------- _SE_R_V_IC_ES_WE ASSIST_WITH INHOMELESS SITUATIONS FOR EMERGENCY _ASSISTANCE _ ARE MOTEL STAYS.- FOOD, GAS, _CLOTHING AND TRANSPORATION AND OTHER EMERGENCY NEEDS WE PROVIDE ---- -- --------------------------------------------- RESOURCES_FOR _SOCIAL SERVICES, DRUG AND ALCOHOL REHAB_PROGR_A_MS_, MENTAL HEALTH ----------------- WORK AND CLOSLY WITH THE LOCAL LAW ENFORCEMENT,--ADULT-PROTECTIVE-SERVICES, CHILD - ------ PROTECTIVE SERVICES AND MANY MORE -TO -ASSIST IN HOUSING THE HOMELESS ._______-___-__ ----------------------------------------------------------------- 4b (Code: ) (Expenses $ 65,709. including gran ) (Revenue $ ) _WINTER _ _S_HE_L_T_ER_ _-_PROVIDES _0_VERNIGHT S AP_ ROxMAT_E_L_Y_ FOUR -MONTHS _PER _YEAR _ _DE_C_E_MB_E_R_ T_0_ _AP_R_I_L_-_ _TO_ MEET _THE _NEEH _ _ i7S_OF TE_M_EC_U_L_A_& MU_R_R_IE_T_A_H_O_M_EL_ESS _E_A_CH_ WINTER _SERVING DINNER AND BREAKFAS � _ DAYS PER WEEKWHILESHELTER IS OPEN,_ _ _ _ _ _ ----------------------------------------------------------------- ----------------------------------------------------------------- ----------------------------------------------------------------- ----------------------------------------------------------------- ----------------------------------------------------------------- -------------------------------------------------------------------- 4c (Code: ) (Expenses $ 61, 891 . including grants of $ ) (Revenue $ } _THRIFT_ STORE - OUR _D_IV_INE DISCOUNT _T_HR_I_FT_STORE_ PR_0_V_ID_ES_A_ WORKABILITY PROGRAM_ THAT _ _ TRAINS CLIENTS FOR FUTURE WORK IN RETAIL, _INVENTORY�_WAREHOUSE,_ STOCKING,_EASH____-_ -------_ T- Ok-------------- - - -- - ------ REGISTER AND CUSTOMER SERVICE SKILLS.----------------------------------------------------------------- 4d Other program services (Describe on Schedule 0.) (Expenses $ including grants of $ ) (Revenue $ ) 4e Total program service expenses ► 875 083. WA rEEA01021. 10!07120 Form 990 (2U20) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 38 ROCK YOUR RED CUrY OF I'UMECULi FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY. SEPTEMBER 12, 2022 �r- PROJECT/PROGRAM INFORMATION 1 Amount Requested: $ 25,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Rock Your Red Nonprofit 11/2022 Project/Program Title: Card��tro"-A varerzes:S� Start Date: End Date: Physical Address of Project/Program: PO Box 1641, Temecula, CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Rock Your Red Nonprofit Mailing Address: 45571 Ponderosa Court Temecula, CA 92592 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Rock Your Red Nonprofit, Organization: — Denyse Wilson 0 Year Founded: 2015 Website: www.Rockyourred.info Number of Paid Staff: 0 Geographic Area(s) the Organization Serves: Social Media: FB: Rock Your Red . Number of Volunteers: 12-14 Temecula, Murrieta, Winchester Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE E&CLUSlVELY USED TO SERVE TEMECULA. Contact Name: Denyse Wilson Title/Position: CEO/Founder Contact Person's Direct Telephone: 909-224-3984 Contact Person's Email: Denysewilson 1 @gmail. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 5/1/20 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 85-2536062 State Identification Number: PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: htt :Ila s.irs. ovla /eos/ 2, ❑ Attach State Entity Status Letter using this link: htt sJ1www.€tb.ca. ovlonline/self serve entity status letter/index.as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt .//rct.do .ca. ovN r ti ationlWebl a rch. x?facili = City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No tK Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No 11 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee ❑ Board of Directors # Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES, Mission: Is to significantly improve the cardiovascular health and wellbeing of the members of our community through education awareness, training, support, and services to reduce the lives lost to cardiovascular diseases. Goal: To provide free preventiable education & services to our Heart community to reduce the overall death rate by 10%. Objective: Promote a healthy way of living free of heart and stroke diseases where each person have a chance to make a healthy choice. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No 0 Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH +YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO E Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT, 1. Organize defibrillator & BP training at High schools, Community events, Senior senior, special needs adults etc. 2. Outreach programs teaching warning signs of heart attacks-and—stroke--3 Provide BP -tool -kits, pamplets, health screening for underrepresented population and community. 4, Organize health fairs, education webinars. 5. Partner with health coach, dietitician, fitness coach, TVH, AHA to provide Health services to community. 6. Rock your Red annual health event w/Drs., Nurses, health screening & assessments etc. These are just a few of the services we are working hard to provide to our community. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. (1) Purchase BP & Emergency medical kits. (for resident training) (2) Purchase portable AEDs and educational supplies (for training) (3) Marketing materials, Health & Wellness seminars, Dietitician training �(4) Laptop, Printer, Scanner, Label maker, projector, screen (5) Provide meal gift cards to assist Temecula residents after cardiovascular surgeries (6) Free lunch/snacks for Temecula residents at health events hosted by Rock Your Red. UP H=_mini heal h fairs in Teme_aWa witb AKk TV-H. We loess -Coaches 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Each program, workshop, training, webinar and services will be customized to accomodate our diverse community by focusing on their needs, health, overall well-being, but not limited to our seniors, military, special needs, adults, school aged, homeless, etc. Our services will consist of those who live in Temecula areas of 92590, 92591, 92592. These services will remain free to our Temecula residents. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT ,15%-25% FROM THIS PROJECTIPROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGR�'18_20 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 14 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Cardiovascular disease is the leading cause of deaths in the United States, arc.nrding-to-the-Center-for Disease Control and Prevention. The American -Heart - Association estimates that more than 90 million Americans are living with some form of heart disease or after-effect of stroke. These grant funds will be used only for our Temecula residents to provide programs, health events, workshops, webinars to educate, our Men, women, children, special needs, homesless, military, etc. on how to live a healthy life, free of cardiovascular diseases for all! 15 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Due to the COVID-19 Panademic we were not able to hold our face-to-face events to reach the maximum levels we were used to, but we did hold a zoom health and wellness event which attracted over 90 people. We also were able to put together a team for the virtual heart walk benefiting heart and stroke. This is an important cause and we believe we must continue educating, training and saving lives by being a resource in our community and this grant will help us do that. We kindly ask that you would approve our grant of $25,000. Thank you. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. With the approval of the $25,000 grant our annual event that provides one-on-one health questions and answers with a cardiologist, stroke physicians, nurses, health fair attendees, etc can now reach our Temecula community FREE of charge to all who would like to attend including lunch. A few of our new projects that this grant will assist with is providing Blood Pressure kits to our community of residents living with high BP after they have attended a training or ,workshop on "Living with High BP". Another new project/program will be purchasing AED units to train residents in our community, HOAs, schools etc. how to use them in an emergency. We would also like to provide screening to our vopulatbn in ow_ -needs. disadvantaa-edt. Hpalthv City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill In shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 25,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 4,000 Organization Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 2,500 TOTAL REVENUE $ 31,500 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Laptop, printers, projector, screen, scanner, AED, CPR kit, 1st aid kit, BP machines, etc Facilities/Rent/Insurance Rental space for events & workshops etc, Office shared s ace-HeraHub, Non -Profit insurance gl Supplies Credit card reader, pens, paper, ink, labels, stationary, binders, folders etc. Marketing Mailings, flyers, handouts, stamps, postcards, signs, website & FB fees p Services BP training, Dietitian, health coach, Presenters/Speakers: Nurses and Doctors etc. 0 Food lunch & snacks provided at workshops, live events, training etc. (onlv free for Temeculans) 0 Other Miscellaneous, things that may come up that's not budgeted. m Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET I $ $3,500 $1,800 $1,300 $2,000 $1,500 $3,000 $1,000 $O $14,100 $20,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. I If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional 'back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1, Fill out table below (make additional copies if needed to explain all expenditures ) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3 Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Rock Your Red Non Rock Your Red Nonprofit Organization: profit,_ Name of Project/Program: Cardio/Stroke Awareness Denvse Wilson o FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on E Name of Company Receipt/invoice 5 on Receipt or Invoice MUST BE ON OR BETWEEN Amount JULY 1, 2021 - JUNE 30. 2022 4Z Expenditure Description Purpose DESCRIBE THE EXPENDITURE I PURPOSE OF EXPENDITURE ! 3 4 5 6 EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit andlor require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation -including -the -table -below -with accompanying receipts/invoices, must be submitted -to -the -City -as -outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $6,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Rock Your Red Nonprofit, Name of Project/Program:. Rock Your Red Nonprofit Denyse Wilson o Cardio/Stroke Awareness a TOTAL FY 2022.2023 Month & Year FIRST $6,000 check Amount of Grant Fund Awarded: S was received from City: 1, Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report Is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) c E Name of Company E !on Receipt or Invoice � Date on Receipt/Invoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, 2024 ExpenditureMUST SUPPORT PROJECTIPROGRAM IN APPLICATION & AWARD LETTER I I Amount I Description EXPENDITURE TOTAL $ EXPENDITURE TOTAL Purpose City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Rock Your Red Nonprofit, Denyse Wilson MAILING ADDRESS: 45571 Ponderosa Court Temecula, CA 92592 PHONE: (909 )224-3984 EMAIL: Denysewilson1@gmail.com PRESIDENT/ AUTHORIZED OFFICER:Denyse Wilson, CEO/Founder PRINT NAME SIGNATURE. IF DIFFERENT THAN OVE, APPICATION PREPARED BY: PRINT NAME TITLE DATE: Sept. 6, 2022 MONTH, DAY, YEAR TITLE +1 SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 of the Treasury jrjDepartmont Internal Revenue Service Date: IDQ Tax Exempt and Government Entities P.0• Box 2508 09/02/2022 Employer ID number: 1W Cincinnati, OH 45201 85-2536062 Person to contact: Name: Suzanne Richey ID number: 50750 ROCK YOUR RED Telephofie�87-7-829-5500 C/O SHARON DENYSE WILSON Accounting period ending: 45571 PANDEROSA COURT December 31 TEM.ECULA, CA 92592 Public charity status: 509(a)(2) Form 990 1990-EZ 1 990-N required: Yes Effective date of exemption: May 1, 2020 ._Contribution deductibility: Yes Addendum applles: No DLN: 26053603004162 Dear Applicant: We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170, You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522• This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under .IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter, If we indicated at the top of this letter that you're required to file Form 9901990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter, For important information about your responsibilities as a tax-exempt organization, go to www.ii•s.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Sincerely, r au cz WW -4;Z Stephen A. Martin Director, Exempt Organizations Rulings and Agreements Letter 947 (Rev. 2-2020) Catalog Number 35152P STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/20/2022 ESL ID: 4259398646 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 4590840 Entity Name: ROCK YOUR RED 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States Stacey Brown From: Denyse Wilson <denysewilsonl @gmail.com> Sent: Friday, September 2, 2022 6:20 PM To: Betsy Lowrey Cc: Stacey Brown Subject: City of Temecula - Grant Funding Opportunity Attachments: Grant Application.pdf Follow Up Flag: Flag for follow up Flag Status: Flagged CAUTION: This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Happy Labor Day Weekend Ladies! Please see attached our grant application for Rock Your Red. Our nonprofit status is pending and expected in a few weeks. I hope this application is the right one. It was the only fillable one available on the city's website. If I need to fill out another one, please forward it to me and I will complete it ASAP. Thank you. On Thu, Jun 30, 2022 at 9:08 PM Betsy Lowrey <betsy.lowrey@temeculaca.gov> wrote: Good evening — I'm pleased to share the attached Press Release that announces an exciting funding opportunity for local nonprofit organizations that provide charitable goods and services for the benefit of Temecula residents. Thank you, Betsy Lowrey Assistant to the City Manager City of Temecula (951) 693-3959 b etsy.lawreyf?Temecu IaCA,gov 41000 Main St Temecula, CA 92590 K Please note that email correspondence with the City of Temecula, along with attachments, may be subject to the California Public Records Act, and therefore may be subject to disclosure unless otherwise exempt. Denyse Wilson, CRS, Realtor FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 39 ROTARY CLUB OF TEMECULA 11 12 cb , --�4 L�l CITY OF TLMFCUIL I FISCAL, YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TPROGRAM APPLICATION(Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 20lp PROJECT/PROGRAM INFORMATION Amount Requested: $ 30,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Food for low-income seniors, veterans and students 7-1-2022 5-30-2023 Start Date: End Date: Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: P.O. Box 64, Temecula, CA 92593 Mailing Address: ORGANIZATION AND GEOGRAPHIC AREA SERVED I Name of Applicant Organization: Rotary Club of Temecula Year Founded: 1999 Website: www.rotarycluboftemecula.com Social Media: Rotary of Temecula Number of Paid Staff: 1 Number of Volunteers: 100 Geographic Area(s) the Organization Serves: Temecula Valley Geographic Area(s) the Pro'ect/Pro ram Serves. Temecula Valley NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Kim Gerrish Title/Position: President Contact Person's Direct Telephone: 951-265-3936 Contact Person's Email: rotarykimg@gmail.com NONPROFIT STATUS l Is this organization incorporated as a nonprofit? Yes ❑ Date of Incorporation as a Nonprofit: 5-4-1999 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0856109 State Identification Number: 2163211 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: htt://a sirs. ov/a /eos/ 2. V Attach State Entity Status Letter using this link: htt s:lfwww.ftb.ca. ov/online/self serve entity status letter/index.as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: ht! ://rct.doi.ea. ov/Veritication/Web/Sa rc .as x?I cili =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 + APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION, This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION i BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Rotary international motto is "service above self' as is the goal of ROTARY Temecula Noon club. Objectives: 1) to serve low-income seniors, veterans, military, and low-income students and their families residing in Temecula Valley with supplemental food both monthly and during cold weather months; 2) purchase food boxes, other food and grocery store gift cards from local grocery superstores and grocery chains; 3) members contribute non-perishable foods; 4) deliver to seniors (monthly) in Temecula and to low income students with families during the cold weather months of November and December. 5) provide transportation vouchers to home bound senior, veterans and military to access healthcare appointments by using transportation services available in the City of Temecula. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ® IF YES, PROVIDE BELOW NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANTOR SPONSORSHIP food boxes for seniors, students/families in Temecula I AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP $ 5,000 FY 21-22 Jan CSF food boxes for seniors, students/families in Temecula $ 5,000 FY 20-21 CSF maniHy Food coxes [or low inronno seniors $ 1,000 June 2022 Council Member Funds $ $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ❑ Yes ® IF YES, PROVIDE INFORMATION IN TABLE BELOW, f AMOUNT MONTH + YEAR li RECEIVED NAME OF ENITY FUNDING RECEIVED $ 5,000 Riverside County Supervisor -Chuck Washington 21-22 $ $15,000 Loma Linda University Healthcare- 21-22 $ $5,000 State Farm 21-22 $ 6,000 ROTARY District 5330 21-22 $ $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMIT] ED TO THE CITY TO VALIDATE THE ORGANIZATION SPEN T GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE i 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Funding will be used to support 1) food boxes, other food, grocery gift cards for low-income seniors, veterans, military, and TVUSD students and their families either monthly and during cold weather months of November and December; 2) transportation vouchers/gas cards to be distributed to home bound seniors to schedule transportation services to access healfhrare appointments All low-income recipients are referred by TVUSD. Mary Phillips Center and Temecula Veteran office and City of Temecula homeless task force. All Food purchases and grocery gift cards will be purchased From local grocery stores in Temecula. All transportation vouchers will be used by services available in Temecula. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Food Boxes from focal agency= $5,000 Other Food from grocery stores=$5,000 Grocery Gift Cards from grocery stores=$5,000 Transportation Vouchers= $15,000 (using services like GOGO Grandparents, LYFT, UBER, bus passes 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Grant funding specifically benefits low-income seniors and veterans as identified at low income housing in Temecuta, or by Mary Philllips Center or Elizabeth Hospice On average 25 seniors are served food boxes monthly residing in Temecula- Addy TVUSD personnel identifies low income students and their families for delivery of supplemental food baskets distributed during the cold weather months of November and December. Seniors in need of transportation to access healthcare are identified by seniors living in low income housing in Temecula, the Mary Phillips Center and Elizabeth Hospice. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT I FROM THIS PROJECT/PROGRAM: 1660 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM 1100 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. Request funds to be used to provide supplemental food to low-income seniors, veterans, military and TVLISD students and families both monthly and/or during the cold weather months, and transportation assistance to low-income seniors to access healthcare. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Rotary Club of Temecula started the senior supplemental food box deliveries at the beginning of COVID to help low income seniors get food since their population was at risk of exposure to COVID. After the pandemic ended in 2021, the seniors still needed food every month, as they survive on limited incomes. Now with the recession, food is extremely expensive and difficult to afford. Transportation services needed to access healthcare has become another challenge for seniors who can no longer have a car or drive and/or have funds to pay for transportation to their medical appointments. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Funds will expand the existing programs by supporting RC Temecula Noon providing/serving an additional 25% of low-income seniors, veterans, military and TVUSD students/families either food boxes, other foods or grocery gift cards on an annual basis. Additionally, funds will support transportation assistance for low-income seniors needing access to healthcare appointments. All funds will be spent in Temecula and benefit Temecula residents. i City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES II EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 30,000 Amount contributed to the Project/Program by the Applicant $ Organization 20,000 Other grants or funding already awarded for Project/Program, if any I $ In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 60,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food Other - transportation assistance for seniors to access healthcare Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET $ 60,000 I $30,000 $30,000 $ $ 60,000 � • 1 111 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up Information to substantiate how tunds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to- City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 1 Organization: Rotary Club of Temecula Foundation FY 2021-2022 Amount of $ CSF Grant Fund Awarded: 5.000 Name of Project/Program: Month & Year CSF Grant Received from City: 01-2022 Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not 550 have precise number): E v Date on Expenditure r Name of Company Receipt/Invoice Description Purpose a. z' on Receipt or Invoice 'MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1.2021 -JUNE 30, 2022 Grocery gift cards 12/22/21 Food for low-income Seniors 1 Walmart $ 980.00 Walmart 12/20/21 Grocery gift cards Food for low income seniors, 2 $1,760 military, veterans, families Western Eagle Foundation 7-20-21 Food boxes Monthly food boxes for low- 3 3 Western Eagle Foundation 9-21-21 645.00 seniors Food boxes Monthly food boxes for low 4 315.00 income seniors Western Eagle Foundation 10-19-21, 1-18-2021, 37 Food boxes Monthly food boxes for low 5 2-15-2021 $ 270.00, .00, income seniors 300.00 Walmart 12-21-2021 Spiral hams Food for TVUSD low income 6 Q $2,469 59 students and families `V$2,570.43 .- EXPENDITURE TOTAL �9,685A2 (OR GREXPENEATER) TOTAL MUST BE EQUAWARD TO AMOUNT (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: ■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date orthis application may be rejected as incomplete. /we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Rotary Club of Temecula Foundation MAILING ADDRESS: PO BOX 64 Temecula, CA 92593 PRESIDENT / AUTHORIZED OFFICER: Kim Gerrlsh PHONE: (951) 265-3936 EMAIL: rotarykimg@gmail.com President 22-23 SIGNATURE ..+ DATE:6-31-2022 IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: MONTH, PAY, YEAR !'RINi' NAML TI T I_E SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELPO MENU Home > Chan i s and Non -Pr f s > -51mb fgr Charities > Tax Exempt Organization Search Results for Tax Exempt organization Search Select Database 0 Search All Search By 0 Employer Identification Number (EIN) Search Term 0 330856109 City Temecula State All States Search SearchTip-5 Showing 1-1 results of 1 Sort by: Name A-Z Country V United States Reset v V V Rotary Club Of Temecula Fa ndation EIN: 33-0856109 1 Temecula, CA, United Stites Pub 78 Data Copies of Returns Items per page: 25 v Return to DP Additional information • Frequently asked questions - Exempt Organizations Select Check • Revocations of 501(g).(3)_Detgrminations • Suspensions P t to Code Section 501(p). • Exempt Organ izatiyns Business Master File Extract (EO BMF): a list of organizations recognized as exempt by the IRS • Tax Exempt4Cganiu-tlon Search: Bulk_Datil Downloads Page Last Reviewed or Updated: 20-November-2020 OIRS Our Agency AboutlRS Work at IRS Help Contact Your Local Office Tax Stats, Facts & Figures Know Your Rights Resolve an Issue ShareI E 4; Print 910 @ in a 0 Other Languages Related Sites Taxpayer Bill of Respond to a Notice Espanol Rights Independent Office rp3Z (ja'f*) Taxpayer Advocate of Appeals Service () Identity Theft Civil Rights Protection lE Cl Freedom of Report Phishing PycCKMA Information Act Tax Fraud & Abuse Tieng Viet No Fear Act Kreyol ayisyen English Other Languages U.S. Treasury Treasury Inspector General for Tax Administration USA.gov STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/31 /2022 ESL ID: 1161199347 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 2163211 Entity Name: ROTARY CLUB OF TEMECULA FOUNDATION 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m, to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Form990—EZI Department of the Treasury Intemal RRVw11le Service Short Form Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private founded ► Do not enter social security numbers on this form, as it may be made public. ► Go to www.irs.gov/Form990EZ for instructions and the latest information. W-B No 1545 ON( 2020 Open to Public Inspection A For lice 70PO calendar year, or lax year beginning JUL 1. , 2020 and ending J'UN 2021 i ts 1*M1 C Narfnd of ur alrialton 9 0 Employer identification number �j—�a"w'rxi,rw,w% 1�Jli<kkaa� rhan ROTARY CLUB OF TEMECULA FUUiVllATION 3J-0856109 —}Inrclai return NIJmber arid street (arbox If mail is not delivered to street address) fiocm/suite Te i8dhaun nuniher nar,,,a; P.O. BOX 64 951-837-5736 F�=uncned LJ M+unnml rewrn Ity or town, state or province, country, and or orelgn post3 co. e F Group Exemption TEMECULA , CA 92593 Number JO- G Accounting Method: LX_j Gash Lj Accrual Other (specify) No. H Check ► 1-1 if the organization is I Website: No. WWW . ROTARYCLUBOFTEMECULA . COM not required to attach Schedule B J Tax-exempt status check nuly one — LX-1 501(c)(3) _ 501(c) ( ) 4(fnserl no.) LJ 4947(a)(1) or 1. .( 527 (Form 990, 9911-EZ, or 990-PF). K Farm of organization: Corporation Trust Association Other L Add lines 5b, 6c, and 7b to fine 9 to determine gross receipts. If gross receipts are $200,000 or more, or it total assets (Part 11, coiuwn R are $500.000 or more Pie Form 990 Instead of Form 990-EZ ► $ 97,205. Part ( Hevenue, Expenses, and Changes in Net Assets or Finid nances fsne [lie insirucfinns forPag 1) Check if the orrjanimlion used Schedule 0 to rospand to any quoslirud in this Part I 1 Contributions, gifts, grants, and similar amounts received 1 ] 5 2 Pwgrarn service revenue including government fees and contracts 2 3 Membership dues and assessments _ 4 Investment income ,..... ......:........... . SEE. SCHEDULE 0 4 55. 5a Gross amount from sale of assets other than inventory 5a b Less: cast or other basis and sales expenses _ __... ,.._ _ _ 5b c Gain or (loss) from sale of assets other than inventory (subtract line 5b from Tine 5a) 5c 6 Gaming and fundraising everts: 7 a Gross income from gaming (attach Schedule G if greater than m $15,000) 6a 'm b Gross income from fundraising events (not Including $ of contributions Ir from fundraising events reported on line 1) (attach Schedule G if the SLIM of such gross income and contributions exceeds $15,000) 6b c Less= direct expenses from gaming and fundraising events Be d Net income or (loss) from gaming and fundraising events (add lines 6a and 61b and subtract 1111e.61:) 6d 7a Gross sales of inventory, less returns and allowances 7a b Less: cost of goods sold 7b c Gross profit or (loss) frorn sales of inventory (subtract line A from line 7a) _ 7c 8 Other revenue (describe in Schedule 0) a 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 ► g 97,205. 10 Grants and similar amounts paid (list m Schedule 0) _ _ SEE SCHEDULE 0 10 11,996. 11 Benefits paid to or for members „- 11 12 Salaries, other compensation, and employee benefits 12 13 Professional fees and other payments to independent contractors 13 5,400. „ 14 Occupancy, rent, utilities, and maintenance 14 Lu 15 Printing, publications, postage, and shipping 15 16 Other expenses (describe in Schedule 0) SEE SCHEDULE 0 16 6 9 , 4 17 Total expenses. Add lines 10 through 16 .. ► 17 (j t ti 18 Excess or (deficit) for the year (subtract line 17 from line 9) 18 10 T15 . N19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end -of -year figure reported on pricryear's return) ._. 19 126,258. Z20 Other changes in net assets or fund balances (explain in Schedule Oi 20 21 Not assets or fund balances at ontrnr ear. Combine lines 18 throe h 20 „...... ..------------ ,_ .. 10 21 1 Tr,-5-TT LHA For Paperwork Reduction Act Notice, see the separate instructions. Fornt 990-EZ (2020) Jy21'1 01-08-21 Form 990-EZ f:rrl:If1) ROTARY CLUB OF TEMECULA FOUNDATION 3 3 - 0 8 5 610 9 Page 2 lPart111 alance Sheets (seethe instructions for Part 11) Check if the organization used Schedule 0 to respond to any QUOStion in this Part II (A) Beginning of year 22 Cash, savings, and investments .. 19 , 1 3 . 22 23 Land and huildn s E3 24 Other assets (describe in Schedule 0) ,. SEE SCHEDULE_,_ 0„ 7,125. 241 25 Total assets .. ..... ..... ... 126,258. 25 26 Total liabilities (describe in Schedule 0) SEE SCHEDULE 0. 0 . 26 27 Net assets or fund balances (line 27 of column (ii must;t roe with line 21) 126,258 . 27 Part III Statement of Program ServfCe ACcomphshments {sae the instructions for Part lit) Check if the or anixettion used Schedule 0 to respond to any question in this Part III XX (6) rnd at year 7, 117,153. 5 136,573. Expenses (Required for section 501(c)(3) and 501(c)(4) organizations; optional for others-) What is the organization's primary exempt purpose?SEE SCHEDULE 0 Dena iba, me nrdrmiz-fic-'s procn+ru service acromplishntents rcr each or its three largest program se vices. as meacwed ov exoen.ses. In a cle j1d rorcis;e Inannrvr, do-, !rs tIio services provided, ;he n�jmhei of person-s t-flteU, and other relevant infer m9tlon for each program 28 SEE SCHEDULE O Grants $ If this arnount includes form rl grants. check here ..... I► 1_ Ha 13 , 4 0 0 . 29 SEE SCHEDULE O CiranTs �, If this amount includes foiwr in Ulatills, Check lrer8 29A 43,984. 3o INTERNATIONAL SERVICE FOR THE ADVANCEMENT OF INTERNATIONAL FJ UNDERSTANDING, GOODWILL, AND PEACE. Grants $ If this amounl includes ford n ofanh. check here 8,814. 31 Other program services (describe in Schedule O) grants $ 11 this anwunt rnchides tnreic r c1rants, check here U s1 32 Total erogram sar vice expense s 0nod lines 28a ihrmic h 31.r 32 Part IV List of Officers, Directors, TrUSteeS, and Key Employees ,list each one oven i' no, cornpnnsated See thtr lnshneCenq for pa't lv, Check if the oroanization used Schedulra O to rosnond to nnv n,xastinn in this Furl 1V Ix 1 (a) Name and title (b)Average hours per week devoted to position (c) Fel,„rlahle enr°r'ensn°oil lF°'°'s f css,tinsc) rfool wr-a: paid, enler-D.) (d) Health benefits, er pio'y- bsne1;t pinns, and do&rred carnoensatlan (c)Estimated arnount of other compensation ,J'UDY ZULFIQ.AR 40.00 0. 0. 0. PRESIDENT CHERISE MANNING 15.00 0. 0- 0. PRESIDENT ELECT KIM GERRISH 15.00 0. 0. 0. VICE PRESIDENT ALIEN ORR 15.00 0. 0. 0. TREASURER TINA ROY 15.00 0. 0. 0. SECRETARY LEIF JACOBSEN 15.00 0. 0. 0. IMMEDIATE PAST PRESIDENT ALLYSON TRANTUM 15.00 0. 0. 0. E'OUNDATION DEBRA JOHNSON 15.00 0. 0. 0. COMMUNITY SERVICE ALYSON DRAGO 15.00 0. 0. 0. INTERNATIONAL CAROL POPEJOY 15.00 0. 0. 0. CLUB SERVICE JENNIFE:R EVANS 15.00 0. 0. 0. PUBLIC RELATIONS JULIE NGO 15.00 0. 0.1 0. MEMBERSHIP 032v2 01 08 21 Form 990-EZ on2n1 -.atm 090-ET. (2020) ROTARY CLUB OF TEMECULA FOUNDATION 3 3 - 0 8 5 6I 0 9 page 3 dartV Other Information (Note the Schedule A and personal Benefit contract statement requirements in the instructions for Part V.) Check if the organization used Sch. O to respond to any question in this Part V 33 Did the organization engage in any significant activity not previously reported to the IRS? If'Yes," provide a detailed description of each activity in Schedule 0 34 Were any significant changes made to the organizing or governing documents? If 'Yes," attach a conformed copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain the change on Schedule 0. See instructions 34 X 35a Did the organization have unrelated husiness grass inr,ome of $1,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)? _ . 35a X b If "Yes" to line 35a, has the organization filers a Form 990-T for the year? If''No," provide an explanation in Schedule 0 -• •,..,• •. -..- - -•,. - -- 35b N/ c Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III „ • 35c X 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 X 37a Enter amount of political expenditures, direct or indirect, as described in the instructions ■ 31a 0 . b Did the organization file Form 1120-POLfor this year? ..... 37b X 36a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee; ar were any such loans made in a prior year and still outstanding at the end of the tax year covered by this return? _.. .................. 36a X b If "Yes," complete Schedule L, Part II, and enter the total amount involved 301r N/A 39 Section 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 9 - •_ 39a NIA b Gross receipts, included on line 9, for public use of dub facilities ,_••_,- _,- --•. - 39b N/A 40a Section 501(c)(3) organizaiion,s- Enter amount of tax imposed on the organization during the year under: section 4911 ► 0 . ; section 4912 ► 0 . ;section 4955 ► 0. b Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in any seciian 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction if, a prior year that has not been reported on any of its pi icr Forms 990 or 990-EZ? If•'Yes;' complete Schedule L, Part I ,• ............, „ ,. •,.. ,• 40b X c Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax imposed on organization managers or disqualified persons during file year under sections 4912, 4955, and 4958 .. -•, „ ► 0. d Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax on line 40c reimbursed by the organization ► 0 . e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If "Yes," complete Farm 8886-T 41 List the states with which a copy of this return is Well ► CA 42a The organization's books are in care of ► SUSIE MARS -HALL Telephone no.►951-837-5736 Located at ► P . 0 . BOX 64, TEMECULA, CA ZIP + 4 lo-92593 b At anytime during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial Yesl No account)? ........ ... 42b X If "Yes;' enter the name of the foieign country ► See the instructions for exceptions and filing requirements for FaCEN Form 114, Report of Foreign Bank and Financial Accounts (FEAR). c At any time during the calendar year, did the organization maintain an office outside the United States? 42e X If "Yes;' enter the name of the foreign country ► 43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 -Check here ► G_] and enter the amount of tax-exempt Interest received or accrued during the tax year ,•• --., .,,._, •- .- . ►+ 43 N/A Yes No 44a Did the organization maintain any donor advised funds during the year? If"Yes," Farm 990 must be completed instead of Form 990-FZ 44a X b Did the organization operate one or more hospital facilities during the year? If "Yes," Term 990 must be completed instead of Form 990-EZ 44b X c Did trte organization receive any payments for indoor tanning services during the year? 44c X d If "Yes" to line 44c, has the organization filed a Forms 720 to report these payments? If "No " pi ovide an explanation in Schedule D 45a Did the organization have a controlled entity within the meaning of section 512(b)(13)? 45a X b Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If -Yrb," Form 990 and Sctsrdulc R easy need to be complcted instead of Form 991 See instructions 45b Form 990-EZ (2020) 032 113 i? 0B 21 Form 990-EZ (2020) ROTARY CLUB OF TEMECULA FOUNDATION 3 3 - 0 8 5 610 9 Page 4 Yes No 46 Did the organization engage, directly or indirectly, in political campaign activities an behalf of or in opposition to candidates for public office? If "Yes: eomplelo Schedule C. Part I ......... .. ... . .... 1.�46 X Part YjI Section 501(C)($) Organizations Only All section 501(c)(3) organizations must answer questions 47-49b and 52, and complete the tables for lines 50 and 51. Check if the organizatiori used Schactatle O to respond W an c uestion rn this Part VI ... Yesl No 47 Dirt the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year? If "lies;' complete Sch. C, Part II 47 Y' 48 Is the organization a school as describe,' in section 170(b)(1)(A)(k)? If "Yes;' complete Schedule E - 48 X 49a Did the organization make any trancfore to an oxompt non charitable related organization? 49a X b If "Yes," was the related organization a section 527 organization? 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 Compensalion from the arganlrnlian, If there Jume. enter "None." (a) Name and title of each employee NONE (b) Average hours per week devoted to position (C) Reportable rnmpensntion (Forms w-7i1099-misc} (d) Heelth beneets. contributions to employee beneril plans, apd deterred compensation (e) Estimated amount of other compensation r i mai numuor or Omer employees pala over $IUU,uuu 51 Complete this table for the organization's five highest compensated independent contractors who each received snore than $100,000 of compensation from the a I oral numher of We,,, independent contactors each receiving over $100,000 52 Did the organization complete Schedule A? Note: All section 501(c)(3) organizations must attach a cornpleted Schedule A ................ ... ..... .. .... ► 0 Yes Na Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and conip3eill. Declaration of ((repute, (other than alficar) is based on all information of which preparer has any knawledue. Sign r "rru,vuu.n nmcaruaji Here ALLEN ORR, TREASURER p—. g 11 na I— apt n PrintlType preparer's name Preparer's signature oat Uneck I f' FIPt Paid self- employed Prepare, HICHAEL R. NOON P00646857 Use Only tom'S name NOON & ASSOCIATES CPAS , INC . Firm's EIN ■ 8 4 18 9 Firrrt'Sarldress 7555 YNEZ RD, STE 135 Phoneno. 95 677 814 TEMECULA, CA 92591 Vay the IRS -discuss this return with theprepamr shown above? See instructions lil� LXJ Yes LJ No Farm 990-EZ(2020) 03P1M 01 00 21 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 40 SANTA ROSA PLATEAU FOUNDATION CITY OF TEMECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 I PROJECT/PROGRAM INFORMATION Amount Requested: $ 13,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Promotion Environmental Project/Program Title: _protPfdon through Start Date: fan 2023 End Date: Dec 202 Education ("PEPE") Physical Address of Project/Program: 39400 Clinton Keith, Murrieta and TVUS❑ Schools INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: SRPNEF Mailing Address: P.O. Box 941 Murrieta CA 92564 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Santa Rosa Plateau Nature Organization: Education Foundation Website: srpnef.org Number of Paid Staff.. 3 Year Founded: 2003 Social Media: Yes Number of Volunteers: 250 Geographic Area(s) the Organization Serves: Southwest Riverside County Geographic Area(s) the Project/Proc tram Serves: TVUSD - High School Students NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Ginger Greaves Title/Position: Executive Director Contact Person's Direct Telephone: 909-732-2209 Contact Person's Emailexecdirector sr nef.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ❑ Date of Incorporation as a Nonprofit: 2003 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 71-0946697 State Identification Number: 2531858 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ■U Attach IRS Deductibility Status using this link: hft .,Ila s.irs. ov/a /eos/ 2. 0 Attach State Entity Status Letter using this link: https://www.ftb.ca.gov/online/self serve entity status letter/index.as 3. ■❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rctdoi.ca.gov/VerificationtWeb/Search.aspx?fsciliiy=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No !!J Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No llp Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION, - This Application has been authorized by the organization's: Executive Committee (wj Board of Directors ❑ Members -at -Large ❑ C MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES Mission: To educate and empower youth to appreciate, preserve and protect nature. Goals & Objectives: • Reconnect a generation of youth to nature who grown up in doors and isolated from the natural world. • Provide education, experiences and tools to guide a young citizen towards a life of environmental stewardship. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ❑ IF YES, PROVIDE BELOW, NAME OF PROGRAM/PROJECT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP AMOUNT FUNDING RECEIVED OR SPONSORSHIP Distance Learning Video $ 2,500 December 202 CSF Grant SRP Fire Fund $ 3,500 June/July 2020' Various Council M I$ $ I$ I � $ $ _ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ❑ Yes 10 IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT - NAME OF ENITY MONTH + YEAR RECEIVED I _ FUNDING RECEIVED $ 46,275 Gimbel Family Foundation Aunust gngq City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT Engage TVUSD high school students and their teachers in a year -long research project studying climate change and fire on threatened and endangered plants and animals. The project involves place -based, hands-on field -work experiences, using the collaborative Nature's Notebook national platrcrin. It will promote cross -subject engagement (STEM,Climate Literacy) while addressing specific high school standards of learning. Project involves the establishment of a collaborative community science program known as a Local Phenology Program (LPP) through the USA National Phenology Network. Students observe, study, analyze and record data to be used throughout the US by biologists/land managers. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT, Note: Funds received from the Gimbel Family Foundation for the PEPE program have been geographically earmarked for high school students enrolled in schools other than TVUSD. The Gimbel grant allows for cost of salaries and coverage for substitutes when teachers accompany the students. Support requested in the City of Temecula grant will be specific to the TVUSD component of the program- Equipment and services needed for the TVUSD project are transportation, PocketLabs, backpacks, interns, t-shirts, journaling supplies and supplies and chrome notebooks, binoculars. In order to teachers to participate, substitute coverage will be needed. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. 1, Benefits TVUSD teachers as the PEPE augments their environmental science curriculum requirements. Program aligns with the Next Generation Science Standards and California's Environmental Education Initiative. 2. The community in which the students live will benefit by their broadened understanding of how climate change and fire affects the plants, animals and the air they breath. 3. Student's college applications will be enhanced by being part of a valid research study that is generally not available to high school students. 4. Students are introduced to the concept of being a Citizen Scientist and learning the impact they might be able to affect right in their own back yard. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT ,� 00 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: [�5 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT- SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. The PEPE program will be an exciting, adventurous experience for TVUSD high school students. They'll be able to explore their curiosities and expand their knowledge about the true challongos facing our natural world due to the effects of climate change and fire. They'll learn how to research and observe plants and animals in the field; how climate change and fire have affected them. They'll record that data, and their work will be reviewed by biologists and land managers throughout the US. The project is the start of becoming a Citizen Scientist and pursuing a life of environmental stewardship. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. The effects of the pandemic AND the closure of the Reserve from the Tenaja Fire presented extreme opportunities. On -site and classroom programs were eliminated. We pivoted by developing a YouTube channel "Hawks Rocks and Nature Talks"; produced and distributed distance learning videos for use in classrooms. The SRPNEF Board sustained staffing during the two years; applied and received PPP funding and had good reserves to see us through. The fire destroyed a stage structure that had been used as an interpretive and fundraising site. SRPNEF organized a fundraising effort to rebuild the structure now known as the "Plateau Pavilion". City of Temecula council members donated towards the rebuild. While we were able to provide some level of nature education through the distance learning videos, we saw first hand that children learn best about nature IN NATURE. We cannot create a new generation of environmental stewards unless they learn in the natural world; hands in the ground and minds on solutions as the planet is burning around us. ,6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Promoting Environmental Protection Through Education (PEPE) is a new program focused on providing opportunities for high school students to gain knowledge and an understanding about the affects of climate change and fire on our environment, habitats and plants and animals. This will be accomplished by working collaboratively with the National Phenology Network (study of biological changes), Nature's Notebook, TVUSD high school teachers, and local open space properties including the Santa Rosa Plateau Ecological Reserve and the Plateau Management Committee comprised of The Nature Conservancy, Riverside County Regional Parks, California Fish and Wildlife and Metropolitan Water District. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 13,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any r ? 17,000 $ 46,275 In -Kind match amount or volunteer credit hours estimated amount $ 2,500 TOTAL REVENUE $ 78,775 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment rocicetLab Glimate Monitoring Devices (1 for each group of 3 students = 10 x $350 Facilities/Rent/Insurance Supplies Backpacks, chrome books, 'ournalin supplies, P 9 1 first aid kits, binoculars, snake chaps. Marketing Services Approx 3 biology interns to assist. Substitute coverage needed for TVUSD Food Other Transportation - 5 trips to SRP x $400 x 2 bus Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. EXPENSES $ 3,500 $ 3,000 $ 2, 500 $ 4, 000 $ 8, 000 TOTAL EXPENSES f $ 21, OOO TOTAL BUDGET $ 78,775 1 $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receiptsfinvoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED i Organization: Santa Rosa Plateau Nature Name of Project/Program. Promotion Environmental Cuucauun ruunudiwrl riukeL;uun inrvugn r_uucau TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: _ 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) Date on txpencliture Name of Company Receipt/lnvoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Eon Receipt or Invoice MUSTBE ON OR BETWEEN 3 2ozah 20, 2020 - JUNE 30, Amount Description Purpose cc Z 1 2 I$ 3 EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 I � , PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021. and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receiptslinvoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receiptslinvoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Santa Rosa Plateau Nature Name of ProjectlProgram: Education F-undation FY 2021-2022 Amount of CSF Grant Fund Awarded: Did not submit __. Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on _ Expenditure Name of Company Receipt/invoice Eon Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose Q z JULY 1, 2021-.TUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE i I 1 2 3 4 5 6 R I EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding dogs not rnnstitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Santa Rosa Plateau Nature Education Foundation MAILING ADDRESS: P. 0. BOX 941 PHONE: ( 909, 732.2209 Murrieta 92564 EMAIL: execdirector@srpnef.org PRESIDENT/ AUTHORIZED OFFICER: ...Austin Linsley VRlflf �l�tv9t ZIILF SIGNATURE: GC.GI�-L c--+!l�%�L-- DATE: Sept 12, 2922 u 1: )N, 1 1 1 •;,, ,S;',P IF DIFFERENT THAN ABOVE, Ginger Greaves APPICATION PREPARED BY: i ! f -- SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD F PO BOA 942857 SA SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/12/2022 ESL ID: 4179177847 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 2531858 Entity Name: THE SANTA ROSA PLATEAU FOUNDATION 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d, ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Pi a J W on v c 0 400 0 LIM 4W m rml m 44 0 w m 4W tig w E m 40 c 0 ._ 4W m V •� r a 7" 0 0 N i N .p O Z O d1 Off 0�1 d1 C1 N E LL E LL E LL E LL E LL o N N 10 In rl N � ao rl N ILO rl N ILO w rl N ILO � a, v aJ, o, Form 8879-EO Department of the Treasury Internal Revenue Service IRS a -file Signature Authorization for an Exempt Organization For calendar year 2020, or fiscal year beginning JUL 1 , 2020, and endvn0 J N 3 0 or person ► Do not send to the IRS. Keep for your records. Go to www.irs.gov/FormBS79E0 for the latest information. OMB No. 1545-0047 W21- I 2020 Santa Rosa Plateau Foundation **-***6697 Name and title of officer or person subject to tax Shirley Broz CFO Part I Type of Return and Return Information (Whole Dollars Only) 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 la, 2a, 3a, 4a, 5a, 6a, or 7a below, and the amount on that line for the return being filed with this form was blank, then leave line 1b, 2b, 3b, 4b, 5b, 6b, or 7b, whichever is applicable, blank (do not enter -0-). But, if you entered -0- on the return, then enter -0- on the applicable line below. Do not complete more than one line in Part I. 1a Form 990 check here ► ® b Total revenue, if any (Form 990, Part Vill, column (A), line 12) 1b 303,597. 2a Form 990-FZ check here ► E71 b Total revenue, if any (Form 990-EZ, line 9) ....... ....................................2b 3a Form 1120-POL check here ■ 0 b Total tax (Form 1120-POL, line 22) _--......... .................... 4a Form 990-PF check here ► b Tax based on investment income (Form 990-PF, Part VI, line 5) 4b 5a Form 8868 check here ► b Balance due (Form 8868, line 3c) ............... 5b 6a Form 990-T check here ► b Total tax (Form 990-T, Part III, line 4) gb 7a Form 4720 check here le Total tax Form 4724 Part III line 1 7b art It DeclaratiPerson on and Signature Authorization of Officer or Subject to Tax Under penalties of perjury, I declare that LX1 I am an officer of the above organization or LJ I am a person subject to tax with respect to (name of orgarvzationt (EIN) and that I have examined a copy of the 2020 electronic return and accompanying schedules and statements, and, to the best of my knowledge and belief, they are true, correct, and complete. I furtherdeclare that the amount in Part I above is the amount shown on the copy of the electronic return. ( consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send the return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the retum or refund, and (c) I h a date of any refund. II applicable, I aulhorim the U.S. Treasury and its designated Financial Agent to initiate an olectronlc funds withdrawal (direct deblt) entry to the financial institution account indicated in the tax preparation software for payment of the federal taxes owed on Oils 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 Inslitutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer Inquirles and resolve issues related to the payment. I have selected a personal identification number (PIN) as my signature for the electfonlC return and, if applicable, the Consent to electronic funds withdrawal. PIN: check one box only ®I authorize Smith Team CPAs, LLP ERO firm name to enter my PIN Enter five numbers, but do not enter all zeros as my signature on the tax year 2020 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my PIN on the return's disclosure consent screen. 0 As an officer or person subject to tax with respect to the organization, 1 will enter my PIN as my signature on the tax year 2020 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a slate agency(les) regulating charities as part of the IRS Fed/State program, I will enter my PIN on the return's disclosure consent screen. olflcer or P050p, r.AJt'*I I Ii'% ERO's EFIN/PIN. Enter your six -digit electronic filing identification number (EFIN) followed by your five -digit self-selected PIN. 89 8 28 6 5 Do not enter all zeros Dale I certify that the above numeric entry is my PIN, which is my signature on the 2020 electronically filed return indicated above. I confirm that I am submitting this return in accordance with the requirements of Pub. 4183, Modernized a -File (MeF) Information for Authorized IRS a -fife Providers for Business Returns. ERO's signature ► Date ► 09/16/21 ERO Must Retain This Form - See Instructions Do Not Submit This Form to the IRS Unless Requested To Do So LHA For Paperwork Reduction Act Notice, see instructions. Form 8879-EO (2020) 023051 11-03-20 13100916 151235 3040 2020.04020 Santa Rosa Plateau Foundati 3040 1 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 41 SCORE 503 SERVICE CORPS OF RETIRED EXECUTIVES' ASSOCIATION C1TV OF TEMECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 Amount Requested: $ 50,000 PROJECT/PROGRAM INFORMATION MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Entrepreneur & Leadership Series Start Date: 1/25/23 End Date: 1/25/24 Physical Address of Project/Program:.26442 Beckman Ct Murrieta, CA 92562 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Service Corps of Retired Executives Association Mailing Address: 3985 University Ave Riverside, CA 92501 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: SCORE 503 Website: www.inlandempi're.score.org Number of Paid Staff: 0 Year Founded: 1964 Social Mediaht[r)s:l/www.fa_cebook.cafn/SCOREIniandEmpire Number of Volunteers: Over 10,000 Nationwide Geographic Area(s) the Organization Serves: Nationwide Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Rick Schoenberg Title/Position: Fundraising Team Lead Contact Person's Direct Telephone: (951) 790-6335Contact Person's Email: richard.schoenberg@scorevolunteer.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 1964 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 52-1067290 State Identification Number: PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: htt ://a sirs. ov/a /eosl 2. ® Attach State Entity Status Letter using this link: https:llwww.ftb.ca, ov/online/self serve entity status letter/index.as 3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool htlp:/lrcl.doj.ca.ctovlVerilicationlWehlSearch.asgx?facility=Y tc:t City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: NA _. Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? 1 No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: NA This Application has been authorized by the organization's: Executive Committee ® Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. SCORE's mission is to foster vibrant small business communities through mentoring and education.We aim to give every person the support they need to thrive as a small business owner. Clients matter Our clients' success is our success. The quality of their experience at SCORE is the truest measure of our success as an organization, Small business matters Small business drives our national economy through business formation, job creation, and wealth building. Small businesses are critical to vibrant communities in our society. https://www.score.org/contenVmission-vision-and-values FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP I FUNDING RECEIVED OR SPONSORSHIP II� 9$ i I OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH +YEAR RECEIVED NAME OF ENITY — FUNDING RECEIVED $22,000 $ 9,000 $ 3,000 $ 4,200 $ 3,000 $ SBA Corona Economic Development Ctr September 2021 August 2022 San Bernardino Economic Development Ctr !August 2022 Lester,Muriel, & Edie Fraser Women Entrepreneur Fund May 2022� Fundraising June 2022 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Entrepreneur and LeaderstNp Series will be tailored specically for Temecula entreprenuers an0 a will Include a series of business workshops, certified mentors, expert panels, tips, resources, checklists templates, cheat sheets, workbooks and expert materials to help Entrepreneurs who have been in business 0 - 3 years navigate starting or Improving a business. This unique workshop enables students to interactively work on the steps to starting or growing their business . Students will collaborate and learn from industry leaders in the following core areas: Start Up Basics, Business Concepts, Marketing, Financial Planning and Funding. Students will participate in cohort projects to solidify their business accumen. The Series is completed with a Pitch Presentation where students can share their elevator pitch with a panel of Judges comprised of community lenders and local businees professionals who will score and provide valuable feedback. Students will have access to exclusive monthly expert business panels. Students will create and/or improve a business plan, marketing plan,elevator pitch, and a budget. Students will also be provided an year long mentorship comprised of a team of expert mentors. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT Start Up Business Training Materials Resource Kit, $100 per participant x 150 participants. = $15,000 Food for 10 Days x 170 people (Parlicpants and Workshop Team) = $10.000 water and light refreshrnants 10 days x 170 people = $2.000 Marketing using social media, text services, alliance marketing = $7.500 5 Specialized Business Related Speaker fee and Materials $2000 each = $10,000 Services total $44,500 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Given the important role small businesses play in the local economy, there is lot riding on the ability of business owners to bounce back from Covid's impact to improve their businesses, grow their businesess and stay in business. The Entrepreneur and Leadership Series will be tailored specically for Temecula entreprenuers and a will include a series of business workshops, certified mentors, expert panels, tips, resources, checklists templates, cheat sheets, workbooks and expert materials to help Entrepreneurs who have been in business 0 - 3 years navigate starting or improving a business. This unique workshop enables students to interactively work on the steps to starting or growing their business . 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 150 Entreprenue FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM; If 84 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS, SCORE Mentors is seeking $44,500 to help Entrepreneurs 0-3 years in business via workshops certified mentor sessions, expert panels, and resources. Small businesses are the backbone of local economy. Our one-year program helps to start and grow businesses stronger in a post covid economy. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Given the important role small businesses play in the local economy, there is lot riding on the ability of business owners to bounce back from Covid's impact to improve their businesses, grow their businesess and stay in business. SCORE Inland Empire partnered with the SSA to respond to Businesses in dire need of assistance during the pandernic by making information regarding EIDL PPP Restaurant Revitalization and Forgiveness readily available to communities in our area. Our service points for this collaboration alone totaled almost 108,000. We are now being asked to help these businesses (a lot in dire need of our services) navigate post covid protocols and business norms this has drastically made our budget swell year over year and we are seeking financial assistance to provide the support our community is asking For. IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM, We serve the Temecula community via webinars and mentoring. These funds will allow us to expand our service offering to include a live in person series of workshops designed to educate and support Entreprenuers in business 0-3 years. In doing so, this bolsters Temecula's econom, through the growth of small businesses. This ensures that we help people in business, we help their families. Then they can pay their bills, keep food on the table, and maybe even hire others. SCORE mentoring and volunteering makes changes exponentially. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE.ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula Community Services Grant (Not to exceed $50,000) $ 44,500 Amount contributed to the Project/Program by the Applicant $ 4,500 Organization Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 33,600 TOTAL REVENUE $ 88,100 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/Insurance $ Supplies $15,000 $ 7,500 Marketing Services $10,000 Food $ 12,000 Other $ Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ 38,100 $ 88,100 TOTAL EXPENSES TOTAL BUDGET $88,100 $88,100 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures,) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Name of Project/Program: 1 FY 2021-2022 Amount of $ CSF Grant Fund Awarded: _ Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on Expenditure E Name of Company Receipt/Invoice 0.0 1 on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose Q E JULY 1, 2021 - JUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE 5 6 EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO Q (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization Is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), summit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. tt c� c ies of cei ts/ nvoic s n the sa r listed in tab[ b w). ar Up ��isiness �raini�ng �aterlaefs �esourcei. $1� per participan?x ?50 participants. _ $15,000 3 ood tp�10 D x 1 �ppeg le�{P rt' s n W rksho Te } _ �8,OQ0 �hd figh%rrM€i �il�ATOO9Able �9% 9Z , Marketing usill� Obi �fr1lf ?�@ k R1s," fti ngrd $Temecula' 5 Specialized Business Related Speaker fee and Materials $2000 each = $10,DOQ Services total $44,500 EXPENDITURE REPORT DATED Organization: TOTAL FY 2022-2023 Amount of Grant Fund Awarded: $ Name of Project/Progr a: Month & Year FIRST $5,000 check was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received & of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) E Name of Company on Receipt or Invoice ro E aZ 2 3 Date on Receipt/Invoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, 2024 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount Description i Purpose EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENUSIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: SCORE MAILING ADDRESS: _ 3985 University Ave PHONE: (951) 790-6335 Riverside, CA 92501 EMAIL: richard.schoenberg@scorevolunteer.org PRESIDENT / AUTHORIZED OFFICER: Richard Schoenberg Fundraising Team Lead PRIN r NAME TITLE SIGNATURE: PAA DATE: 70zZ3 � C9 41lp MONTH, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Cn Q.1 Q O O L a O 07 C-J r- QO O cV Ln Z W M." W 0 IN ofth" 4-0 4 � �r CL CF4 F7 cm L .. raww �p��r7r 4*0 iw 0 STATE OF CALIFORNIA ' FRANCHISE TAX BOARD F T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/20/2022 ESL ID: 5156652186 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 2640987 Entity Name: SERVICE CORPS OF RETIRED EXECUTIVES ASSOCIATION 1. The entity is in good standing with the Franchise Tax Board. 0 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States WATSONRICE LLP 5 PENN PLZ, FL 19 NEW YORK, NY 10001 2124477300 March 14, 2022 Service Corps of Retired Executives Association 1 165 Herndon Parkway, Suite 100 Herndon, VA 20170 Dear Client: Your 2020 Federal Return of Organization Exempt from Income Tax will be electronically filed with the Internal Revenue Service upon receipt of a signed Form 8879-EO - IRS e-file Signature Authorization. No tax is payable with the filing of this return. Please be sure to call us if you have any questions, Sincerely, 6aAzitb &dLalo- Baruti Bediako, CPA I RS Department of the Treasury Internal Revenue Service CINCINNATIOH 45999-0038 a In reply refer to: 0248188029 Oct. 22, 2018 LTR 4168C 52- 1o67290 000000 00 00015646 BODC: TE SERVICE CORPS OF RETIRED EXECUTIVES ASSOCIATION 1175 HERNDON PKWY STE 900 HERNDON VA 20170 01071B Employer ID number:52-1067290 Form 990 required: YES Dear Taxpayer: We're responding to your request dated Oct. 11, 2018, about your tax-exempt status. We issued you a determination letter in July 1976, recognizing you as tax-exempt under Internal Revenue Code (IRC) Section 501 (c) (3). We also show you're not a private foundation as defined under IRc Section 509(a) because you're described in IRC Sections 509(a) (1) and 170(b) (1)(A) (VI). Donors can deduct contributions they make to you as provided in IRC Section 170. You're also qualified to receive tax deductible bequests, legacies, devises, transfers, or gifts under IRC Sections 2055, 2106, and 2522. In the heading of this letter, we indicated whether you must file an annual information return. If you're required to file a return, you must file one of the following by the 15th day of the 5th month after the end of your annual accounting period: - Form 990, Return of Organization Exempt From Income Tax - Form 990EZ, Short Form Return of Organization Exempt From Income Tax Form 990-N, Electronic Notice (e-Postcard) for Tax -Exempt organizations Not Required to File Form 990 or Form 990-EZ - Form 990-PF, Return Of Private Foundation or Section 4947(a)(l ) Trust Treated as Private Foundation According to IRC Section 6033(j) , if you don't file a required annual information return or notice for 3 consecutive years, we'll revoke your tax-exempt status on the due date of the 3rd required return or notice. mation return of notice for's consecutive years, we'll revo ke ra You can get IRS forms or publications you need from our website at www.irs.gov/forms-pubs or by calling 800-TAX-FORM (800-829-3676) . If you have questions, call 877-829-5500 between 8 a.m. and 5 p.m., 0248188029 Oct, 22, 2018 LTR 4168C 0 52-1067290 00000000 00015647 SERVICE CORPS OF RETIRED EXECUTIVES AssoCIAMN 1175 HERNDON PKWY sTE 900 HERNDON VA 20170 local time, Monday through Friday (Alaska and Hawaii follow Pacific time). Thank you for your cooperation. Sincerely yours, Alolluse Kim A. Billups, Operations Manager Accounts Management Operations 1 R::i)AUTFOl A",; FetITn990 J. vIrlal Inv Irnrtir Iris: ri,.,' f;,.•,.:rn ,: ':r:, _i•:r• Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) ► Do not enter social saeurity numbers on this form as it may be made public, ► Go to www.lrs.gov1Fornj990 for instructions and the latest information. A_ For the 2020 calendar year, or tax B ci rt- it zpL,r, bl : C ning 10/01 , 2020, and ending 9/30 ^,L,,.,,ot•,u+,tr SERVICE CORPS OF RETIRED EXECUTIVES Ilyr: LIwr.ry, ASSOCIATION I dI r,l rr,;,,.+, 1165 HERNDON PARKWAY, SUITE 100 HERNDON, VA 20170 • .1 i ,. F Marne ano address of principal officor: BRIDGEI WESTON SAME AS C ABOVE I Idx-eaeml:t slalfis: X 501 60) 501te) ( )' (insert no.) 4947(a)(1) of OM13 No. 1545 Ud47 2020 Open to Public Inspection 20 2021 0 Employer idenlification number 52-1067290 r T,.Whcme number (l 634-0245 G Gross recoipts $ 15 H(a) Is this a group retun for suhordinate: FI(b) Arc all subordinates included? If "No," atlach a list, See Inslrur.,;ions 4 5P 129. Yes No Yes P No j_ Website: ► WWW. SCORE. ORG — H(c) Group exerriow nwnbel K I wm of nrganiza!fon: Ll Colooraliun Trust )(Association11 Other" L Year of formation: 1964 M State of legal domicile', DC Par# — i Summary 1 13rieTly describe the organixatlolis mission or most significant activllies:PROV-10E -f FREE AND SMALL '3US:I Nf7, DUNSELING i'QR ENTREPRENEURS—NATIpN� TDE _CONFIDENTIAL U-------------------------------------- --------------------------- --------------------------------------------------------------- CID 2 ------------- — — — — —— ------------------------------- Yheck this box ► if the organization discontinued its operations or disposed of C more than 25% of its net assets. — (s 3 Number of voting mc:nlbors of the governing body (Part VI, line 1 a) ..... .. . . . ........................ 3 1.7 `6 ).- 4 Nun;ber of independent voting members of the governing body (Part VI, 'line 1 b)....... ....... ... 4 li -Y 5 olal number of individuals employed in calendar year 2020 (Part V, line 2a) . . - - .... - .... . ........... 5 49 6 total m.irnber of voluntocrs (estimate if necessary)........... . ....... .. .. ... ... .. 6 14 032 a 7a lot d :mrelated business revenue frorn Part VIII, ",olul (C), line 12. ... ........ 7a Q, b N-c-1. unrelated business iaxahle income frol?n Form 990-T, Part I, line 1 I - - - - - - - - - - ---- —� , , ............ 7b Q , Prior Year Current Year N 8 Contributions and grants (Part Vill, line Ih)...... ......................... ........ 131`726 915. 14,222., 619• 73 9 Program service revenue (Part VIII, line 2g) .......... ............................. 1,320,442. 11, 161, 776. > 10 investment income (Part All, column (A), lines 3, 4, and 7d) ....... . .......... . . .. . . 50. 11 Other revenue (Part VIII, column (A), lines 5, 1 8c, 9c, 10c, and 11e)......... ...... 715 255. 312, 159. 12 Tic i revenue — add lines 8 througll 11 (must equal Part VIII, column (A), line 12)..... 15, 762, 662. 15,696, 554, 13 Grai is anti similar amounts paid (Part IX, column (A), lines 1-3)........ . . . . . . ... .. . 14 Benefits paid to or for rric nbers (Part IX, column (A), line 4), , ,,. , , , , , , ....... ..... a 15 Si:ilitlries, other compensation, employee benefits (Part IX, column (A), lines 5-10),.... 3,740 909. 9 637 895, 16 a f'rbfessinn l fundraising fees (Part IX, column (A), line 1 le) ... . . .... .. . .. . . . Cb Iota! fundraising expenses (Part IX, column (D), line 25) ► 11 298 734. 101 715 485. 17 Other expenses (Part IX, column (A), lines lla-11d,]If-24e)......................... 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25)-............ 15, 039, 643, 15 353, 380. 19 — Revenue less expenses. Subtract line 18 from line 12................................ -- 723 019. 343 174, 20 4lctal X, Beginning of Current Year End of Year 10, 052,562. 10 399, 530. yJ assets (Part line 16) . .............. . ............................. .... 21 'Folal liabilities (Part X. line 26). .. .... .... .. ... .......... ........... .... ..... 1, 450,763. 1 454, 557, z? 22 Net assets or fund baianccs. Subtract line 21 frorn line 20 .. .. .......... . . ..... 8, 601, 799. 8 944 973, Part II — Signature Bioek Jnrcr of pe:Wry, I c2dore 'hat'? have examined 'his return, i❑cludirig ❑ccompa(Virig schedules Intl slat�nntnls, and to the hest of my knavlerlge and b�.lief, it •:ornp!eie Dsclarolisn of meparor (ether thai officer) Is based on ale inf::,mation o.r wliicl, prepamr has any know1cdoa. is rote, corer [• and —� Sign rI 61 ulkelf onto Here BLUDGET WESTON CEO ?rinU'ype Pm:paror'S name Pmpnryr's sianahue Gut. Check ILI if P rIN Paid BARU'1'I BEDIAKO CPA BARUTI BEDIAKO, CPA 3/14/22 sclfemployed P00790658 Preparer rifni, r,ar ,. ► WATSONRICE LLP Use Only ,addr<=;; 5 PENN PLZ, FL 19 Firm'sEIN ► 26-1726741 _ NEW YORK NY 10001 Phooeno• 2124477300 ( My the IRS discuss this return with the preparer shown above? See instructions . . ............. ....................... JXJ Yes I I No BAA For Paperwork Reduction Act Notice, see the separate instructions. uE-Aaloll- 01119,121 Form 990 (2020) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 42 SKYROCKET PEDIATRIC THERAPY FOUNDATION CITY OF TEMECUI[A FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Pediatric Development Outreach Program Start Date: 1/1/2023 End Date. 12/31/2023 Physical Address of Project/Program: various preschools, schools da cares childcare community event locations INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Skyrocket Pediatric Therapy Foundation Mailing Address: 43406 Calle Carabana Temecula CA 92592 I ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Skyrocket Pediatric Therapy Foundation Year Founded: August 2021 Website: www.sk rocketthera .or Social Media: ht_tps:llwww.ins(ggram.comiskyrockettherapvl Number of Paid Staff: Number of Volunteers: Geographic Area(s) the Organization Serves: Southern California Geographic Area(s) the Proiect/Propram Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Rachel Troccoli Title/Position: Founder & Executive Director Contact Person's Direct Telephone: (949) 350-4053 _ Contact Person's Email: rachel a@skvra_cketlherapy_or�L_ NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 2/9/2022 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 87-2744121 State Identification Number: 4773558 PRINT UT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. Attach IRS Deductibility Status using this link: http://agps.irs.goy/appleos/ 2. Attach State Entity Status Letter using this link: hUps://www.ftb.ca,gov/online/self serve entity status letter/index.as 3. Eh Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt :1 r t.do'.ca. ov/Verificati nlWeb/Search.as x?fa ill =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 I APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES, Skyrocket Pediatric Therapy Foundation (Skyrocket) is a 100% volunteer run organization that supports children with developmental disabilities and their families to help them gain access to essential developmental therapies that will improve functional life skills and enable greater participation in their social, academic, and community environments. The mission of Skyrocket it to support pediatric therapy clinics, including those providing speech -language therapy, occupational therapy, and physical therapy, through the provision of free educational opportunities and through building collaborative relationships in the community that will improve access to developmental services to children and families in need. We are committed to providing no -cost assistance to families in Temecula by: 1) providing information about typical and atypical development; 2) facilitating community outreach; 3) providing information about services available in the community; 3) assisting families in obtaining services; 4) assisting families in accessing funding for services; 5) providing case management to families to coordinate services and ensure collaboration; 6) creating community events for the families to be able to participate and foster relationships with other families with special needs. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. MONTH + YEAR NAME OF CITY FUNDED BYITHEOCITY GRANT OR SOPONSORSHIP + AMOUNT j FUNDING RECEIVED OR SPONSORSHIP w OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR NAME OF ENITY RECEIVED FUNDING RECEIVED T City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Pediatric Development Outreach Program sponsors social media content, free digital materials. printed materials, attendance to community events, and organized in-service events for Temecula area families, daycares, preschools, elementary schools, and healthcare providers. The information shared on social media and printed material support knowledge of developmental milestones, red flags for developmental delay, how to encourage development of communication, motor, feeding, and sensory skills, and the process for accessing and funding services for children. In -services are provided to increase the knowledge of those who work with young children regarding developmental milestones, signs of delay, and services available in the community. Local family events will be attended to help spread this information as well. We want to increase community and caregiver capacities including knowledge, skills, and resources to identify children who may have a developmental delay and who may benefit from developmental services as early as possible and ensure families are utilizing services already available in the community. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Skyrocket will use the grant funding to promote and expand the reach of the current outreach program. Funding will be used for professional design and printing services for both promotional and educational materials (brochures, flyers, signs, etc) to be provided directly to families and service providers at community events and educational in -services. Skyrocket will use grant funding to better utilize search engine optimization and targeted advertising on social and traditional media platforms to further expand reach within the Temecula community. To meet the increased interest and demand for events, Skyrocket will use grant funding to increase current educational in-service capacity to 2 free in-service events per month (24 total throughout the year). Grant funding will be used to purchase equipment and supplies needed to conduct the educational in-service presentations, as well as the cost of consultation services provided by a Speech -Language Pathologist, Occupational Therapist, Physical Therapist and Licensed Marriage & Family Therapist. Examples of these services include the development and review of educational materials, assessment tools, educational resentations, and instructional support presentations within the community. Please see attached list. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Fhis program will potentially benefit all Temecula residents with children 0-5 years old and even older More than half of California families report not receiving screenings for their children under three years old. More than two-thirds of California children who receive services start AFTER they turn three, missing out on crucial early intervention. Over 75% of families receiving services DO NOT get assistance arranging and coordinating the services. Early intervention is crucial to improving lifelong social, academic, and career outcomes for people with disabilities, but it is not being utilized as much as it could. This program will increase the capacity of families, childcare providers, teachers, and healthcare providers to identify children as early as possible who may benefit from developmental services and give them information about how to receive and fund services. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c 25,000+ families ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 110 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 14 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. This program supports all families with children and pediatric service providers in Temecula by increasing their knowledge about development, existing community resources and developmental services, and the process for accessing services. Grant funding will support the continued provision of free educational materials, free in-service events, and community events. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Skyrocket was incorporated in August 2021, so fortunately we were not impacted by COVID-19. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. This grant will allow Skyrocket to expand the current capacity and reach of our Pediatric Developmental Outreach Program. Since its inception in June of 2022, the Pediatric Outreach Program has been met by high demand, which is beyond the current capacity of our volunteers. Grant funding would allow for the expansion of the current program to meet the growing demand and to support the needs of the Temecula community. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM 1 REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 40,383 Organization Other grants or funding already awarded for Project/Program, if any $ 2,500 In -Kind match amount or volunteer credit hours estimated amount $ 0 TOTAL REVENUE $ 92,883 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET I $ 92,883 EXPENSES $ 5,708 $ 660 $ 46,754 $ 7,361 $ 32,400 0 �$ 0 $ 92,883 T_$92,883 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Skyrocket Pediatric Therapy Foundation MAILING ADDRESS: 43406 Calle Carabana Temecula CA 92592 PHONE: (-a ) 475-7O02 EMAIL: info[a)skyrockettherapy.org PRESIDENT / AUTHORIZED OFF R: _Rachel Troccoli President / Executive Director J FRIPIT N IP E TIT! F SIGNATURE: ' DATE: t 1 �r M,��?IdTH [aAY.'lFA,R IF DIFFERENTT AN ABOVE APPICATION PREPARED BY: PRIPIT NAM,' SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Skyrocket Pediatric Therapy Foundation Pediatric Development Outreach Program Goods, Equipment, Services to be Purchased Services Speech -Language Pathologist Educational Presentation Occuptaional Therapist Educational Presentation Licensed Marriage and Family Therapist Presentation EQUIpment Dedicated Computer (Microsoft Surface Pro) Printer (HP LaserJet) Projector (Kodak Luma 350) Projector Remote (DinoFire) Projector Case Projector Tripod External Battery Pack HDMI Cables Laptop Travel Case Lavalier Microphone system (Tarion) Portable Screen Supplies Milestone Booklet Design Milestone Booklet Printing/ 250 Speech -Language Teacher Resources Design Speech -Language Teacher Resource Printing 150 Sensory -Motor Teacher Resources Design Sensory -Motor Teacher Resource Printing / 50 Toner Cartridges Paper Ream Marketim Marketing Consultation Promotional Products Insurance Liability Insurance Per Unit Cost Number Required Year Total 450 / 3 hours 24.00 $ 10,800 450 13 hours 24.00 $ 10,800 450 / 3 hours 24.00 $ 10,800 Services Total $ 32,400 1349.99 3.00 $ 4,050 489,99 1.00 $ 490 299,99 1 $ 300 15.99 1 $ 16 19.99 1 $ 20 29.99 1 $ 30 349.99 1 $ 350 19.99 1 $ 20 54.99 3 $ 165 89.99 2 $ 180 86.99 1 $ 87 Equipment Total $ 5,708 4500 1 $ 4,500 836 / 250 36 $ 30,096 3500 1 $ 3,500 46.80 / 50 24 $ 1,123 3500 1 $ 3,500 46.80 / 50 24 $ 1,123 228.64 12 $ 2,744 6.99 24 $ 168 Supplies Total $ 46,754 2500.00 1.00 $ 2,500 9.72 500 $ 4,861 Marketing Total $ 7,361 660 / year 1.00 $ 660 Expenses Total $ 92,683 Department of the Treasury Date: Internal Revenue Service 02108/2022 Tax Exempt and Government Entities 1�]Q P.O. Box 2508 Employer ID number: .1Q Cincinnati, OH 45201 87-2744121 Person to contact: Name: Customer Service ID number: 31954 Telephone: 877-829-5500 SKYROCKET PEDIATRIC THERAPY FOUNDATION Accounting period ending: 43406 CALLE CARABANA December 31 TEMECULA, CA 92592 Public charity status: 170(b)(1)(A)(vi) Form 9901990-EZ 1990-N required: Yes Effective date of exemption: August 04, 2021 Contribution deductibility: Yes Addendum applies: No DLN: 26053716002031 Dear Applicant: We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Sincerely, 11- t a.. otx-� Stephen A. Martin Director, Exempt Organizations Rulings and Agreements Letter 947 (Rev. 2-2020) Catalog Number 35152P Q HELPB MENU Home > Tax Exempt Organization Search > Skyrocket Pediatric Therapy Foundation Skyrocket Pediatric Therapy Foundation EIN: 87-2744121 1 Temecula, CA, United States Determination Letter o A favorable determination letter is issued by the IRS if an organization meets the requirements for tax-exempt status under the Code section the organization applied. Final Letters • FinalLetter 87-2744121 -S-KYROCKETPED18TRICTHERAPYFOUNDATION1 0 2 if Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Form 990-N (e-Postcard) o Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. Tax Year 2021 Form 990-N (e-Postcard) Tax Period: 2021 (01/01/2021 - 12/31/2021) EIN: 87-2744121 Legal Name (Doing Business as): Skyrocket Pediatric Therapy Foundation Mailing Address: 43406 Calle Carabana Temecula, CA 92592 United States Principal Officer's Name and Address: Rachel Troccoli 43406 Calle Carabana Temecula, CA 92592 United States Gross receipts not greater than: $50,000 Organization has terminated: No Website URL: www.skyrockettherapy.org Page Last Reviewed or Updated: 20-November-2020 f* Share 9 Print STATE OF CALIFORNIA FRANCHISE TAX BOARD tB)PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 10/12/2022 ESL ID: 5217483050 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 4773558 Entity Name: SKYROCKET PEDIATRIC THERAPY FOUNDATION 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of reviver may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States STATE OF CALIFORNIA 7 B FRANCHISE TAX BOARD PO Box 1286 Rancho Cordova CA 95741-1286 SKYROCKET PEDIATRIC THERAPY FOUNDATION ATTN: RAC H EL TROCCO LI 43406 CALLE CARABANA TEMECULA CA 92592 Regarding: _ Organization's Name: CCN: Purpose: R&TC Section: Form of Organization: Accounting Period Ending: Tax -Exempt Status Effective: Date: 09.08.2022 Case: 26560798970699610 Case Unit: 26560798970699613 In reply refer to: 760:DG:F120 Tax -Exempt Status SKYROCKET PEDIATRIC THERAPY FOUNDATION 4773558 Charitable 23701d Incorporated 12/31 08/04/2021 Exempt Acknowledgement Letter We have received your federal determination letter and Form 3500A, Submission of Exemption Request, and have approved your request for California Tax-exempt status. Under California law, Revenue and Taxation Code (R&TC) Section 23701 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. Generally, the effective date of an organization's California tax-exempt status is the same date as the federal tax-exempt status. To retain tax-exempt status, the organization must be organized and operating for nonprofit purposes within the provisions of the above R&TC section. An inactive organization is not entitled to tax-exempt status. In order for us to determine any effect on the tax-exempt status, the organization must immediately report to us any change in: • Operation • Character ■ Purpose ■ Name • Address FT6 9944 PASS (REV 08-2018) Exempt Application\Correspondence \LTR 001- EAL 2of2 For filing requirements, refer to FTB Pub.1068, Exempt Organizations - Filing Requirements and Filing Fees. Go to ftb.ca.gov and search for 1068. All California public benefit corporations must register with the California Attorney General's Office Registry of Charitable Trusts within 30 days of first receiving any assets. The Attorney General regulates charities and the professional fundraisers who solicit on their behalf. The purpose of this oversight is to protect charitable assets for their intended use and ensure that the charitable donations contributed by Californians are not misapplied and squandered through fraud or other means. Please refer to oag.ca.gov/Charities for further information on registration requirements and contact information. Also see the publication Attorney General's Guide for Charities. This exemption is for state franchise or income tax purposes only. For information regarding sales tax exemption, contact the California Department of Tax and Fee Administration at 800.400.7115 or go to their website at cdtfa.ca.gov. Daniel Galeazzi Telephone: 916.845.4171 Fax: 916.364.2791 FTB 9944 PASS (REV 08-2018) Exempt Application \Correspondence \LTR 001- EAL LO 00 Q c N ° a r LO r N Z N d � a � O W 7 OZ Li N ly 07 u 6 V O � � PPP L � `p N o d "? u CD LL 0 00 00+ 7 A Sk1 N en rn L D O C o o m d tj e y =J a A 12 .0 o C LC gC = u v �� •C M C) co aai di iJJ N •cC0 Q cG 0) eA E N N m `A z p d H m Z A H Q C� LL LL c E 'i7 nl A y� V w � � o 0 O L Ln (A W O LO m c OIL �- U) y y G >_ p C al Wp C LL U ~ LL n= a co D �7 w m 0 0 4) ry rti N c N 'C: a 4) ❑1 ro a Edi m a, TL ❑ ro ❑ N � •t C3 E Q W Y N N 111 7, lD tll > 7 a E O i� C En � Q > � •U � Y rA+ E E U CL �' w .� E N Q ro 4) O C L0,1 j C ro N Cs C $ nr A O U) ph Z A SU C a C & N 4 4f f E E ro CL N C D D yO N �+ ro c m C<+ m O 0 _ =J C0 T �� m p w as 43 UI n 3 V3 N rn v C V ❑ - �C 4f a o E c 4) `E' 'O z ro O 4 4 m U W CS) Vi C [i O D 'D C N C Q U N V 10 L U C .Q c� b E? a! 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FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 43 SMILES BY ANGELS FOUNDATION E s— m 'rr ?02� CITY OF TEMECULA � o Ur FISCAL YEAR 2022 - 2023 U COMMUNITY SERVICE FUNDING - REINVESTMENT IN c1 PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 Project/Program Title: Temecula - Smiles Physical Address of Project/Program: MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Start Date: 12/22 End Date: 12/23 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Smiles by Angels Foundation Mailing Address: 42248 Via Nortada Temecula, CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Smiles by Angels Organization: Foundation Website: in development Number of Paid Staff. 0 Year Founded: 2019 Social Media: Facebook: Smiles by Angels Number of Volunteers: 20+ Geographic Area(s) the Organization Serves: Riverside, LA and OC counties Geographic Area(s) the Proect/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Corine Peralta Title/Position: Executive Director Contact Person's Direct Telephone:7143282883 Contact Person's Email: corinekperalta@gmail.c NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 6/2019 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 841991401 State Identification Number: 4287742 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑■ Attach IRS Deductibility Status using this link: htt ://a s.irs. oVIa /eOS/ 2. (1 Attach State Entity Status Letter using this link: https://www.ftb.ca.qov/onlino/self serve entity status letter/index.as 3. 9 Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt:/Irci.doi.ca. ovfVerification/Web/Search.as x?facilit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No Do Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No X Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee 0 Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The purpose of this corporation is to empower communities and organizations to inspire hope, strength, and joy to disadvantaged and underserved children. We aim to increase support, social impact, and economic justice through empowering people and communities across our society. We will provide these services for disadvantaged, low income, neglected, delinquent, and maladjusted youths in our community. Our mission is to create and implement positive teaching methods that educates, informs, and inspires young minds. Our goal is to create program initiatives that support " at -risk " children and youths by creating positive structures in their lives that will ultimately help promote civic responsibility in the future. These educational methods will be used within our care, counseling, and mentoring programs. With encouraging lessons of good citizenship, personal accountability, and self-esteem, the foundation believes that these are essential qualities for children and youths to develop in order to live a productive, self-sufficient, happy and fullfilling life. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No R Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT MONTH + YEAR NAME OF CITY GRANT AMOUNT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP i I I I OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO ! Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Temecula grant funding will provide us the means to continue, strengthen and expand our relationships with the following Temecula organizations and prioritized communities: OakGrove, Temecula Public Schools, Koinonia Family Services, Brandywood Foundation, Temecula youth of disadvantaged families, foster care, USA armed forces youth, all at -risk Temecula youth and new community outreach programs by providing new books, clothing, food, literacy based entertainment and at risk mentoring and internship programs. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT Funding will be spent on continuing and expanding our book/literacy program within Temecula (planning on buying approximately 10,000 books focused on skill development, community enhancement, self-improvement, diversity, among other topics). Clothing, food and entertainment for our disadvantaged and at risk students. The expansion of internships, mentors, curriculum and tutors. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. This will offer the community a long-lasting service by teaching children valuable lessons that encourage them to be respected pillars in society. Our program will help develop life management, social skills, and increase literacy for low-income individuals that are underserved, handicapped, underprivileged, disenfranchised and disadvantaged. Our program gives underprivileged youths in our community a safe haven to express their feelings while also learning positive lessons in life. We will host events in the community that assist parents with teaching them these valuable social, emotional, and educational skills.The target group will comprise of children and youths to help to combat illiteracy, poverty, violence, and 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3C ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: rrn 50,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. We moved to Temecula in October 2 221, and we have brought our already successful programs from LA. Now that we have found our new here in Temecula, we are eager to lay roots and expand our involvement with our new community to make a difference. Our work will demonstrate that youth and parents working together are a powerful force for improving our communities and making real change. We will provide opportunities and resources to underprivileged youths to keep them off the street, promote higher education, develop creativity and provide the tools for children to be afforded with the means 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. We started our foundation in Los Angeles in 2019 but moved to Temecula in October 2021. Covid-19 has impacted our ability to raise funds through events and other type of campaings; and certainly inflation has limited the cash flow available from our supporting families and organizations to keep contributing to our different programs. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The funds from this grant will help us create new programs and partnerships with local organizations, as well as expand our already succesful partnerships with the aforementioned local organizations that we have ongoing efforts and programs. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES f EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 10000 Organization Other grants or funding already awarded for Project/Program, if any $ In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 60000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment miscelanious equipment to support events $ 1000 Facilities/Rent/Insurance $ Supplies Books and other supplies to support programs and events $ 50000 Marketing $ Services Various services from third -party vendors $3000 Food Food for kids while participating in events $ 3000 Other variable expenses due to programs and events requirements $ ,3000 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ HOWEVER PLEASE INCLUDE, $60000 TOTAL EXPENSES TOTAL BUDGET $60000 $60000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. ■ Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. /we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Smiles by Angels Foundation MAILING ADDRESS: lrr-' Via NOrtada PHONE: (714 ) 32H2HH3 Temecula, CA 92590 EMAIL: corinekperalta@gmail.com PRESIDENT/AUTHORIZED OFFICER: Luis Peralta - P esident PRINT NAME ZtIT SIGNATURE: _ - DATE: MONTH, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PRINT NAME SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 r H u x E y w.+ HH py y y N 'A' ,qyN Q y y �.nI wq 41i 10, O �C W W .q{ p� 'cl N G y Z Ul A W k b 8' O C J w N N Ti w Hdu oa ori aC�V1ll W,u W ui W Jp rl •m.1 +oW° rod NroGuOi •p, Jgi�� a oP. � ~ oa u�uQ! W"/y0�J1 u5a'nYq; roNq LW •a�.drms+i •WN �hrl -�q' A � o awuw .1-1 '" H 'O dnNHY3Oa1GS H� ar7i N C. N N Ol N yl aE N fs T N it �tl d H H O N ,py UUUU m •.�i 7 fi •n u K7 m u O 4i .-1 ,ypl V w O rl ut �tl U al 7 dl U b m N •.1d H b U st y Y1 1' W � .q •.a ,q qy [ 1y} �y ri U y� L o0 Q N u U U W U A 7 ul U i+ 4,4 rj 0 ',N 'U "Si p [l�I 1 H .1�� W 0.' W w W U R N LIG ] V Y ti7��� 0p1 Y W Y i F y si 1g} [. 1.1 q3 p1 y� y�1 if U 11 I� Sqy� ♦. Y 4 4 W 'O 7. E IO i ri N H F ly N ds ii it 77731 QUi aw N q 3 kG N rt m W 0 1 b 9 rS •w A. 41n T CV pp, ,4 L .4 yi ."i fl it u m Y rd ii rl FF p'. 3a f. H yy Q I! per, W bl ]y Q U 71 Q 4� •pC E O W ^j�C � �(I�, Y pa O o o p V V M N O u D 3lu YI lu O p a �•i ip }. LLL777 �l V X ro N un C= � °O vaw� L C�1 ro c .Y1 uY 1 V q p is F W ro .i [i p ry ao W N W F yC �4l yy� N L u x N y �U C 1 to doa N O 00 O rU� Itl DIY f. +J N 7 m r! f(11 itl! IT.87. L E1 rqP •.Ui i7 'n p' W 1 H y' �' W P. ! se Ul a m N n it .i L ++ +1 14 .n N ry •ty m O ry m ,� �ru al p� 1. o w V c u N au a rAUofie"i �aafup Hai u�o�'i x wro � N O N N U � q Lei .-I m a a a f• '� Secretary of State ._ Certificate of Status I, SHIRLEY N. WEBER, Ph.D., Secretary of State of the State of California, hereby certify: Entity Name: SMILES BYANGELS FOUNDATION File Number: C4287742 Registration Date: 06/11/2019 Entlty Type: DOMESTIC NONPROFIT CORPORATION Jurisdiction: CALIFORNIA Status: ACTIVE (GOOD STANDING) As of March 18, 2021 (Certification Date), the entity is authorized to exercise all of its powers, rights and privileges in California. This certificate relates to the status of the entity on the Secretary of State's records as of the Certification Date and does not reflect documents that are pending review or other events that may affect status. No information is available from this office regarding the financial condition, status of licenses, if any, business activities or practices of the entity. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of March 19, 2021. SHIRLEY N. WEBER, Ph.D. Secretary of State Certificate Verification Number: YWM4XJZ To verify the issuance of this Certificate, use the Certificate Verification Number above with the Secretary of State Certification Verification Search available at bebizfile.sos.ca.gov/certifrcationfindex. U') O N O z CO O W Z N d N ,p N Q7 T X m O c`a 2 0 m L' C a� ro a� a� a 0 Q E w 0 mQ0 w r y W m v U) w m� C — E _R C3'— N 7 E� > o a a E 'o v CL a c - N ❑ Q] ❑ o V t .� u C u U Y N _ (Q w r � U 0 U : C ti O O aMx � � w C'n C a� a� _ E ro E N 0 4 C O JC L O CL E G d o r C m N N❑ cm rn E m` p a C) a m 04 C 0 L)�p`f E y �� �_pE Z a H O❑ R 7 °to N 0 o n 5 T V =f N Ok N T3 O E 7 c m Z��r E �. u � gyp ~ O tj ^ta Q C '0 0 C .O � VV O Q7 y L ❑ 7 O E d T. r.! w`co ❑ ❑ W d W p � � m cn � E > y C m o a.d 7T D_ c UO o N o ❑— vrnz a, c dr m o� ❑ � me � . Ln E u E Ctq m C y E u °' q° O7 V' E F- m m a c E uo . o is E n' 7 Ln 9/8/22, 12:39 PM Details HOME ABOUT MEDIA REGULATIONS RESOURCES PROGRAMS CONTACT ��yy Registrant Registrant Details Entity type: Corporate Class as registered with the Secretary of State or based on founding & registration documents, Organization Name: SMILES BY ANGELS FOUNDATION IRS FEIN: Entity Type: Public Benefit SOS/FTB Corporate/Organization Number: 841991401 4287742 Registry Status: RCT Registration Number: Record Type: :Date of Last Renewal: Current Renewal Due/Exp. Date: CT0280096 Issue Date: Charity Registration Effective Date: DBA: 5/15/2023 7/8/2022 7/8/2022 Mailing Address I`^�ddress Street: Street Line 2: City, State Zip: 42248 VIA NORTADA TEMECULA CA 92590 Flilrigs & Correspondence ;Fm,g Documents Click on Document Type at the left to open PDF Farm RRF-1 2019 Renewal Filing 2020 Renewal Filing 2021 Q -451 C ISt Click on Document Type at the left to open PDF Atinual Renewal Data Status of Filing: Accounting Period Begin Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT TR 1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Accepted 1/1/2019 12/31/2019 7/25/2022 Status of Filing: Accepted Accounting Period Begin Date: l/l/2020 Accounting Period End Date: 12/31/2020 Filing Received Date: 7/25/2022 Form RRF-1 Rejectllncomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: 1/1/2021 Accounting Period End Date: 12/31/2021 Filing Received Date: 7/25/2022 Form RRF-1 Reject/Incomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: https://ret.doj.ca.govNedficaUon/Web/Detalls.aspx?result=e76dbecc-23eb-46fc-9dcb-ol b828sca613 1/2 . 9/8122,12:39 PM From Registry Staff - Detalls Rek to i trati - ., -s , �- - vex rat Reports I lie. slated records shown bUIwvv delpend f)FI Ji, record type being viewed: Charity Registrations ,elate to Piorr�ssjoral 17 Lincr alslI n( t-vercs which relat(, to Professional Fundraiser Registrations. RaffIr Registrations relate to Raffle Click,nin, tho RCT Registratimi Klt* to nevfgace to the related record, No Related Records https:Hrct.doj.ca.govIVerificationAlVablDetails.aspx?result--976dbecc-23ob-48fc-9deb-el b8289m613 2/2 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 44 SOUTHWEST WOMEN"S CHORUS CrrY DF TE3MCUI1A FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING w REINVESTMENT IN TEMECUL,A PROGRAM APPLICATION (Please Prtnt or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ _5000.00 MAXIMUM ALLOWABLE: $60,000 PER ORGANIZATION Project/Program Title: Emi—aain41 Young Women -Find Your Vokm Throu Start Date: 05/06/23 _ End Date: ON7r23 Sonfl Physical Address of Project/Program: 325M Deer Hollow way, Temecula, CA 92592 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: ,_ „y0KrQmen's cnon,e Mailing Address: alias Engeirnann Oak St [ ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: southwest wemen'a chorus Year Founded: goo Webslte: _hJa.112 ulhwesWormnacherue.org -_—Social Media: r Number of Paid Staff: Number of Volunteers: as Geographic Area(s) the O aeon Serves: Temecula, Murdete, wMdanw. Lake EI61nme, Hemet Geographic Area(s) the grojoct/Prograin Serves: Temewle NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE l=) Cc lj ULU USED TO SERVE TEMECULA. Contact Name: Darlene (DoOy) Nldrerson Title/Position: Preeldent Contact Person's Direct Telephone: 76o-7+e-2319 . Contact Person's Emall: pmsldent@mdlivioutwormnschorus.org NONPROFIT STATUS Is this organization Incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number 20-1694150 State Identification Number. 267M2 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: Nip: lapps.irs.c�ov/aDpleasl 2. L�Attach State Entity Status Letter using this link; hops://www,fti).ca.(Iou1 x1linelself serve entity statics letterlindex.asl� 3. O'Attach first page only of most recent IRS Form 990 g_r attach print out of detailed info about your charity found on this State Registry's Search Tool: w llrci.(JoLr ;�.1.aylV0riff(;aZiojVWub/Searr(a, as.1Lx 1ai;iIitvY City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been Involved with any personal business transactions valued over $500 including any business transactions, negotiations, Investments, or interests in real property with a Temecula City Council Member during the past 12 months? No Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The Southwest Women's Chorus provides women who love to sing with the experience of performing quality choral music while empowering them through artistic growth, camaraderie and community Involvement. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE MME PRQJECTIPROGRAM IN THIS APPLICATION? NO ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT RECEIVED NAME OF ENITY MONTH +YEAR FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECTIPROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. "Empowering Young Women - Find Your Voice through Song", Community event. A one day seminar for female singers ages 12-18 on May 6th (middle and high school students) will be held to encourage female singers' participation in organized singing groups In middle school, high school, and beyond. A one day seminar taught by the Southwest Women's Chorus members and director Including curriculum such as warm up exercises, how to practice and learn a musical number, performance techniques, and teamwork with other performers will be taught. Three songs will be learned during the seminar culminating In a performance with the Southwest Women's Chorus at the Old Town Temecula Theater on May 7, 2022. The event is meant to show how a love of singing can benefit young women during their middle and high school career and how they can benefit their communities after graduation. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAWPROJECT. Southwest Women's Chorus will use the funds for the following items: ■ Rental of seminar Venue • Sheet Music 4 Meals for Participants (breakfast and lunch) o T-Shirts for performance • Accompanist a Miscellaneous Office Supplies (TBD) Publicity for Event 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. There are approximately 20 middle schools, high schools, and charter schools located in Temecula. In addition, there are home schooled young women who do not have access to in -school vocal music programs. Southwest Women's Chorus will publicize the event to all young women ages 12-18 in the Temecula area to show the benefit and joy of singing music In a group setting. If awarded the grant, we will offer this seminar only to Temecula School District students and Temecula residents. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 30-50 20-30 City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. The "Empowering Young Women- Find your Voice through Song" event will teach the joy and benefit of singing with others in a group setting. This will be accomplished by teaching three songs with the Southwest Women's Chorus, culminating In a performance at the Old Town Temecula Community Theater. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Not Applicable 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECTIPROGRAM, AND/OR (3) gONTINUE EXISTING PROJECT/PROGRAM. Not Applicable City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill In shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 5,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 1,500 Organization Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 0 TOTAL REVENUE $ 6,500 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/Insurance $ 1500 Supplies $ 750 Marketing $ 750 Services $ 500 Food $ 750 Other Music, T-Shirts, Office Supplies, Name tags $ 750 Staffing Expense:]- THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ $ 1500 6,500 TOTAL EXPENSES TOTAL BUDGET $ $ 6,500 City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 110 of 113 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT *IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant In FY 2021-2022 (last year) by the City of Temecula, please submit this Information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substentiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up Information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receiptsiinvoices, must be submitted to the City on or before due data: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of recelpts/invoices (in the same order as listed in this table.) r 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF f EXPENDITURE REPORT due on or before September 12, 2022 Organization: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Name of Project/Program., Month & Year CSF Grant Received from City: _ __ Number of Beneficiaries Llving in 92590, 92591, 92592 that Directly Benefitted from this ProgramlProject (approximate number of beneflclarlos If you do not have precise number): - Date on Exoenditure Name of Company Recelptllnvoice on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose DULY 1, 2021- JUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE z 1 2 3 4 5 6 EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT Nyour organization Is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant In FY2022-2023 by the Ci of Temecula follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent, If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation Including the table below with aco❑mpa%ing receipWrivolces, must be submitted to the City as outlined on this page. 1. FIII out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. N awarded $5,000. Submit the f❑tivwing Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [it you were awarded lass than $5,000, submit Expenditure Report for that amount.) 13. if awarded grant funds exceeding $5,000. A) Follow #1A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of recelpts/involces (In the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment In Temecula" EXPENDITURE REPORT DATED Organization: Name of Project/Program: TOTAL FY 2022.2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is thIa Expandtture Rsport fa to provide docurnentatlon for flrat $5,000 awarded and raoalvsd7 Yes or No (already aubmitted). 2. My orpanlratlan firs 0nwKly nmolved i of ttw total FY 2022-23 Orard Fund rrwarcded by the City 3. Is this Expenditure Report is aubmitted to request ralmburaement of funds? No or Yfas If yes, Amount of Requeat>i Number of beneficiaries living In 92590, 92591, 92592 that directly bensfltted from this Program/Project (approximate number of beneficiaries N you do not have precise number) Date on Expenditure _MUST SUPPORT PROJECT/PROGRAM IN APPLICATION s AWARD LETTER Name of Company ReceipUlnVOla on Receipt or Invoice MUST SE ON OR BETWEEN March 20, 2020 - JUNE 30, Amount Description Purpose 2024 3 EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient Is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. ■ Every Community Service Funding application is considered Individually and on its own merit, • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election In which an awarding Council Member Is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. [/we hereby certify the information contained In this Application Is true to the best of our knowledge and belief. ORGANIZATION NAME: MAILING ADDRESS: Oak St Murrieta, CA 92562 PHONE:( 760) 716-2319 EMAIL: president@southwestwomenschorus.orlt PRESIDENT / AUTHORIZED OFFICER: Darlene Nickerson President PRINT TITLE q 1,5- / , r-) SIGNATURE . �.�PGI ]j,(� DATE: MONTH, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PRINT NAME THLF SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Staosy.Brown@TemeculaCA.gov (961) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 13 of 13 12,u lse4 by INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. O. BOX 2508 t CINCINNATI, OH 45201 Employer Identification Number: Date: DEC 10 200 20-1694150 T DLN: 17053307058034 SOUTHWEST WOMENS CHORUS Contact Person: C/O WILLIAM PAISNER ERIC J BERTELSEN ID# 31323 30914 DEL REY RD Contact Telephone Number: TEMECULA, CA 92591-1739 (817) 829-5500 Accounting Period Ending: June 30 Public Charity Status: 509 (a) (2) Form 990 Required: Yes Effective Date of Exemption: July 23, 2004 T Contribution Deductibility: Yes Advance Ruling Ending Date: June 30, 2009 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. During your advance ruling period, you will be treated as a public charity. Your advance ruling period begins with the effective date of your exemption and ends with advance ruling ending date shown in the heading of the letter. Shortly before the end of your advance ruling period, we will send you Form 8734, Support Schedule for Advance Ruling Period. 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) -z- SOUTHWEST WOMENS CHORUS Sincerely, Lois G Lerner Director, Exempt Organizations Rulings and Agreements Enclosures: Information for Organizations Exempt Under Section 501(c)(3) Addendum `*I-- Letter 1045 (DO/CO) STATE OF CALIFORNIA FRANCHISE TAX BOARD FTB , PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/5/2022 ESL ID: 2162142712 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 2670632 Entity Name: SOUTHWEST WOMEN'S CHORUS ® 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. © 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: f711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) STATE OF CALIFORNIA Office of the Secretary of State STATEMENT OF INFORMATION CA NONPROFIT CORPORATION California Secretary of State 1500 lath Street Sacramento, California 95814 IIIBII IIIII IIII Illil IIBI IIIII IIIII Ilill IN 113/11111 IN IIIII 11111111 t BA20220591819 c a r t e r c r (916)853-3516 r c r r Entity Detalls Corporation Name Entity No. Formed In Street Address of Cafifornia Principal Office of Corporation Street Address of Califomia office Mailing Address of Corporation Mailing Address Attention Officers Officer Name z 0 Darlene Nickerson 0 K ya Maxwell 0 Rhonda Maxwell Additional Officers Officer Name 0 Marion Miller Agent for Service of Process E SOUTHWEST WOMEN'S CHORUS r 2670632 h CALIFORNIA is r 42051 MAIN ST TEMECULA, CA 92590 G 41145 ENGLEMANN OAK STREET �t MURRIETA TEMECULA, CA 92562 Dolly Nickerson r Officer Address Y Positlon(s) v 41145 ENGLEMANN OAK ST Chief Executive Officer G MURRIETA, CA 92562 [ t Secretary 45728 CORTE LOBOS TEMECULA, CA 92592 r 41431 BLUE BONNET CT. Chief Financial Officer w MURRIETA, CA 92562 Officer Address 42200 MAIN ST. #139 TEMECULA, CA 92590 r Position Stated Position r Vice President Agent Name Darlene Nickerson Agent Address 41145 ENGLEMANN OAK STREET MURRIETA, CA 92562 Email Notifications Opt -in Email Notifications Yes, I opt4n to receive entity notifications via email. Electronic Signature — — — — g By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign. Sara L Giampiccolo 0712912022 Signature - - — -- Date --- - — - -- Pang 1 of IiC IAA ABO�- F �;l F- D 1,^� C- X' < I L RE-rut 'ki-IONJS R E S O U R G CS P R () G, P �% M (,!U',j] AIC, Registrant- Details Entity type: (-',Iwss as I,)- 1111u, of rM ln1lild"11(l P" Organization Name: SOUTHWEST WOMEN'S CHORUS IRS FEIN: 201694150 Entity Type. Public Benefit SOS/FTB Corporate/Organization Number: 2670632 Registry Status: Not Registered Renewal Due/Exp. Date: RCT Registration Number: Issue Date: Record Type: Charity Registration Effective Date: Date of Last Renewal: DBA: Mailing Address Street: 30914 DEL REY RD Street Line 2: City, State Zip: TEMECULA CA 92591 Fifint I cis & Correspondence No Related Documents Aak-ij,nua.-I Renewal Data No Annual Renewal Data Related Registrations & Event Report.-� n0o,,v rfi,lr,nc' cry lwir,j vjt ow, Clh(k on the RCT Registration No ,o -ovj-j.-� In No Related Records FY, 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 45 SPECIAL OLYMPICS SOUTHERN CALIFORNIA INLAND EMPIRE CITY OF TEMECULAI FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 Amount Requested: $ 5000 PROJECT/PROGRAM INFORMATION MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Special Olympics Southern 7/2022 6/2023 Project/Program Title: Start Date: End Date: Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Special Olympics Southern California Mailing Address: 41880 Kalmia Street, Suite 140 Murrieta, CA 92562 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Special Olympics Southern Organization: California -Inland Empire 0 Year Founded: 1996 Website: www.sosc.org/inlandempire Number of Paid Staff: 3 Social Media: Number of Volunteers: 276 Geographic Area(s) the Organization Serves: Riverside & San Bernardino Counties Geographic Area(s) the Project/Program Serves: City of Temecula and surrounding communites NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Abbey Leffler Title/Position: Development Director Contact Person's Direct Telephone:951-703-6502 Contact Person's Email: aleffler@sosc.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ■ Date of Incorporation as a Nonprofit: 1996 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 95-4538450 State Identification Number: 189240 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: Ilt2,.//apos.irs.gov/app/eos/ 2. ❑ Attach State Entity Status Letter using this link: htts.1/www.ftb.c ov/online/self serve entity status letter/index.as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: hltp://rct. dqi. a.00v/VerificalionLW_gW$Mrch.asox?Facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 [ APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 141 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No LIj Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee INN Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The mission of Special Olympics Southern California is to provide year-round sports training and athletic competition in a variety of Olympic -type sports for children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in a sharing of gifts, skills and friendship with their families, other Special Olympics athletes and the community. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes N IF YES, PROVIDE BELOW, NAME OF PROGRAM/PROJECT AMOUNT { MONTH + YEAR FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP Special Olympics Sports Program $2500 Special Olympics Sports Program $4750 Dec 2021 Dec 2020 �CSF CSF $ $ $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Temecula grant funding will provide Special Olympics athletes in Temecula the opportunity to partcipate in our Fall and Spring sport trainings and tcompetitions. Sports offered will include Tennis, Golf, Softball, Basketball, Bocce and new to Temecula this year Flag Football. These programs will provide sport development training free of charge for our athletes and families with the support from trained volunteers and funding from community champions like the City of Temecula and the Riverside County Sheriffs Department. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Grant funds will be used to cover facility rental fees, athlete uniforms and equipment for Basketball, Bocce and Flag Football. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Temecula Valley has a long history of community engagement with Special Olympics. This includes residents volunteering to coach and train children and adults with intellectual disabilities, law enforcement raising funds through the Law Enforcement Torch Run, local businesses sponsoring events and civic groups staffing competitions. The current sport offerings combine two very important activities that are key to individual health and well being; physical movement and social interaction. For some athletes, Special Olympics is their only opportunity to interact in an accepting and inclusive enviroment. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 90 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM 33 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT -SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. The City of Temecula Service Funding Grant will be used to support the Special Olympics Temecula Valley Fall and Spring Season for individuals with intellectual disabilities. Funds will be used to purchase sports equipment, replace worn uniforms and purchase needed sports equipment. Participation in Special Olympics programming improves health and well-being through physical activity and social connection. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. N/A 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. N/A City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not flll In shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 5,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 30,241 Organization Other grants or funding already awarded for Project/Program, if any $ EXPENSES In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 35,241 LIST OF EXPENSES FOR PROJECT/PROGRAM Basketball, softball, bocce, golf, tennis and flag Tools/Equipment football sports equipment $ 6,750 Facilities/Rent/Insurance $ 4,300 Supplies Athlete uniforms $ 5,115 Marketing $ Services $ Food $ Other $ 600 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ 18,500 TOTAL EXPENSES $ 35,241 TOTAL BUDGET $ 35,241 $ 35,241 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), subrrilt the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Special Olympics Southern Name of Project/Program: Special Olympics Southern California -Inland Empire a California - Temecula m TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) Date on E Name of Company Receipt/Invoice U E on Receipt or Invoice MUST BE ON OR BETWEEN Z . March 20, 2020 - JUNE 30, a z 2024 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER 643 Amount Description I Purpose EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 LACKNOWLEDGEME.NT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. + Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. ■ The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Special Olympics Southern California -Inland Empire Q MAILING ADDRESS: 41880 Kalmia Street, Suite 140 Murrieta, CA 92562 PHONE: ( 951 ) 703-6502 EMAIL: aleffler a@sosc.org PRESIDENT/AUTHORIZED OFFICER: Calvin L. Lyons --President & CEO OVUM NAME SIGNATURE: Calvin L. Lyons. w ..�.'9. w DATE: Sept. 12, 2022 IF DIFFERENT THAN ABOVE, Abbe Leffler - Development Director APPICATION PREPARED BY: Y (� PkIM F ivAM1 F i �41.F SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 ��Mpartment of the Ti rn noy Intcrnal Revenue sekV1Cc N 024993 In reply refer to: 0248188043 CINCINNATI ON 45999-0038 Jan. 21, 2022 LTR 4168C 0 **-***8450 000000 00 00008519 BODC: TE SPECIAL OLYMPICS SOUTHERN CALIFORNIA INC 1600 FORBES WAY STE 200 LONG BEACH CA 90810-1833 Employer ID number: **-***8450 Form 990 required: Yes Dear Taxpayer: We're responding to your request dated Jan. 11, 2022, about your tax-exempt status. We issued you a determination letter in May 1996, recognizing You as tax-exempt under Internal Revenue Code (IRC) Section 501(c) (3). We also show you're not a private foundation as defined under IRC Section 509(a) because you're described in IRC Sections 509(a)(1) and 170(b)(1)(A)(vi). Donors can deduct contributions they make to you as provided in IRC Section 170. You're also qualified to receive tax deductible bequests, legacies, devises, transfers, or gifts under IRC Sections 2055, 2106, and 2522. 1h the heading of this letter, we indicated whether you must file an annual information return. If you're required to file a return, you must file one of the following by the 15th day of the 5th month the end of your annual accounting period: after - Form 990, Return of Organization Exempt From Income Tax - Form 990EZ, Short Form Return of Organization Exempt From Income Tax - Form 990--N, Electronic Notice (e-Postcard) for Tax -Exempt Organizations Not Required to File Form 990 or Form 990-EZ - Form 990-PF, Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation According to IRC Section 6033(j), if you don't file a required annual Information return or notice for 3 consecutive years, we'll revoke Your tax-exempt status on the due date of the 3rd required return or notice.. You can get IRS forms or publications you need from our website at www.irs.gov/forms-pubs or by calling 800-TAX-FORM (800-829-3676). If you have questions, call 877-829-5500 between 8 a.m. and 5 p.m., 0248188043 Jan. 21, 2022 LTR 4168C 0 **-***8450 000000 00 00008520 SPECIAL OLYMPICS SOUTHERN CALIFORNIA INC 1600 FORBES WAY STE 200 LONG BEACH CA 90810-1833 local time, Monday through Friday (Alaska and Hawaii follow Pacific time). Thank you for your cooperation. Sincerely yours, Warren R. Burton, Operations Mgr Accounts Management Operations 1 STATE OF CALIFORNIA FRANCHISE TAX BOARD nT13 POBOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/12/2022 ESL ID: 3421079347 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1898240 Entity Name: SPECIAL OLYMPICS SOUTHERN CALIFORNIA, INC. 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. F3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) ** PUBLIC DISCLOSURE COPY ** Foy 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(aj{1) of the Intemal Revenue Code (except private foundations) oeperrmad of the T,e" ■ Do not enter social security numbers on this form as it may be made public. Inwnarnawnvasmvlca Go to www.irs.gov/Form99D for instructions and the latest Information.. A For the 2020 calendar year, or tax year beginning R 06"k 0 C Name of organization nppilcabl. SPECIAL OLYMPICS SOUTHERN �Gdli+o CALIFORNIA INC. �cnanUn DolnQ business as rnislnl Number and street (or P.O. box it mail is not delivered to street address) L-Dtermer r'"°' 1600 FORBES WAY termin- ated City or town, state or province, country, and ZIP or foreign postal code r_—J=` LONG BEACH CA 90810 oo"Aan°1fca- F Name and address of principal officer: CALVIN LYONS °0i°n'0 iSAME AS C ABOVE C�1 a WWW.80SC.ORG Trust LJ Association 1-1 Other ■ and to Pubic D Employer identification number 95-4538450 ROOM/Suite E Telephone number a00 1 (562)502-1100 0 croeereealpbls 11,767,105. H(a) Is this a group return for subordinates? --]Yes X� No H(b) Are all subordin.. Induded? Yes LD No If "No," attach a list. See instructions 1 Briefly describe the organization's mission or most significant activities: TO ENABLE INDIVIQUALS WITH INTELLECTUAL DISABILITIES TO LIVE BETTER LIVES THROUGH SPORTS. 2 Check this box ■ F 1 if the organization discontinued its operations or disposed of 3 Number of voting members of the governing body (Part VI, line 1a) ...,•..... 4 Number of independent voting members of the governing body (Part VI, line 1 b) 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) 6 Total number of volunteers (estimate if necessary) 7 a Total unrelated business revenue from Part VIII, column (C), line 12 ............................ b Net unrelated business taxable income from Form 990•T. Part 1. line 11 ? 6 Contributions and grants (Part Vlll, line 1h) c 9 Program service revenue (Part VIII, line 2g) ................. 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) .- 11 Other revenue (Part VIII, column (A), lines 5, 6d, Bc, 9c, 10c, and 11e) , .......„........... 12 Total revenue - add lines 8 throu h 11 must egyal Part Vill column fine 1 13 Grants and similar amounts paid (Part IX, column (A), lines 1.3) 14 Benefits paid to or for members (Part IX, column (A), line 4) o 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5.10)- F 16a Professional fundraising fees (Part IX, column (A), line 11e) b Total fundraising expenses (Part IX, column (D), line 25) ► 1,088,620. 17 Other expenses (Part IX, column (A), lines 11 a-11 d, 11 f-24e) 16 Total expenses. Add lines 13.17 (must equal Part IX, column (A), line 25) .................. 19 Revenue loss ex uses. Subtract line 18 from line 12 20 Total assets (Part X, line 16) 21 Total liabilities (Part X, line 26) ............................... CA more than 2596 of Its net assets. ............. I ...... ............ 3 ......re .................. 4 ................................ 5 ........... s ............................... 7a ......... 7b Prior Year 55 55 85 749 0 . Cu MgYear 11,594,345. 5,907,505. 0. 10. 194,870. 174,289. 1,882,843. 2,033,799. 13,672 058. 235,199. 8,115,593. 61,876. 0. 0. 5,624.854. 5,801,750. 34,583. 75,150. 4,379 922. 2,530 165. 10 274 558. 8,468 941. 3,397,500. Be ginnine of Current Year -353 348. End of Year 12,451,693. 13,248,370. 629,147. 1,566,340. X1 822 546. 11,682,030. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, coirect and MPrint o ire rer olher than officer is based on all inforination of which preparer has an knowledge. Sign []ate Here YONS , CEO and €ilfe PrinUFype preparer's name Preparer's signature Date check Q PTlN Paid IZBETH G. NEVAREZ_"-- I;1.� 0139986E Prepare( Firm'snaina GREEN HASSON & JANKS LLP Firm'sFIH 95-•1777440 Use Only Firm'saddress ` 700 SOUTH FLOWER STREET, SUITE 3300 LOS ANGELES , CA 90017 lPhoneno.010) 8 73 -16 0 0 May the IRS discuss this return with the preparer shown above? See instructions ......... ..........M Yes I J No 032001 12-23-20 LHA For Paperwork Reduction Act Notice, see the separate instructions, Form M (2020) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 46 SPEECH AND LANGUAGE DEVELOPENT INC. CITY OF TEMECUI[A FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MOND", SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 10,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Developmental 7/1/22 6/30/23 Project/Program Title: Start Date: End Date: Physical Address of Project/Program: 43385 Business Park Dr, #140 Temecula, CA 9259C INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Speech & Language Development Mailing Address: 43385 Business Park Dr, #140 Temecula, CA 92590 (951-383-8505) I ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Speech & Language Organization: Development Website: www•sldc.net Number of Paid Staff. 140 Year Founded: 1955 Social Media: https://Www.facebook.com/SLDCI Number of Volunteers: 125 Geographic Area(s) the Organization Serves: Riverside, San Bernardino, LA, Orange Counties Geographic Area(s) the Proiect/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Doug Vogel Title/Position: Director of Development Contact Person's Direct Telephone: 714-821-3620 Contact Person's Email: doug.vogel@sldc.net NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 1955 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 95-2162129 State Identification Number: C0420140 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. 0 Attach IRS Deductibility Status using this link: h t ://a sirs. ov/a /eost 2. pp Attach State Entity Status Letter using this link: httos.1/www.ftb.ca.gov/online/self serve entity status letter/index.as 3. ❑■ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: hit ://rct.do'.ca. avNerification/WebtSearch.as x?facilit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No [j Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No 0 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee ❑ Board of Directors 1-1i,j Members -at -Large ❑ E:�-- MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The mission of Speech and Language Development Center is to provide education and therapy to children and adults with special needs in an environment that nurtures growth, inspires achievement and maximizes their potential. We treat the child, not the disorder. This means that we adapt our approach to fit each individual. Because we have a wide range of clinical services in one location (speech, Occupational; Physical and Behavioral Therapy) our professionals are able to collaborate across all environments. This unified approach is one of the keys to our success. We've been helping children with these challenges since 1955 in our primary location of Buena Park. With this program, we are expanding to be a help to children in Temecula. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 r- - __ --- - FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No 0 Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP I FUNDING RECEIVED OR SPONSORSHIP $ $ $ $ I $ 1$ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ❑ Yes E IF YES, PROVIDE INFORMATION IN TABLE BELOW - AMOUNT MONTH + YEAR NAME OF ENITY RECEIVED FUNDING RECEIVED $ 4800 Autism Speaks grant July 2022 $ i - $ $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. In this program, 80 children from poor families in Temecula Valley will receive developmental assessments, social skills classes, behavioral counseling and intervention. They'll be assessed by licensed therapists and attend sessions to help them develop their speech and communication. For the poor, the need is big. The cost for these services is much higher than the average of $21 paid by the typical insurance. Most children develop speech and language at a normal rate. Some are delayed. When these are in poor families, the obstacles are immense. SLDC is expert in 12 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The total cost of the program is $38,312 including $4512 for assessments and screenings, $12,800 for social skills classes and rent. Virtually all of the assessment and session costs are to pay licensed teachers and therapists. At our facility in Temecula, we have the needed equipment and technology to offer these services. SLDC is a pioneer in the use of technology for helping children with developmental disabilities. We have a "do whatever it takes" philosophy. Our innovation has led to a credibility in the field where we help other organizations to develop solutions for their children and clients. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. There is a lack of access to these services in the Temecula Valley. Our research, I conducted through Optum/United Healthcare found that families interested in these services needed to drive an average of 40 miles to reach them. We'll deliver the services IN Temecula. The same market study found that families' insurance covers only $21 for these social skills classes, far below the rate private providers require. We'll offer the courses for $5 per week and have full scholarships available. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 180 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 10 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT- SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Lots of kids in TV need speech and language development. Many are in poor families that can't afford private care. We provide the needed assessments and classes for $5 per week. Services provided by licensed professionals. Kids catch up in speech and language development. They gain confidence. Families gain honor and harmony. L F5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. We launched Stage 1 of our program in October 2021. The virus has an impact in two ways: physical environment and financial. For physical environment, kids were and are more cautious and concerned about the physical environment. We've made accommodations accordingly. Second, families simply have fewer financial resources, especially with high inflation tacked on. Result: An even greater need for services like we offer at the price we offer them. Families with limited finances can participate for only $5 per week. ,6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The program is in Stage 2. In State 1, we made a presence in Temecula by leasing space and beginning to offer services. In the past year, we've provided these services to 26 children. SLDC has committed to building out its services in the Temecula Valley over the next 3 years. We will look to continue to provide Speech Language/Behavior services to children and adults in the Region. In addition, SLDC plans to provide additional services including occupational/physical therapy and mental ' health/family therapy. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 10,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 23,512 Organization Other grants or funding already awarded for Project/Program, if any $ 4800 Autism Speaks In -Kind match amount or volunteer credit hours estimated amount $ TOTAL REVENUE $ 38,312 i LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment 1 $ Facilities/Rent/Insurance Leased space $1750 per month $ 21,000 Supplies $ Marketing $ Services Licensed Teachers and Therapists $ 1 7, 3 1 2 Food $ Other $ Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $ 38,312 TOTAL BUDGET $ $38,312 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent_ If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Speech & Language Developrnent — FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Name of Project/Program: Developmental Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): E* Name of Company Receipt/InvoiceDate on Eon Receipt or Invoice MUST BE ON OR BETWEEN Amount JULY 1, 2021 - JUNE 30, 2022 <Z' + I I , - - 1_ Is 4 ! 1 1$ 61 } 1$ EXPENDITURE TOTAL L7 GA V11UILUIC Description Purpose DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 bv the nit, of Temecula follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92690, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Speech & Language Name of Project/Program: Developmental Screen! ngs/Therapies for a TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes__ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report Is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number). c Date on Expenditure E Name of Company Receipt/Invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER v E on Receipt or Invoice MUST BE ON OR BETWEEN T a V. 2024 2rcch 20, 2020 -JUNE 30. Amount Description Purpose $ 2 { 3 $ lEXPENDITURE TOTAL $EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. ■ Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. •-'1f-awardetr-a-Commcmlty Service FUrrdirrg-Grarit-by'tfTe-City ofTetrfecul91'�St-yea-r,-then compliance recelpts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Speech $ Language Development MAILING ADDRESS: 8699 Holder Street Buena Park, CA 90620 PHONE: ( 714) 821-3620 EMAIL: akessler@sldc.net PRESIDENT/AUTHORIZED OFFICER:Adrienne Kessler, Executive Director PRINT NAME TITLE SIGNATURE: DATE: j r1i I1 8� MONTH, DAY, YEAR IF DIFFERENT THAN ABOVE'DougVogel Director of Development APPICATION PREPARED BY: g p PRINT NAPAE TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@aTemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Internal Revenue Service Date: June 17, 2003 Speech and Language Development Center, inc. 8699 Holder Street Buena Park, CA 90620-3614 Dear Sir or Madam: Department of the Treasury P. O. Box 2508 Cincinnati, OH 45201 Person to Contact: Shirley Rudolph 31-03949 Customer Service Specialist Toll Free Telephone Number: 0:00 a.m. to 6:30 p.m EST 877-829-5500 Fax Number: 513-263-3756 Federal Identification Number: 95-2162129 Accounting Period Ends: June 30 This is in response to your request of June 17, 2003 regarding your organization's tax exempt status. In July 1964 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 Internal Revenue Code. Based on information submitted subsequently, we classified your organization as a publicly supported organization, and not a private foundation, because it is described in sections 509(a)(1) and 170(b)(1)(A)(ii) of the Code. This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's purposes, character, method of operations, or sources of support have changed, please let us know so we can consider the effect of the change on the organization's exempt status and foundation status. Revenue Procedure 75-50, published in Cumulative Bulletin 1975-2 on page 587, sets forth guidelines and record keeping requirements for determining whether private schools have racially nondiscriminatory policies as to students. Your organization must comply with this revenue procedure to maintain its tax-exempt status. Your organization is required to file 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. As of January 1, 1984, your organization is liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more the organization pays to each of its employees during a calendar year. There is no liability for the tax imposed under the Federal Unemployment Tax Act (FUTA). -2- Speech and Language Development Center, Inc. 95-2162129 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, If you have any questions about excise, employment, or other federal taxes, please let us know. 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, 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 Form 990-T, Exempt Organization Business Income Tax Refum. 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. Sincerely, r John E. Ricketts, Director, TE/GE Customer Account Services STATE OF CALIFORNIA p FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/7/2022 ESL ID: 3423479440 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 0420140 Entity Name: SPEECH AND LANGUAGE DEVELOPMENT CENTER INC 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 233051). • The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) • HOME • ABOUT • MEDIA • CAREERS • REGULATIONS • RESOURCES • PROGRAMS • CONTACT Registrant Details Entity type: Corporate Class as registered with the Secretary of State or based on founding & registration documents. Organizati SPEECH AND LANGUAGE 9521 on Name: DEVELOPMENT CENTER, INC. IRS FEIN: 6212 Entity public Benefit Type: Registry Status: Exempt RCT Registration 019761 Number: Record Type: Charity Registration Date of Last Renewal: Mailing Address Street: 8699 HOLDER STREET Street Line 2: I� City, State Zip: BUENA PARK CA 90620 Filings & Correspondence 1 St Delinquency 1 st Delinquency Notice Notice Exempt from Exempt from Registration Registration 9 SOS/FTB 0420 Corporate/Organizatio 140 n Number: Renewal Due/Exp. Date: Issue Date: Effective Date: DBA: 6/30/200 2 6/30/200 2 2015 Raffle AAnp Not 2015 Raffle App Not Subject Subject Annual Renewal Data I Status of Filing: j Accounting Period Begin j Date: Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT-TR-1 i Reject/Incomplete ( Reason: j IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accounting Period Begin Date: ! Accounting Period End Date: Filing Received Date: Form RRF-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Accepted 7/l/2001 6/30/2002 11/18/2002 • Charity Registrations relate to Professional Fundraising Events which relate to Professional Fundraiser Registrations. • Raffle Registrations relate to Raffle Reports, • Click on the RCT Registration No to navigate to the related record. Prereq Type: Prerequisite Relationship: Charity Registrant: ENDOWMENT HORIZONS, INC. Registration E0024891 Registration Fundraising Registration No: Type: Event Status: Complete Date 3/9/2016 Association 10/l/20I5 Expiration 9/30/2016 Established: Date: Date.- Prereq Type: Prerequisite Relationship: Charity Registrant: ENDOWMENT HORIZONS, INC. Registration E0026270 Registration Fundraising Registration Complete No: Type: Event Status: Date Established: Association 3/9/2016 Date: 9/1/2015 Expiration Date: 8/30/2016 Prereq Type: Prerequisite Relationship: Charity Registrant: ENDOWMENT HORIZONS, INC. Registration E0029268 Registration Fundraising Rcgistration No: Type: Event Status: Complete Date 1/26/2017 Association 9/l/2016 Expiration 8/30/2017 Established: Date: Date: EXTENDED TO MAY 16, 2022 Return of Organization Exempt From Income Tax r2o Form Under section 501(c), 527, or 4947(axi) of the Internal Revenue Code (except private foundations))OP",r,r, Wl of u,e l«arMRy Do not enter social security numbers on this form as it may be made public. A For the 2020 calendar year, or tax year beginning JUL 1 2020 and ending 30, 2021 6 [:ham a C Name of organization D Employer identification number opp1i"bdn SPEECH AND LANGUAGE DEVELOPMENT CENTER [ I& 00 INC. =N rnit* ooina husrness as 9 5 — 216 2129 �rn+„r rnSion Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Telephone number []'al"nt 8699 HOLDER ST 714 821-3620 [ermin- t ead City or town, state or province, country, and ZIP or foreign postal code G Gr... 4e wp:n S 11t519,360. 018turn `' BUENA PARK CA 90620 H(a) Is this a group return I�--�1 An t—li "c" F Name and address of principal officer: RON ROTHSCHI LD for subordinates? LlYes EXINo 8699 HOLDER STREET BUENA PARK CA 9 Q 6 2 0 — 3 H(b) we all subordinates included? = Yes = No I Tax-exempt status: M 50Ifc 3 50 t C , insert no. 494! a 1 or 527 If "No," attach a list. See instructions LDC. NET I( Form of organriation. M Corporation �_J Trust I I Association I i Other No. I L Year of formal ion! 19611 M state aI Iona domid[e-CA 1 Briefly describe the organization's mission or most significant activities: SEE SCHEDULE 0 . d u c c 2 _ Check this box 10- L--�] if the organization discontinued its operations or disposed of more than 25% of its net assets. 0 3 Number of voting members of the governing body (Part VI, line 1 a) 3 12 C7 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 12 .e u 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) 5 267 6 Total number of volunteers (estimate if necessary) , 6 141 7 a Total unrelated business revenue from Part VIII, column (C), line 12 7a 0. b Net unrelated business taxable income from Form 990•T part ! line t 1 7b 0. Prior Year Current Year 423, 238. 542,710. e 8 Contributions and grants (Part Vlll, line 1 h) 11 , 6 91 804. 16,919,932. m 9 Program service revenue (Part VIII, line 2g) m 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) -,_ „.... 14 246. 1,613. M 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11 e) —7 5 078. — 4 6 69 6 . 12, 0 5 4 210. 11 417,559. 12 Total revenue • add lines 8 tixotr h 11 must equal Part VIII column A (I no 121 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 0. 0. 0. 0. 14 Benefits paid to or for members (Part IX, column (A), line 4) _ n 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5.10) 9,455, 302. 9 339,109. a n 16a - Professional fundraising fees (Part IX, column (A), line 11e) _ 0. 0. gb Total fundraising expenses (Part IX, column (D), line 25) JO, 1834643 . 2 072 650. 24299,162. u7 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) . 18 Total expenses. Add lines 13.17 (must equal Part IX, column (A), line 25) 11,527,952. 11,638,271. 5261 258. — 2 2 Q 712 . 19 Revenue less expenses. Subtract line 18 from fine 12 ....... .... 6e innin of Current Year End of Year 20 Total assets (Part X, line 16) 10,920,381. 12,066,562. 21 Total liabilities (Part X, line 26) 2,243,755. 3,318,181. Z1. 22 Net assets or fund balances. Subtract line 21 from line 20 8,676,626. 8,748,381. r-UR Ir 1 71tjr1d[UF0 D104GK Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete, Declaration of preparer other lhan officer is based on all information of which pre aver has any knowledge. Sign I Signature of officer Date Here I ADRIENNE KESSLER, CHIEF EXECUTIVE OFFICER Type or print name and title Print/Type preparer's name "r,nmr 's signature Date chmk � MIN Paid LAUREN A. HAVERLOCK AUREN A. HAVERLOCK 102/22/221,1m-em om 00545829 Preparer Firm's name ill MOSS ADAMS LLP Fnm'sEIN 91-0189318 Use Only Firm'saddresslo. 21700 OXNARD ST, SUITE 300 WOODLAND HILLS, CA 91367 Pharieiin.949-221-4000 May,the IRS discuss this return with the prepa re shown above? See instructions Fkl Yes No 0320e1 12-23-20 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2020) SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION Coronavirus Tax Relief Free File Get Your Tax Record Get ail Identity Prowction 111N I1' Pf N • Pay • Refunds • Credits & Deductions • Forms & Instructions Breadcrumb Region 1. Home 2. Tax i :xcinpt Organization Search 3. Speech And Language Development Center Inc. Back to Search Results Speech And Language Development Center Inc. EIN: 95-2162129 1 Buena Park, CA, United States Other Names Publication 78 Data Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990- T) Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non -profits. Tax Year 2020 Form 990 Tax Year 2019 Form 990 Tax Year 2019 Form 990 Tax Year 2018 Form 990 Tax Year 2017 Form 990 Tax Year 2016 Form 990 Page Last Reviewed or Updated: 20-November-2020 Share FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 47 SPERO VINEYARDS INC. FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 4 2, 2022 PROJECT/PROGRAM INI+ORMATION Amount Requested: $ 37,100.00 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: _ Start Date: 1-1-23 End Date: 12`1-23 Physical Address of ProjecUProgram. 32250 Vista Del Monte, Temecula CA 92591 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Spero Vineyards, Inc. Mailing Address: 2076 Lincoln Avenue Pasadena, CA 91103 ORGANI7.ATION AND (GEOGRAPHIC AREA SERVED Name of Applicant Spero Vineyards, Inc. Organization: Year Founded: 2014 Website: www.sperovineyards.org Social Media: Facebook/Instagram Number of Paid Staff: O Number of Volunteers: 15+ Geographic Area(s) the ❑Manixation Serves: Temecula Wine Country Geographic Area(s) the Proiect/Program Serves: Temecula (in partnership with City of Temecula) NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EKQLBSI ELY USED 70 SERVE TEMECULA. Contact Name., Mark Woods -mail Title/Position: President Contact Person's Direct Telephone:213.605.2345 Contact Person's Email: sperovineyards@gmail. rolil NONPROI+IT STATUS Is this organization incorporated as a nonprofit? Yes ❑ Date of Incorporation as a Nonprofit: NO ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 46-5288314 State Identification Number: 3647270 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. K■ Attach IRS Deductibility Status using this link: ttll2.1/Lapps.irs.rlov/arspleos/ 2. 0 Attach State Entity Status Letter using this link: htt s://www.ftb,ca. ov/onlitie/self serve anti!y status letter/index.as 3. W Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: !1 '1lrc . ol.camuvNefifirattqrllWyl�ISaarch.asox7facility=Y City of Temecula Communlly Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been Involved with any personal business transactions valued over $500 Including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No [1 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No Q Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee Coil Board of Directors [J■, Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION } BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. ` Spero Vineyards is dedicated to creating meaningful workforce development and training for our areas young adults with disabilities who have an interest in careers in Temecula's thriving wine and hospitality industries. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABt-L CPA'S AUDIT, 1V1AY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community service Funding - Reinvestment In Temecula GRANT APPLICATION Page 5 of 13 FUNDING SOURCES , CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No A Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR NAME OF CITYGRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ■ Yes ❑ IF YES, PROVIDE; INFORMATION IN TABLE BELOW. AMOUNT MONTH +YEAR l 1 NAME OF ENITY nr rr nir n FUNDING RECEIVED City of Temecula Communlly Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECTIPROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Spero Vineyards, in partnership with the City of Temecula's Global Citizens program, has created a hands on environment where students can learn and practice their skills on a working vineyard and winery. Student participants receive instruction in the history, science, hospitality, business/marketing, and agriculture aspects of the wine making business. Spero has proudly served eight annual classes of students since its founding in 2014. Program alumni now work with current students creating a cycle of successful outcomes. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT, The requested funding will expand Spero's ability to provide essential training in wine lab practices. The goal will be to develop a "hands-on" working lab designed to train students in wine lab basics and best practices. Working together with the City's community services division, purchased equipment will be used in conjunction with an expanded curriculum offering. Currently, the curriculum only covers essential elements of viticulture and hospitality. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. It is our belief that meaningful workforce preparation for the City's youth must include, on a representative basis, individuals with disabilities. Non -disabled youth can readily pursue career exploration though regional classes and vocational programs These programs are traditionally not easily navigable for individuals with disabilities. Hands on training for youth with disabilities must be specially created and managed to ensure accessibility and sometimes accommodated for unique learning styles. Outside of Spero, in partnership with the City, these learning opportunities do not exists on any large scale for Temecula area residents. We are presently unaware of any program in the City or region that Ja.rovid.es.wine lab kainina for -individuals withAisahiiities.. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 115-30+ FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: I10 (wine lab) City of Temecula Communlly Service Funding - Relnvesfmonl In Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Spero is a proven and reliable partner in Temecula. Since 2014, the program, in partnership with the City, has graduated eight classes of Temecula area students, all given the opportunity to pursue their career development dreams in the winemaking industry. These opportunities simply do not exist for individuals with disabilities unless specifically planned and created to serve the unique learning needs of our students in a safe and structured environment. The wine lab curriculum will be a first of its kind innovation and will expand necessary training opportunities for Temecula's young people. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANiZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Spero exists with the generous support of our community partners and friends including: The Spero team; Greg Pennyroyal and Wilson Creek; Temecula Small Growers and Ponte. However, the cost of maintaining the facility and expanding the curriculum is daunting. The pandemic displaced a significant portion of our volunteer and donor base as many were obligated to prioritize their spending and volunteer hours. Many volunteers were unable to serve in person due to pandemic related restrictions. Rising water, fuel and vineyard management costs all threaten the program. Despite these challenges, the program continued throughout the pandemic offering our young people hope and programming when most other programs shut down or paused operations. Spero continued without Interruption, albeit. by distance methods. Please see attached. 6 IF APPLYING FOR MORE THAN $6,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, ANWOR (3) CONTINUE EXISTING PROJECT/PROGRAM. The wine lab curriculum will be a first of its kind innovation and will expand necessary training opportunities for Temecula's young people. Spero advances on a "Teach Me to Fish" paradigm. That is, our young people will live more fulfilling and productive lives if given the opportunity to learn skills that are in high demand by our area employers. These jobs pay well and provide opportunities 'for our students to earn a living wage. Many of our students have unique gifts in science and mathematics. The lab curriculum will allow us to offer next level skill training to students who are hungry for opportunities for learning while also helping the program meet the rising costs of operation for all program elements. i City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM --TREVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 37,100 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 28,000 Organization Other grants or funding already awarded for Project/Program, if any $ 0,00 In -Kind match amount or volunteer credit hours estimated amount $ 8,500 TOTAL REVENUE $ 73,600 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $23,1 oa.00 Facilities/Rent/Insurance $28,000.00 Supplies $6,000.00 $21000.00 Marketing Services $14,000.00 $500.00 Food Other $ $ Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $73,600.00 TOTAL EXPENSES TOTAL BUDGET $ $73,600.00 PREVIOUS* FISCAL YEAR (FY) 2021 2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have bann expanded anytime on or between July 1, 2021, and June 30, 2022, In addition, all grant funds must be substantlated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit andlor require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent approprialeiy, proper back-up documentation including the completed table below with accompanying receipts/Involces, must be submitted to the City on or before due date: September 12, 2022. 1. FIII out table below (matte additional copies If needed to explain all expenditures.) 2. Attach copies of receipts/Invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Spero Vineyards, Inc. FY 2021-2022 Amount of CSF Grant Fund Awarded: Name of Project/Program: Month & Year CSF Grant Received from City: Number of Beneficlarles Llving in 92590, 92591, 92592 that Directly Benefitted from this ProgramlProject (approximate number of beneficiaries if you do not have precise number): Date on _ Expenditure E a Name of Company Receiptlinvoice E on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose Z JULY 1, 2021 - JUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE i$ EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Relnvostment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant In FY2022-2023 by the City of Temecula follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and .June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may Jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent In accordance with the approved/awarded application, the organization may not recelve andlor will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation Including the table below with accompanying recelplslinvoices, must be submitted to the City as outlined on this page, 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. SUIDI It the toliowing Expenditure Report within 60 d;)ys after spending $5,000 no later than Junta 30, 2024. to demonstrate grant funds were spent in accordance wllh the Appl cation. (if you were awarded less than $5,000, submit Expenditure Report for that amount.) S. If awarded grant funds exceeding $5,000, A) Follow #1,A above first. 13) To receive grant funds exceeding $5,000 {between $511-$5010, submit the fallowing Expenditure Report to be reimbursed for the remaining balance of award to demanstrate funds were spent in accordance with (lie Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount Is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (In the same order listed In table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment In Temecula" EXPENDITURE REPORT DATED Organization: Vineyards, Inc. g Name of Project/Program _ TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report Is to proYldn documentation for first $5,001) awrrded and rarulved? Yes_ or No (already submitted). 2. My organization has already recelved $ of the total FY 2022.23 Grant Fund avrarded by the 6 3. Is this Expenditure Report Is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries If you do not have precise numher)__ E Name of Company u E on Receipt or Invoice a z Date on Expenditure Receipt/Invoice MUST SUPPORT PROJECTIPROGRAM IN APPLICATION & AWARD LETTER MUST BE ON OR BETWEEN March 20, 2020 -JUNE 30. Amount Description Purpose 2024 EXPENDITURE TOTAL EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLI,DGEMENT/SIGNATURE+ PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. ■ Every Community Service Funding application Is considered individually and on Its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula, • Funding is not immediately available to the recipient, and requires an award letter signature upon approval, Please allow time for checks to be processed, • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately, • Community Service Funding grants will not be awarded or announced within the 60 days before an election In which an awarding Council Member Is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement, • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Spero Vineyards, Inc. MAILING ADDRESS: 2076 Lincoln Avenue PHONE: (213 ) 605-2345 Pasadena, CA 91103 EMAIL: sperovineyards@gmail.com PRESIDENT /AUTHORIZED OFFICERNark Woodsmall, President r t'RINI rain TITLE- SIGNATURE: _-.. . - 4 _ -. DATE 9- 1 2-2022 MONTH, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEM ECU LA, CA 92590 Questions: Stacey. Brown@TemeculaGA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA,gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD � T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/20/2022 ESL ID: 1893679427 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 3647270 Entity Name: SPERO VINEYARDS, INC. ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # TEDx TEMECULA AKA INLAND VALLEY BUSINESS & COMMUNITY FOUNDATION I W KT� I D. l/i 11 FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 I PROJECT/PROGRAM INFORMATION I Amount Requested: $ 5,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION TEDxTemecula Project/Program Title: Physical Address of Project/Program: _ ULC4 2W41 la -AA Start Date: 9/24/22 vuz: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING If Grant is Awarded, Make Check Payable to: IVBCF dba TEDxTemecula Mailing Address: 40497 Windsor Rd Temecula, CA 92591 End Date: 9/24/22 j ORGANIZATION AND GEOGRAPHIC AREA SERVED I Name of Applicant IVBCF dba TEDxTemecula Organization: Website: tedxtemecula.com Number of Paid Staff: 0 Year Founded: 2012 Social Media: fb.com/tedxtemecula Number of Volunteers: 20 Geographic Area(s) the Organization Serves: Temecula and outlying areas Geographic Area(s) the Pro'ect/Pro ram Serves: Temecula and outlying areas NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Jim McLaughlin Title/Position: Organizer Contact Person's Direct Telephone*951-225-2179 Contact Person's Email:jim@tedxtemecula.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 2008 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 26-4018866 State Identification Number: PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: htt ://a sirs. ov/a leos/ 2. ❑ Attach State Entity Status Letter using this link: htti)s://www.ftb.ca.goy/online/self serve entity status letterlindex.as 3. ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt :Ilrct.do .ca. av erificationMeb/Search.as x?facilil =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No [] Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No X Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATICN: This Application has been authorized by the organization's: Executive Committee ❑■ Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES, The TEDxTemecula conference is a platform for drawing attention to Temecula by highlighting incredible people in and around Temecula, and beyond. We find 6-8 people every year and gain the alignment and contribution of like-minded people and businesses through the area to help host an event like none other. The conference is held at the beautiful and intimate Old Town Temecula Community Theater. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes 0 IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP lTEDxTemecula TEDxTemecula 1 $ 2500 $2500 12022-2023 2021-2022 Economic Develoi Economic Develoi TEDxTemecula 1 $2500 2020-2021 Economic Develor TEDxTemecula $1000 2021-2022 Council Member I � Is --- _ :J OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW, AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. TEDxTemecula is an annual, one -day event held the last Saturday in September. Temecula resident, Jim McLaughlin, has acquired a license from TED Conferences LLC (TED) to do so since 2012, with renewal happening each year based on several factors including audience feedback via survey conducted by TED and videos of the talks beng recorded and uploaded to TED. We have received well over 2 million views. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED, ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Funding will be used to offset the cost of lunch provided to our audience, the speakers, and the volunteers. Other costs are program printing and other printing needs for promotion of the event, and table and chair rental for the theater courtyard, and video production. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. The event will draw people into Old Town on the day of the event to see a unique event. Following the event, many will do business at local restaurants and retail establishments, providing revenues to the City. In addition, the recorded talks will have the TEDxTemecula logo prominently displayed on stage, providing exposure to the City. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT jall FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 20 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. TEDxTemecula is an event that draws attention around the world through the power of the TED platform. All videos have TEDxTemecula prominently displayed throughout the talks. Beyond global visibility and the connection to a highly valued brand, the event itself is high in quality and draws an eclectic group of Temeculans, and others, to be exposed to new ideas and innovations. We're all proud that Temecula has its own TEN event. i5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) l LINE ITEMS FOR PROJECT/PROGRAM IREVENUES 1 LIST REVENUES/INCOME FOR PROJECT/PROGRAM J Amount of money requested from this City of Temecula $ 5,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 15,000 Organization Other grants or funding already awarded for Project/Program, if any $ 2500 I In -Kind match amount or volunteer credit hours estimated amount $ 2100 TOTAL REVENUE $ 24,600 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE, TOTAL EXPENSES TOTAL BUDGET 1 $24,600 EXPENSES $1600 $3000 JJ1 $2500 $12000 $2500 $3500 $3000 $0 $24,600 W City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: IVBCF dba TEDxTemecula Name of Project/Program: TEDxTemecula FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living In 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on Expenditure Name of Company Receipt/Invoice r~ a Amount on Receipt or Invoice MUST BE ON OR BETWEEN Description Purpose Qz JULY 1, 2021 - JUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE $ 4 1 1 !$ 5I $ EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-550K), submit the Following Expenditure Report to be reinibursedfor the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: IVBCF dba TEDxTemecula Name of Project/Program: TEDxTemecula TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: T. 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No __ or Yes It yes, Amount of Request S_ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) C Date on Name of Company Receipt/lnvoice U E on Receipt or Invoice MUST BE ON OR BETWEEN Q Z arch 20, 2020 - JUNE 30, l 1 2 3 EXPENDITURE TOTAL I Expenditure f! MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Amount Description Purpose EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 I 4 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: IVBCF dba TEDxTemecula MAILING ADDRESS: 40497 Wind-sor Rd PHONE: (951 ) 225-2179 Temecula, CA EMAIL: jim@tedxtemecula.com PRESIDENT / AUTHORIZED OFFICER: Jim McLaughlin_ P NT NAMV/17�TE. SIGNATURE: IF DIFFEREN T{iAN ABOVE, APPICATION PREPARED BY 09-12-2022 MONTH, DAY, YEAR PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: JUN 0 3 2010 INLAND VALLEY BUSINESS AND COMMUNITY FOUNDATION INC 29970 TECHNOLOGY DR STE 211 MURRIETA, CA 92563-2649 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 26-4018866 DLN: 17053356346039 Contact Person: FAITH E CUMMINS ID# 31534 Contact Telephone Number: (677) 829-5500 Accounting Period Ending; December 31 Public Charity Status: 170 (b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: November 12, 2008 Contribution Deductibility: Yes Addendum Applies: No 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) Short Form .m990EZ Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) iamnent of (lie ► Do not enter social security numbers on this form as it may be made public. asury !malRevenue Service ► Go to www.lrs, ov Far j9 0 Z for instructions and the latest information. Far the 2019 calem r year,or tax year beginning 01-01-2019 and ending 12-31-2019 Check if applicable: C Name of argarlization Address change INLAND VALLEY BUSINESS AND COMMUNITY FOUNDATION IN Name change Number and street (or P, 0. box, if mail Is riot delivered to street addm ) oomisu Initial return 40335 Winchesterrd suite E Final return/terminated Amended return City or town, state or province, country, and ZIP or foreign postal code Application pending Temecula, CA 92591 OMB No. 1545-1150 2019 D Employer identification number E Telephone number F Group Exemption Number IN, 4ccounting Method: ❑ Cash lZ Accrual Other (specify) ► H Check ► ❑ if the organization is not required to attach Schedule B l/ebsite: ■wWW IVBCF.COM (Form 990, 990-EZ, or 990-PF), ax-exempt status (clieck onfy one) . © 501(c)(3)❑ 501(c}{ ) -4 (insert no.) ❑ 4947(a)(1) or ❑ 527 orm of organization: 0 Corporation ❑ Trust ❑ Association ❑ Other - 1dd lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B) below) $500,000 or more, file Form 990 instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . ► $ 18,447 Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I) Check if the organization used Schedule 0 to respond to any question in this Part [ . ❑p i Contributions, gifts, grants, and similar amounts received . . . . . . . . . . . . . . . . . . . . 1 4,500 2 Program service revenue including government fees and contracts . . . . . . . . . . . . . . . . 2 13,895 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Investment income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 52 5a Gross amount from sale of assets other than inventory . . . . . . . 5a b Less: cost or other basis and sales expenses . . . . . . . . . . . Sh c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) . . . . . . Sc 6 Gaming and fundraising events a Gross Income from gaming (attach Schedule G if greater than $15,000) 6a b Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) 6b c Less: direct expenses from gaming and fundraising events 6c d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) 6d 7a Gross sales of inventory, less returns and allowances . . . . . . 7a b Less: cost of goods sold . . . . . . . . . . . . . 7b c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) . . . . . . . . . 7c 8 Other revenue (describe in Schedule 0) . . . . . . . . . . . . . . . . . . . . 8 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 . . . . . . No, 9 18,447 10 Grants and similar amounts paid (list in Schedule 0) . . . . . . . . . . . . . . . . 10 11 Benefits paid to or for members . . . . . . . . . . . . . . . . . . . . . . it 12 Salaries, other compensation, and employee benefits . . . . . . . . . . . . . . . 12 13 Professional fees and other payments to independent contractors . . . . . . . . . . . . 13 2,325 14 Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . . . . . . . . 14 15 Printing, publications, postage, and shipping . . . . . . . . . . . . . . . . . . . 15 1,351 16 Other expenses (describe in Schedule 0) . . . . . . . . . . . . . . . . . . . 16 17,746 17 Total expenses. Add lines 10 through 16 ► 17 21,422 18 Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . . . . . 18 -2,975 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end -of -year figure reported on prior year's return) . . . . . . . . . . . . . . . . . 19 4,423 20 Other changes In net assets or fund balances (explain In Schedule 0) . . . . . . . . . . . 20 21 Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . . . . . . . 21 1,448 r Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 10642I Form 990-EZ (2019) I Balance Sheets (see the instructions for Part II) Check if the organization used Schedule O to respond to any question in this Part fI rn t Cash, savings, and investments . . . . . . . . . . . . . . . . 3 Land and buildings . . . . . . . . . . . . . . . . . . . . 4 Other assets (describe in Schedule 0) . . . . . . . . STotal assets . . . . . . . . . . . . . . . . . . . . . . STotal liabilities (describe in Schedule O). . . . . . . . . . . . . 7 Net assets or fund balances (line 27 of column (B) must agree with line 21) A Beginnino of vear B End of year 2,6621221 1,448 01 231 0 1,761 24 0 4,423 25 1,448 0 26 0 4,4231 27 1.448 ll Statement of Program Service Accomplishments (seethe instructions for Part III) Check if the organization used Schedule O to respond to any question in this Part III ❑ Expenses (Required for section 501(c) (3) and 501(c)(4) organizations; optional for others.) Iat is the organization's primary exempt purpose? ;ANTS FOR HIGH SCHOOL STUDENTS ascribe the organization's program service accomplishments for each of its three largest program services, as aasured by expenses. In a clear and concise manner, describe the services provided, the number of persons neflted, and other relevant information for each program title. e Additional Data Table rants $ ) If this amount includes forelgn grants, check here . ► ❑ 28a 1 See Additional Data Table rants $ ) If this amount includes foreign grants, check here . ► ❑ Zga P rants $ ) If this amount includes foreign grants, check here ► ❑ 30a Other program services (describe in Schedule 0) . rants $ ) IF this amount includes Foreign grants, check here ► ❑ 31a Total program service expenses add lines 28a through 31a) ► 1321 0 ��. LfsC or vrrlcers, Directors, Trustees, and Key Employees (list each one even if not compensated — see the instructions for Part IV) Check if the organization used Schedule O to respond to any question in this Part IV. . . . . . . . . . ❑ (a) Name and title (b) Average hours per week devoted to position (c) Reportable compensation (Forms W-2/1099- MISC) (if not paid, enter -0-) (d) Health benefits, contributions to employee benefit plans, and deferred compensation (e) Estimated amount of other compensation 1RIE WAITE EASURER 1.00 0 0 0 HN RICHARDSON OF PUBLIC RELATIONS 4.00 0 0 0 M. Other Information (Note the Schedule A and personal benefit contract statement requirements in the instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V . . ❑ 3 Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule O . . . . . . . . . . . . . . . . . . . Yes No 33 No I Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain the change on Schedule 0, See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . 34 No Sa Did the organization have unrelated business gross income of $1,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)? . . . . . . . . . . . . 35a No b If "Yes," to line 35a, has the organization filed a Form 990-T for the year? If "No," provide an explanation in Schedule o 35b c S Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organlzation subject to section 6033(e) notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III 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 . . . . . . . . . . . . . . . . 35c No 36 No 7a Enter amount of political expenditures, direct or indirect, as described in the instructions, ► 1 37. b Did the organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . . . 37b No 3a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made in a prior year and still outstanding at the end of the tax year covered by this return? 38a No b If "Yes," complete Schedule L, Part II and enter the total amount involved 38b 3 Section 501(c)(7) organizations, Enter: a Initiation fees and capital contributions included on line 9 . . . . . . . 39a b Gross receipts, included on line 9, for public use of club facilities 39b )a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under: section 4911 ► ; section 4912 ► ; section 4955 ► b Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I 40b No c Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections4912, 4955, and 4958 No. d Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax on line 40c reimbursed by the organization ► e All organizations, At any time during the tax year, was the organization a party to a prohibited tax shelter 40e No transaction? If "Yes," complete Form 8886-T . 1 List the states with which a copy or this return is filed. ► Za The organization's books are In care of ► MARIE wAITE Telephone no,► (951) 696-4903 Located at ► 28820 VIA NORTE VISTA Murrie EA ZIP + 4 ► 92563 Yes I No b At any time during the calendar year, did the organization have an interest in or a signature or other authority over a 42b No financial account in a foreign country (such as a bank account, securities account, or other financial account)? If "Yes," enter the name of the foreign country: 0- See the instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FEAR), c At any time during the calendar year, did the organization maintain an office outside the U.S.? 42c No If "Yes," enter the name of the foreign country: ► 3 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 - Check here . . . ► ❑ and enter the amount of tax-exempt interest received or accrued during the tax year ► 43 Yes No $a Did the organization maintain any donor advised Funds during the year? If "Yes," Form 990 must be completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44a No b Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44b No c Did the organization receive any payments for indoor tanning services during the year? . . . . . . . 44c No d If "Yes," to line 44c, has the organization filed a Form 720 to report these payments? If "No," provide an explanation in Schedule 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44d Sa Did the organization have a controlled entity within the meaning of section 512(b)(13)? . . . . . . . . . 45a No Sb Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of Form 990-EZ (see instructions) . 45b No c,,,,.., oon_c7 e-min) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # TEMECULA PLAY & LEARN SCHOOL INC. (PALS) CrrY OF TEMECULA FISCAL YEAR 2022 -- 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECUPROGRAM INFORMATION Amount Requested: $ 50,000.00 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Temecula Play And Learn School Project/Program Title: PALS Budget Relief _ Start Date: 9 - 6 - 22 End Date: 6 - 9 - 23 Physical Address of Project/Program: 42690 Margarita Rd. Temecula, Ca. 92592 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Temecula Play And Learn School (P.A.L.S.) Mailing Address: 42690 Margarita Rd. Temecula, Ca. 92592 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant I emecula may And Learn School (P.A,L.S.) Organization: Year Founded: 1991 Website: www.temeculapals.org Number of Paid Staff. One teacher/director Social Media: Temecula Play and Learn - PALS Number of Volunteers: 40 Volunteers Geographic Area(s) the Organization Serves: Primarily Temecula, as well as surrounding areas Geographic Area(s) the Proiect/Program Serves: Primarily Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE E7CGLUSIVELY USED TO SERVE TEMECULA. Contact Name: Andrea Borrell Title/Position: Teacher/Director Contact Person's Direct Telephone: (951)551-3490 Contact Person's Email: ab—pals@hotmail.com NONPROFIT STATUS _I Is this organization incorporated as a nonprofit? Yes a Date of Incorporation as a Nonprofit: 12 - 91 No Q IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0474430 State Identification Number: 1804754 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. K■ Attach IRS Deductibility Status using this link: hit :1lappsjrs.gov/ eosl 2. 0 Attach State Entity Status Letter using this link: htt s:/1www.fib.ca. oviodine/self serve entity status letter/index.as 3. A■ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htlp:/Ir,-L.dvi.ca.goylVerificatiar�IWeblSearch.asl,x?facility Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No W Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No* Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee Cop] Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES Our mission at P.A.L.S. is to provide a safe and nurturing environment wherein the teacher and parents work together to teach children through play -based instruction.We believe in a developmental philosophy which promotes successful growth socially, emotionally, cognitively and physically as we prepare our students for Kindergarten. Parent involvement is required in this strong, family -based school community.We strive to educate both students and parents during the most formidable years of a child's life. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No M Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT $ MONTH +YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP I $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO ❑ Yes 0 IF YES, PROVIDE INFORMATION IN TABLE BELOW. I AMOUNT MONTH + YEAR 1 RECEIVED NAME OF ENITY FUNDING RECEIVED $ 10,000.00'Marjorie Mosher Schmidt Foundation $ 5,000.00 Marjorie Mosher Schmidt Foundation $ 2,000.00 $ $ Millipore , 2020 - 2021 2021 - 2022 2021 - 2022 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Temecula Play And Learn School is a non-profit parent participation preschool serving any and all families with children ages 3 - 5. We have been successfully operating this co-op preschool since 1991, meeting our budget each year. Our esteemed reputation in this city, combined with our thorough set of By -Laws and state licensing regulations, have ensured our longevity. Our current teacher/director has been with us for over 20 years, providing consistency and stability to the program. She was named the 2018 North American Preschool Teacher of the Year by Discovery Toys, and received a Proclamation from the City 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. If awarded any amount, PALS will first and foremost invest the grant money in meaningful ways to support the early educational needs of our co-op, including a quality classroom and outdoor environment (we rent from Temecula United Methodist Church), learning materials, educational toys, school supplies, and parent training. The maximum amount would allow us to update worn down classroom furniture, and invest in office equipment, educational field trips, special school events, and new playground equipment. If able to, we would love to build a new sandbox and purchase a new shade cover for our outdoor play area. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Our membership is primarily made up of Temecula families. We are the longest running co-op preschool in Temecula. We are able to offer a non-profit program because our parent volunteers give of their TIME in order to pay less in tuition. For many, this makes preschool possible for their children. Funding will not only enable P.A.L.S. to continue providing educational programming to our families, but will also allow for the highest levels of safety and comfort for some of Temecula's most precious resources... our little ones! 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 30 families FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 40 families City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Temecula Grant Funding will support a loved non-profit co-op preschool that has been a part of this community for over thirty years. Our doors are open to all families wishing to be an integral part of their children's first school experience. Such funding will greatly enrich this unique school program. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. In March of 2020, we had to stop all in -person learning and our school doors remained closed until March of 2021. During that time, we created a distance -learning program for our families. When we started our 2020-2021 school year, we only received half the number of families that we typically serve. When we went to in -person learning in March of 2021, we kept our numbers low for safety reasons. It was challenging to take care of our school expenses. Now that the pandemic is under control, P.A.L.S. has been able to increase its enrollment once again, which also increases the need for financial support. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. As a non-profit, we create an annual budget to meet our needs for the school year. We rely on tuition, fundraising, personal donations, and community support to be successful. Having additional funds from grants helps us to continue our existing program as well as expand it. We can continue to offer our families a safe environment, quality school supplies, equipment and furniture, field trip experiences, special events, and educational opportunites for both the students and parents that we would not otherwise be able to afford. We can go beyond our needs and focus on some of our wants. This enriches our program not just in the present, but also in the future as new families join us. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount $ 41,609 W $0 TOTAL REVENUE I $ 91,609 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies { Marketing Services 1 Food Other Staffing Expense i THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET $91,609.00 EXPENSES $ 8, 600 $229910 $7,920 $100 $5,510 $2, 700 $2,225 $41,609.00 $91,574.00 $91,574.00 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Temecula Play And Learn Name of ProjecUProgram:Temecula Play And Learn School (-P:�L:.S:� School -PALS -Budget Reliel—] . FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living In 92590, 92591, 92592 that Directly Benefltted from this Program/Project (approximate number of beneficiaries if you do not have precise number): c Date on Expenditure E i Name of Company Receiptllnvoice o E on Receipt or Invoice MUST BE ON OR BETWEEN Amount Description Purpose QE JULY 1, 2021- JUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE 1 3 4 5 L L EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT, City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. Awards will be given to organizations and activities that directly benefit the residents of Temecula. Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. ■ If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Temecula Play And Learn School ( P.A.L.S.) MAILINGADDRESS:42690 Margarita Rd. Temecula, Ca. 92592 PHONE: (951 ) 551-3490 EMAIL: ab_pals@hotmail.com PRESIDENT / AUTHORIZED OFFICER: Andrea Borrel I SIGNATURE: �J IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Teacher/Director DATE: 9 — 9 — 2022 SUBMIT ORIGINAL APPLICATION BY MONDAY.. SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELPB MENU Home > Charities and Non -Profits > Se&rch for Charities > Tax Exempt Organization Search Results for Tax Exempt Organization Search Select Database 8 Search All V Search By 8 Employer Identification Number (EIN) v Search Term 8 330474430 city Enter City State Country All States V United States V Search ' Reset Search Tipa Showing 1-1 results of 1 Sort by: Temecula Play And LearnSchov Name A-Z V EIN: 33-04744301 Temecula, CA, United States Pub 78 Data Form 990-N Copies of Returns Items per page: 25 V Additional information Return to Top • Emquentl . asked questions - Exempt Organizations Select Check • Revocations of 501(,C)(3), Dgftrminatlons • 50ktaLi Qn.5pursuantto_ Code Section 501(p). • Exem tjQrganizations BusinoMa5tg!r File Extract (EO BMF): a list of organizations recognized as exempt by the IRS • Tax ExemlQlganiz,�Von Search, Bulk Data Downloads Page Last Reviewed or Updated: 20-November-2020 LXIi Our Agency About IRS Work at IRS Help Contact Your Local Office Tax Stats, Facts & Figures Know Your Rights Resolve an Issue f* Share $ Print 910@inai� Other Languages Related Sites Taxpayer Bill of Respond to a Notice Espanol Rights Independent Office Taxpayer Advocate of Appeals Service cP3Z () Identity Theft Civil Rights ProtectionEOj Freedom of Report Phishing PYCCK149 Information Act Tax Fraud & Abuse Tieng Vigt No Fear Act Kreyol ayisyen English Other Languages U.S. Treasury Treasury Inspector General for Tax Administration USA.gov STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/8/2022 ESL ID: 8355246376 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 1804754 Entity Name: TEMECULA PLAY AND LEARN SCHOOL, INC. a1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Form 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Department of the Treasury ► Do not enter social security numbers on this forth as it may be made public. Internal Revenue Service ► Go to www.irs.gov/Form990 for instructions and the latest information. A For the 2020 calendar year, or tax year beginning Sep 1 , 2020, and B Check if applicable: CNarneoforganizallon TEMECULA PLAY & LEARN SCHOOL ❑ Address change Doing business as ❑ Name change Number and street (or P.O. box if mail is not delivered to street address) ❑ Initial return PO BOX 890973 ❑ Final retum/terminated City or town, state or province, country, and ZIP or foreign postal code ❑ Amended return TEMECULA, CA 92589-0973 ❑ Application pending F Name and address of principal officer: ICANDICE LACKEY PO BOX 850973 TEMECULA CA 925E OMB No. 1545-0047 2020 ng Aug 31 ,2021 C O Employer identification number 33-0474430 Room/suite E Telephone number lf661)477-3651 I Tax-exempt status: Q 501(c)(3) ❑ 501(o); ) -4 (Insert no.) ❑ 4947(a)(1) or ❑ 527 J Website: ► N/A K Form of orpanilat€en: nCormoration i`) Trust n Association n Other► L Year of formation: a Gross receipts $ 54,616. His) Is this a group robim for subordinales? ❑ Yes ®No H(b) Are all subordinates included? ❑ Yes ❑ No if "No," attach a list. See Instructions H(c) Group exemption number ► 19 91 M Stete of Iona] domicile: CA Summary 1 Briefly describe the organization's mission or most significant activities: EDUCATION ----------------------------------------------------- AND CARE OF CH ILDREN m ----------------------- --------------------------------------------------------------------------------------------------------------- ------ .......... .--------- .._ 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 1 a) . . . . . . . . . 3 4 °d 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 4 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) . . . . . 5 0 B Total number of volunteers (estimate if necessary) . . . . . . . _ . . . . 6 10 a 7a Total unrelated business revenue from Part VIII, column (C), line 12 . . . . . . . . 7a 0. b Net unrelated business taxable income from Form 990-T, Part I, line 11 71b 0. Prior Year Cu►rmtYesr 9 Contributions and grants (Part VI 11, line 1h) . . . . . . . . . . . 16,255. 34,031. 43,776. 20 583. 9 Program service revenue (Part VIII, line 2g) . . . . . . . . . 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) . . . . . . 6. 4. IX 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) . . . 60,037. 54 618. 12 Total revenue —add lines 8 through 11 (must equal Part VIII, column (A), line 12) 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) . . . . . 14 Benefits paid to or for members (Part IX, column (A), line 4) . . . . . . 35,239. 31,893. v; 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 16a Professional fundraising fees (Part IX, column (A), line 11e) . . . . . . b Total fundraising expenses (Part IX, column (D), line 25) ► 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) 32,946. 21,352. 68,185. 53,245. 16 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) -8,148 . 1 373. 19 Revenue less expenses. Subtract line 18 from line 12 b ffi 'Beginning of Current Year End of Year cg 20 Total assets (Part X, line 16) . . . . . . . . . . . . . . . . 43,075.#36, 45, 594. 21 Total liabilities (Part X, line 26) . . . . . . . . . . . . . . . . 625 . 7,770. 22 Net assets or fund balances. Subtract line 21 from line 20 4 50. 37,824. imm, Si nature BtocK Under penalties of periury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. _ 10/21L21 Sign ignstvm of officer Date Here CANDICE _LACKEY, TREASURER Type or print name and title Paid Prinl/Type preparer's name Preparer's signature Date Check ❑ if I PTIN Preparer LEONARD P COLE EA CFP ILEONARD P COLE EA, CFP /10/21/2021 seif-employedi P00003795 Use Only Firms name ► TEAMTAX Firm's EIN ► 36-4 513004 _ Firm'saddress ►40395 WINCHESTER ROAD SUITE A TEMECULA CA 9259 11 Phone no. 951 308-6444 May the IRS discuss this return with the preparer shown above? See instructions [9 Yes ❑ No For Paperwork Reduction Act Notice, see the separate instructions. EM Rev 09/08/21 PRO For, 990 (2020) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 50 TEMECULA SUNRISE ROTARY CLUB CITY OF TEIVIECUifA FISCAL YEAR 2022 " 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 1 2, 2022 Amount Requested: $ Project/Program Title: PROJECT/PROGRAM INFORMATION 15,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Start Date: �nd Date: Temecula Community Christmas Dinner 12/25/202 12/25/2022 MSJC Temecula Cam us (2022 onl - See ex lanation b I w Physical Address of Project/Program: p y p e o 1 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Temecula Sunrise Rotary Foundation Mailing Address: P. O. Box Temecula, CA 92590 IORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Temecula Sunrise Rotary Foundati 1987 Organization: Near Founded: Website: temeculasunriserolary.com Social Media: Facebook Number of Paid Staff: None Geographic Area(s) the Organization Serves: Number of Volunteers: 16 Temecula Valley Geographic Area(s) the ProjectlProgram Serves: Temecula Valley NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Mark Sitar Title/Position: Committee Chairman Contact Person's Direct Telephone: 909-376-3639 Contact Person's Email: mdsitar@verizon.net NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: ''/2`911IzM7 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0484340 State Identification Number: 1694701 PRINT O T AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. Attach IRS Deductibility Status using this link: http://al)ps.irs.gov/ano/eos/ 2. ['Attach State Entity Status Letter using this link: iselT serve enter = 3. UAttach first page only of most recent IRS Farm 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htElk:/lrvt.dA�caJnylVerifir.:r�tinnlW blSraarGh x?facilityY City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No [21 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors 0 Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Temecula Sunrise Rotary is a service organization comprised of business and professional persons that are united worldwide through Rotary International and provide humanitarian service, encourage high ethical standards, help build goodwill and peace. This is exemplified in the official Rotary International Motto, "Service Above Self'. Temecula Sunrise Rotary works with local schools to provide a literacy program, the "Safety Town" workshop for local children, takes part in the Rotary Youth Leadership Awards camp, works with the local Interact Club (community service club) at Chaparral High School, provides college scholarships for local students, and organizes the Temecula Community Christmas Dinner in addition to other local community service projects. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No M Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR I NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED II OR SPONSORSHIP $ $ I OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ❑ Yes D IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT RECEIVED NAME OF ENITY Community donations Community donations MONTH + YEAR FUNDING RECEIVED $ 13,234 12/2020 $ 8,964 12I2021 $ 16,127 Community donations 7/2022 $ $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGF" DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Temecula Community Christmas Dinner, typically held at the Mary Phillips Senior Center, is an annual event. It is a completely free, fully cooked, sit-down dinner that has served the general community of Temecula residents for over 25 years, Temecula Sunrise Rotary, Temecula Noon Rotary, New Generation Rotary and Old Town Temecula Rotary clubs organize the event. The dinner brings the community together on Christmas day to share the joy of Christmas. Anyone and everyone who would like to spend Christmas day with others is welcome. While the event is not based on financial need, there are many low income and homeless people that attend. Children attending the dinner get to meet Santa Claus, get their picture taken with Santa, and receive a wrapped gift. As a part of this event, we also deliver fully cooked meals to home -bound seniors residing in senior apartment complexes in the area. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. In early 2022, our 28 ft cargo trailer with all of our equipment in it was stolen. We need to replace the cargo trailer, our oven, restaurant quality pots, pans and utensils and other various equipment needed to hold the dinner. We also need to purchase the food and supplies needed for the dinner. Estimated cost for all of this is approximately $42,000 ($32,000 for replacement and $10,000 for food and supplies for the 2022 dinner). This grant funding, in combination with community donations, will fund replacement of the trailer and equipment as well as the cost of the food and supplies for the 2022 dinner. It should be noted that the Mary Phillips Senior Center will be under construction and not available in 2022 for our event. Mt. San Jacinto College has agreed to let us hold the dinner in their cafeteria this year. Therefore, the 2022 event will take place at MSJC. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Historically, approximately 1,200 people are impacted each year. In addition to the meals served and delivered to those seniors that are not physically able to attend, there over 100 local people that volunteer at the event. People look forward to serving their community and it has become a part of sharing the Christmas spirit for many families in the area. This dinner brings the Temecula community together and provides a vital service to those in need as well as those that would otherwise be alone for the holiday. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: I 110 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. There are many Temecula residents that depend on the Temecula Community Christmas Dinner for their Christmas meal and their interaction with others in the community. This event exemplifies the community spirit that is a unique part of being a resident in the City of Temecula. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. COVID-19 mandates restricted our ability to hold a sit-down dinner in 2020 and full capacity dinner in 2021. We still wanted to serve the community on Christmas day, so we provided a drive -up dinner in 2020 and a limited capacity dinner in 2021. In 2021 and now especially in 2022, inflation has significantly increased the cost of food and supplies for this event. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. This grant funding will allow us to purchase necessary equipment to continue this event as well as provide fund", for food and supplies for the 2022 dinner. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET ado not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 15,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 27,000 Organization Other grants or funding already awarded for Project/Program, if any 1 $ In -Kind match amount or volunteer credit hours estimated amount $ 1,000 TOTAL REVENUE $ 43,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. TOTAL EXPENSES TOTAL BUDGET I $ $ 32,000 $ 1,500 C� 8.500 $ 1,000 $ 43,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. ■ Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Temecula Sunrise Rotary Foundation MAILING ADDRESS: P r) 13-92n3 Temecula, CA 92593 PRESIDENT / AUTHORIZED OFFICER: PHONE: I 909) 76-36 9 EMAIL: mdsitar@verizon.net President PRINT NAME TITLE I/JSIGNATURE: DATE: MONTH, DAY, YEAR IF DIFFERENT THA BOVE, APPICATION PREPARED BY: Mark Sitar, Temecula Community Christmas Dinner Chairman PRINT NAME TITLE SLIBMfT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELPED MENU Home > Tax Exempt Organization Search > Temecula Sunrise Rotary Foundation Temecula Sunrise Rotary Foundation EIN: 33-0484340 1 Temecula, CA, United States Publication 78 data e Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Form 990-N (e-Postcard) a Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. > Tax Year 2020 Form 990-N (e-Postcard) Tax Period: 2020 (07/O1/2020 - 06/30/2021) EIN: 33-0484340 Legal Name (Doing Business as): Temecula Sunrise Rotary Foundation Mailing Address: PO Box 2203 Temecula, CA 92593 United States Principal Officer's Name and Address: Roger Weber PO Box 2203 Temecula, CA 92593 United States Gross receipts not greater than: $50,000 Organization has terminated: No Website URL: Tax Year 2019 Form 990-N (e-Postcard) Tax Year 2018 Form 990-N (e-Postcard) Tax Year 2027 Form 990-N (e-Postcard) Tax Year 2016 Form 990-N (e-Postcard) Tax Year 2015 Form 990-N (e-Postcard) Tax Year 2014 Form 990-N (e-Postcard) Tax Year 2013 Form 990-N (e-Postcard) Tax Year 2012 Form 990-N (e-Postcard) Page Last Reviewed or Updated: 20-November-2020 P# Share Print STATE OF CALIFORNIA �TB FRANCHISE TAX BOARD PO BOX 942857 SA SACRAME TCA 94257 0540 Entity Status Letter Date: 8/24/2022 ESL ID: 4507030048 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1694701 Entity Name: TEMECULA SUNRISE ROTARY FOUNDATION 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. X] 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 51 TEMECULA THEATER FOUNDATION CITY DF TMMECULA FISCAL YEAR 2022 M 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 i PROJECT/PROGRAM INFORMATION I Amount Requested: $ 50,000.00 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Arts Connection New Works Project/Program Title: Start Date: 10/22 End Date: on -going Physical Address of Project/Program: 42051 Main Street, Temecula CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Theater Foundation Mailing Address: 42051 Main Street Temecula CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Temecula Theater Foundation Organization: Website: www.temeculatheaterfoundation.org Number of Paid Staff: 0 Year Founded: 1999 Social Media: FB Number of Volunteers: 13-50 Geographic Area(s) the Organization Serves: Temecula Geographic Area(s) the ProiectlProaram Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Sherry Williams -Fletcher Contact Person's Direct Telephone: 951-302-0133 Title/Position: past president/board membe Contact Person's Email: sherrywilliamsmusic@v e NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ■ Date of Incorporation as a Nonprofit: 4/20/99 Federal Identification Number: 33-0871129 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING State Identification Number: 114757 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. Attach IRS Deductibility Status using this link: lirs7ylFrralc€f 2. m Attach State Entity Status Letter using this link: h1Ip'1'/iWvyw tll) ca s€ lvc onlity ,t,�t�_.; iettia`r`Ifldox iy:_st 3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: wtp h'ict �_Ir�1. �,��3v_r�r:�riftC ��[ri to !>rs r�ircaf.rssF7;t?(�r_.i it . Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ❑■ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No J Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑o Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES The purpose of the Theater Foundation is to encourage and educate adults and youth in our target community through participation and involvement in the performing arts. The Theater Foundation also provides charitable support to performing arts organizations within our community to help them in developing programs, creating live performances and advocate for them when necessary. The Theater Foundation objective is to create programs that ensure that our community has a healthy, growing and thriving arts community. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 — FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ff Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO ■ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ I $ $ r City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 11 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Arts Connection program began with a legacy gift from Bob & Jeanne Burns to provide access for our school age youth (K-12) to see live performances free of charge. Over the past 10 years that program has grown and evolved. Annually, 'we bring 4000+ students to see multi -cultural productions in dance, music, plays, musicals for no cost to them. With the addition of the New Works phase, we are adding the excitement of performance with education element of development and creation. Students will see a work in its unfinished phase and have an opportunity to be part of the process through discussion, essay critique and, of course, visual anpreciation. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Annually, we do fund raising and use the Burns Legacy to help underwrite the Arts Connection program. The need and requests for "free field trips" of this caliber for the schools is great and in order to continue to meet those needs and offer this new addendum to the program we will use the City grant to fund the expenses involved in providing and expanding this program. Expenses include payment to the presenting organizations and/or artists, curriculum materials for the teachers, and in-house production costs to prepare the program for the presentation. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Temecula resident benefit, first of all, through the experience their youth have in see live performances. The New Works segment builds on what is already offered and creates an experience that is interactive and participatory in exposing students to local composers, playwrights, lyricists, actors and dancers. Temecula, the City, benefits as the presenting home of New Works as they are developed, which brings prestige to the City, as well as trickle down dollars. We hope to build a reputation for Temecula as "The City of Song" where the arts are encouraged and embraced. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 4000+ annual) FROM THIS PROJECT/PROGRAM: y 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 1125+ annually City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Arts Connection -New Works will support and expand the scope of outreach created through the Arts Connection program. This program will continue to offer K-12 students (in Temecula) opportunities to experience theatrical productions while expanding the program to include a new work so students can experience the building and creative process. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. From March 2020 through September 2022, we have been unable to offer programs to our youths due to the school's guidelines of social distancing. We are starting the program up again, now that those restrictions have been lifted. Additionally, we have been unable to do any annual fundraising or galas, for the same reason. Consequently, we are in need of an infusion of funds to quick start this program until we can get all of our fundraising activities back in place. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The addition of funds will supplement our currently depleted reserves to reestablish Arts Connection to the community, allow us to bring in more students and create our New Works program which incorporates a performance but also the language arts skills, business development skills (math) and visual arts (seeing the development of sets, costumes and scenic design). This grant will accomplish creation, expansion and continuation of a program that has been hugely successful for the past 10 years. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) f LINE ITEMS FOR PROJECT/PROGRAM - - + REVENUES - EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM I Amount of money requested from this City of Temecula $ 50,000, Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any $ 10,000 In -Kind match amount or volunteer credit hours estimated amount $ 100,000. TOTAL REVENUE $160,000. LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food development materials, construction, "lyricists, directors, composers, choreographers, actors" -these are in -kind expenses, transport $ 12, 000.00 $ 3,000.00 $102,000.00 .a Other materials for teachers & students, photocopy $ 35 000.00 services, school day show expenses & licensing Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $160,000.00 TOTAL BUDGET $160,000.00 $160,000.00 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office -CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Temecula Theater Foundation - FY 2021-2022 Amount of $ CSF Grant Fund Awarded: N/A Arts Name of Project/Program: nnection New Works Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): EName of Company 0.8 E on Receipt or Invoice az' 1 2 4 5 Ev Date on _ Expenditure ReceiptlInvoice Amount MUST BE ON OR BETWEEN Description Purpose JULY 1, 2021 - JUNE 30, 2022 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE I EXPENDITURE TOTAL EJ Ea J EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization;Temecula Theater Foundation TOTAL FY 2022-2023 - Amount of Grant Fund Awarded: $ Name of ProjectlProgram: Arts Connection New Works Month & Year FIRST $5,000 check was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022.23 Grant Fund awarded by the City 3. Is this Expenditure Report Is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) c E Name of Company Eon Receipt or Invoice aZ 3 Date on Receipt/invoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, 2024 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER i Q Q` EXPENDITURE TOTAL $ Amount Description EXPENDITURE TOTAL Purpose City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. ► Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Temecula Theater Foundation MAILING ADDRESS: PHONE: ( 42051 Main Street 951 541-2588 Temecula, CA 92590 EMAIL: info@temeculatheaterfoundation.org PRESIDENT / AUTHORIZED OFFICER: Sherry Williams -Fletcher, past president/board member SIGNATURES ` i 1 DATE: IF DIFFERENT THAN ABO . Bobbi Boes/Beverly Stephenson founder/board member APPICATION PREPARED BY: SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 W Help News Language � Charities & Nonprofits Tax Pros File Pay Refunds Credits & Deductions Forms & Instructions Home> Taxexemntorganizatian.Scarch > Theatre Foundation � []it+.Ii.[��.�CrZLij!-IiC5111[� Theatre Foundation EIN: 33-0871129 1 Murrieta, CA, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions, Users may rely on this list In determining deductibility of their contributions, On Publication 78 Data List: Yes '14 Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non -profits. Tax Year 2019 Form 990EZ Tax Year 2018 Form 990EZ Tax Year 2017 Form 990 Tax Year 2026 Form 990 Tax Year2015 Form 990EZ Page Lost Reviewed or Updated: 20-November-2020 r► share $ Print INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: APR 12 Z004 THEATRE FOUNDATION 41391 KALMIA ST STE 200 MURRIETA, CA 92562 Dear App] ' ,nt : DEPARTMENT OF THE TREASURY Employer Identification Number: 33-0871129 DLN: 17053087739094 Contact Person: JEFFERY A CULLEN ID# 31215 Contact Telephone Number: (877) B29-5500 Public Charity Status: 170 (b) (1) (A) (vi) Our letter dated February 2000, stated 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 charity during an advance ruling period. Based on our records and an the information you submitted, we are pleasad to confirm that you are exempt under section 501(c)(3) of the Code, and you are classified as a public charity under the Code section listed in the heading of this letter. Publication 557, Tax -Exempt Status for Your Organization, provides detailed information about your rights and responsibilit•iera as an exempt organization, You may request a copy by calling the toll -free number for forms, (800) 829-3676. Infornmation is also available on our Internec web Site at www.irs.gov. If you 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 , . Kerner Director, Exempt Organizations Rulings and Agreements Letter 1050 (DO/CG) STATE OF CALIFORNIA FRANCHISE TAX BOARD FTB PO BOX 942857 SACRAMENTO CA 94257-0540 1-1� Entity Status Letter Date: 9/9/2022 ESL ID: 1536616878 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 2162332 Entity Name: THE THEATER FOUNDATION 1. The entity is in good standing with the Franchise Tax Board. El2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Form WO-EZ I Department of the Treasury Internal Revenue Service EXTENDED TO NOVEMBER 15, 2021 Short Form OMB No. 1545-0047 Return of Organization Exempt From Income Tax ���� Under section 501(c), 527, or 4947(aui) of the Internal Revenue Code (except private foundations) ► Do not enter social security numbers on this form, as it may be made public. Open to Public ► Go to www.irs.gov/Form9WEZ for instructions and the latest information. Inspection A For the 2020 calendar year, or tax year beginning El „wig I C Name of organization Address change [:]Namechange I THE THEATER FOUNDATION OInitial return Number and street (or P.O. box if mail is not delivered to street address) C]t' terminated eedn 41391 KALMIA STREET, SUITE 200 Amended return City or town, state or province, country, and ZIP or foreign postal code MURRIETA CA 92562 G Accounting Method: [7] Cash [M Accrual Other (specify) ► I Website: No. TEMECULATHEATERFOUNDATION . COM and end D Employer identification number 33-0871129 E Telephone number 951-696-060 F Group Exemption H Check lllo-L& if the organization is not required to attach Schedule B J Tax- exem t stal us check only one - L&I 50 11 c 3 501 c ■ insert nQ 1 14947 a 1 I or ;ill Fnrm 990 9 -EL or 990-PF 1. K Form of organization: 0 Corporation 0 Trust [] Association ® Other L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part 11, calumn B ai a 1500,000 of mare llIa Form 990 instead of Foim 990-EZ . .. 30,635. pat{ ( Revenue, Expenses, and antes to et ssets or un a antes (see the instructions for Part 1) ra7rink I Ittr- nrti anizii inn heart k 41krh110 n fh rA4nn11d 1A 9nu mrn.erinn In q,ic 0-1 I I X I 1 Contributions, gifts, grants, and similar amounts received „.. .... ... . . ... . .. 1 16,184. 2 Program service revenue including government fees and contracts _--- . 3 Membership dues and assessments _-•____•• . .......... ........................... . 4 Investment income ...... ............... ......... ......... $n-scum "s .. p..... 4 3,451. 5a Gross amountfrom sale of assets otherthan inventory . -- _ __•,-,•,. .,,._ .. . b Less: cost or other basis and sales expenses . ......................... ....... ........ e Gain or (loss) from sale of assets other than inventory (subtract line 5b from line 5a) 6 Gaming and fundraising events: e cc a b Gross income from gaming (attach Schedule G if greater than $15,000) 68 Gross income from fundraising events (not including $ 16.184 . of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) c Less: direct expenses from gaming and fundraising events ,... .. ..... . ... . . 6c 9,657. d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract litre 6c) 6d 1 , 3 4 3 , 7a Grass sales of inventory, less returns and allowances _-_......... . ... 7s b Less: cost of goods sold ,.... .., c Gross profit or (loss) from sales of inventory (subtract line 7b from line 7a) 7c 8 8 Other revenue (describe in Schedule 0) 9 20,978. 9 Total revenue. Add lines 1 2 3 4 5c 6d 7c and 8 10 Grants and similar amounts paid (list in Schedule 0) ----- -- --- - -- - - _SEE -,SCHEDULE _0. - - 10 2,250. 11 11 Benefits paid to or for members - 12 y, 12 Salaries, other compensation, and employee benefits -. ....__.. 13 3,000. 13 14 Professional fees and other payments to independent contractors ..• Occupancy, rent, utilities, and maintenance ,., , SEE - SCHEDULE ......... .0 14 15,637. 15 15 Printing, publications, postage, and shipping ,.., „• to 1 2 913 . 16 Other expenses (describe in Schedule 0) .--. -SEE . SCHEDULE 0--- -_ 17 1 23, 800, 17 Total a enses. Add lines 10 through 16 . _ _ 18 19 Excess or (deficit) for the year (subtract line 17 f(O) m line 9) .__ Net assets or fund balances at beginning of year from line 27, column A 18 -2, 822. (must agree with end -of -year figure reported on prior year's return) , _ , ... , , _, „ 19 3 2 4 832. 20 -14 831. z 20 21 Other changes in net assets or fund balances (explain in Schedule 0) SEE SCHEDULE Net assets or fund balances at end of year. Combine lines 18 through 20 0 11111, 21 307, 179, LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990-EZ (2020) 2 10181109 146105 200001.213 2020.05000 THE THEATER FOUNDATION 200001.1 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 52 TEMECULA VALLEY ALANO CLUB CITY OF TEMECt f FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Temecula Valley Alano Club Start Date: ongoing End Date: Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Temecula Valley Alano Club Mailing Address: 27470 Commerce Center Dr. C Temecula, CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Temecula Valley Alano Organization:__ Website: Thetvac.org Number of Paid Staff: 0 Year Founded. 2009 Social Media: TemeculaAlanoclub... facebook Number of Volunteers: 40 Geographic Area(s) the Organization Serves: Temecula Valley Geographic Area(s) the Proiect/Program Serves: Temecula Valley NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Julie Perez Title/Position: Treasurer Contact Person's Direct Telephone: 760-310"1977 Contact Person's Email: tvacmanager@gmail.co m fNONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes K Date of Incorporation as a Nonprofit: 11 /201( No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 80-0488892 State Identification Number: C3227878 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. 1-K Attach IRS Deductibility Status using this link: http://apps.irs.gov_/app/eos] 2. (] Attach State Entity Status Letter using this link: htt s:/lwww.fth.ca. ovlonline/self serve el7titystatus letterfindex.asp 3. C1 Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool h� l/rcLdo.ca.gov/Ve6fication/WebiSearcli.ztvx'?Iacit(ty=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No � YYes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No X Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION; This Application has been authorized by the organizations: Executive Committee ❑ Board of Directors L] Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The Temecula Valley Alano Club is a nonprofit organization whose purpose is to provide a safe environment for those that have a desire to recover from alcoholism, addictions, codependency and other compulsive behaviors. We are supported through community contributions, club members and fundraisers, Our primary purpose is to help others to achieve a new freedom for life. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGETTINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 -- — _ FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No * Yes ❑ IF YES, PROVIDE BELOW, NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT I MONTH + YEAR FUNDING RECEIVED ^ NAME OF CITY GRANT OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ktf Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW, AMOUNT MONTH +YEAR NAME OF ENITY RECEIVED FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. We provide guidance and support for those Temecula residents coming out of rehabilitation centers whether it be for drug addiction or alcoholism. We help them to bridge the gap between recovery and being a productive member of society. We impower people to reclaim their lives and give hope to the loss and hurting. Computers are available to help with job searching, filling out online work applications, as well as a place to do school work. Those who volunteer here get work experience as well as community service hours. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Rent for our facility for the year, 12 step books, information pamphlets and workbooks. New Coffee Bar for the purpose of fellowshipping. New Tables and chairs for the meeting hall, used for 12 step meetings. Pool table for fund raising events. Cable and internet. Couches and tables for a clean safe environment. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Helping those who struggle with addiction of all kinds to have a better attitude and find hope of recovering helps all of Temecula by improving the number of people living on the streets in active addiction. Helping families to better understand and deal with their loved ones condition can better help relieve the homeless population and crime. The Temecula Valley Alano Club spreads positive energy throughout Temecula and provides a safe environment for these people and their families. This grant will help us keep our doors open and regain financial stability that was lost due to Covid19 shut down. Covid cut down on memberships, meeting rent, and donations that are our main income sources. 315 ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 1 ZOO-1300 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 80 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. We provide guidance and support for those Temecula residents coming out of hospitals and rehabilitation centers due to drug addiction and alcoholism. We bridge the gap between recovery and being a productive member of society. We offer education and information thru our literature and our workbooks to the community and families for those who suffer. We offer a clean and safe place for 12 step meetings of all kinds. We provide computers for the use of job applications, school applications/school work and outpatient programs. We offer Temecula Valley Community multiple opportunities to fulfill community services 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Most of our funding comes from donations and many people lost their jobs due to Covidl9 and could not donate. The Covid19 mandated put restrictions on our number of people allowed in the building. Many members relapsed as a result of not having a place to meet for 12 step meetings due to the Covidl9 shut down. The cost of our disposable coffee cups, coffee, creamer, sugar and stir sticks that we offer have increased in cost. Electricity, water, and utilities are also on the rise. In turn our overhead has increased. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL; (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Create new fundraising event that include the community. Expand the opportunities we provide for the Temecula Valley Community to successfully complete community service hours. Continue providing literature, books, pamphlets to those involved in the 12 step programs who can not afford them. We will provide brochures and information to the Temecula Valley community including hospitals and recovery centers about our services. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 0 Organization Other grants or funding already awarded for Project/Program, if any I $ 0 In -Kind match amount or volunteer credit hours estimated amount 1 $ 0 TOTAL REVENUE $ 50,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/Insurance Rent 12 months $28,680 i Supplies $ 5000 Books, pamphlets, workbooks Marketing Brochures, Shirts, Hats , Coffee cups $ 5000 Services $ 2400 Phone Bill /Internet/ Computer Access Food $1800 _ Coffee/Creamer/Sugar/Water Other $ 6000 Electricity Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ 0 HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $48,880 TOTAL BUDGET: $50,000 $48,880 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. ■ Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. ■ Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. ► The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. 0 Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Temecula Valley Alano MAILING ADDRESS: 27470 Commerce Cente Temecula, CA 92590 PRESIDENT/AUTHORIZED OFFICER: Julie Perez SIGNATURE: IF DIFFERENTTFI#N ABOVE, APPICATION PREPARED BY: PHONE: (95 ) 6931212 EMAIL: tvacmanager@gmail.corr Treasurer DATE: September 11,2022 -v UN1 [4, 0AY, r-AR SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 � 2 � f�k E EJ 52 2a Go m A ��7)) =\\2 �§E$\ �A§fk &%kf F-A C - a c 0.CL 45 � r � 23 m ro u t� ova M INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: NOV 12 2010 TEMECULA VALLEY ALANO CLUB C/O ROBERT MYERS 27470 COMMERCE CENTER DR STE C TEMECULA, CA 92592-2522 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 80-048BB92 DLN: 17053229302030 Contact Person: STEPHANIE L JONES TAYLOR ID# 31395 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 509(a)(2) Form 990 Required: Yes Effective Date of Exemption: September 3, 2009 Contribution Deductibility: Yes Addendum Applies: No 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) STATE OF CALIFORNIA FRANCHISE TAX BOARD ,T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/9/2022 ESL ID: 2752682993 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 3227878 Entity Name: TEMECULA VALLEY ALANO CLUB 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) 32218IS ' U A EN❑O�SE� - FILM dLE❑ ate 0f �e S1618 61 CAl[fsrrki ARTICLES OF INCORPORATION OF TEMECULA VALLEY ALANO CLUB A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION, INC. The name of this corporation is TEMECULA VALLEY ALANO CLUB_ II This co oration is a nonprofit Public Benefit Corporation and is not organized for the private fain of any person. It is organized under the Nonprofit Public Benefit Corporation Law for public and charitable purposes. This corporation is organized exclusively for charitable purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code of 1986, as amended or any corresponding provision 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 on (a) by a corporation exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended 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, as amended or the corresponding provision of any ture United States intemai revenue law. The specific purpose of this corporation is to aid and assist people in the recovery of their alcohol problem, and to provide a meeting place for members of all twelve -step programs by providing and maintaining physical facilities for educational and recreational uses. tt The name and address in the State of California of this corporation's initial agent for service of process is: Julian V. Lee, Esq. c/o Redwine and Sherrill 1950 Market Street Riverside, California 92501 This corporation is organized and operated exclusively for charitable purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code. No substantial part of the activities of this corporation shall consist of lobbing or propaganda, or otherwise attempting to influence legislation, except as provided in Section 501(h) of the Internal Revenue Code of 1986, 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. u 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 or officer 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 he distributed to such organization (or organizations) organized and operated for charitable purposes which has established its tax exempt status under Section 501(c)(3) of the Internal Revenue Code (or such corresponding provisions of any future federal internal revenue law). Dated: August L% 2009 STUART H. SHELDON, Leorporat r 1 hereby declare that I am the person who executed the foregoing Articles of Incorporation, which execution is my act and deed. UART H. SHELDON, Incorporator wp2000\julian\Temecula Valley Alano Club\TVAC Articles.doc f�CE Qp Wo % in T -2- ShortForm Form 990_EZ Return of Organization Exempt From Income Tax Under section 501(c), 577or 4947(, 1(1) of the Internal Revenue Code f1 (exr:ept private nundalion 9) Do not enter social security numbers on this form, as it may be made public. OMB No. 1545.0047 2021 D ailment of OW Treasury 1,Go to www.bs.gov1Form990EZ for instructions and the latest information. Open to a ticllon ublic Inlenraf Revenma Service Insp A For the 2021 calendar year, or tax year beginning 2021, and onding , B Check it applicable: C P Employer ideM16canon number Address change Name change Temecula Valley Alano Club 80--0488892 Initial return 27470 Commerce Center Drive C E Tek,plwna number Flnairelurn/terminated Temecula, CA 92590 951_375-7845 Amended rerun, F Grou 1=xemption AJ—jpplication pending Nurn�rer G Accounting Molhotl: IM Cash ❑ Accrual Other (specify) ► IH Checl } if the organization is not I Websitel ' N/A required to attach Schedule B J Tax-exempt status (check only one) — JR1501(cx3) f ] 501(c) ( ) -4(insert no,) 4947(a)(1) or 527 (Form 990), It Form of organization: X Corporation Trust 11 Association U Other L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B)) are $500,000 or more, file Form 990 instead of Form 990-EZ ................... . . ' $ 84,591. pelt I Revenue, Expenses, and Changes In Net Assets or Fund Balances (see the instructions for Part 1) Check if the organization used Schedule O to respond to any question in this Part I.... .. ..... .. _ x 1 Contributions, gifts, grants, and similar amounts received ....... . ............ . ..... . .. . .. . . ..... 1 2 79 913 . 2 Program service revenue including government fees and contracts ..... ............. . ....... ... .. . 3 41684. 3 Membership dues and assessments . . . ....................... . .................... . • -- -. • 4 4 Investment income ............................. . ..... . .... . . ........... .... ............. 5a Gross amount from sale of assets other than inventory ................... . $A b Less: cost or other basis and sales expenses .......................... . .. 5b c Gain or (loss) from sale of assets other than inventory (subtiact line 5b from line 5a)....... .. . 6 Gaming and fundraising events: a Gross income from gaming (attach Schedule G if greater than $15,000) b Gross income from fundraising events (not including $ of contrihtllions y from fundraising events reported on line 1) (attach Schedule G ifif itlA sum 6b cc of such gross income and contributions exceeds $15,000)...... ^_ c Less: direct expenses from gaming and fundraising events ............... 6 c d Net income or Qoss) from gaming and fundraising events (add lines 6a and 6d 6b and subtract line 6c)................................................ i as 7 a Gross sales of inventory, less returns and allowances, ................ • . • . b Less: cost of goods sold ................................................. 7 b c Gross profit or (loss) from sales of inventory (subtract line 7b from line 7a).. ........... . ... •.. • 8 o Other revenue (describe in Schedule 0)................... • ... • . • - • - • • • • • • • • • • •' —1 ' " r 9 84 9 Total revenue. Add lines 1, 2, 3, 4, 5c. 6d, 7c, and 8 . 10 _ 10 Grants and similar amounts paid (list in Schedule ............... • • • • • - • • .. _........ . .. .. ., 11 Benefits paid to or for mrfm�rs .. . . . ............... ......................... ... 12 m12 Salaries, other compensation. and employee benefits .. .. ........................... - .. .. 13 69t3 . N ................. 13 Professional Fees and other payments to independent contractors........... _ 14 51 14 6� • .. -' .... ; • "'."' 14 Occupancy, rent, utilities, and maintenance.. : ; ; :: i • i :: 1S ui ... , , . 15 Printing, publications, postage, and shipping . See � Gheauie , o . , , _ .. 16 32 740. 16 Other expenses (describe In Schedule .... ... . 17 84 584, 17 Total expenses. Add lines 10 thrautlh 16 ...... _ ... _ ... ... 1s 13. 18 Excess or (deficit) for the year (subtract line 17 from line 9) .... • .... • • .. . Net or fund balances at beg -inning of year (from line 27, column (A)) (must agree with end -of-yea( 19 0 19 assets ligtire reported on prior year's return) ........ . ............. .......... 'See Schedule Q O). 20 —13 . 20 Other changes to net assets or fund balances (explain in Schedule lines 18 through 20...... . - :: 21 0 21 Net assets or fund balances at end of year. Combine Forrn 990-EZ (2021) 6ilA For Paperwork fteducllun Act Notice, see the separate instructions. TEEA0812L 09127/21 Forrn$$�9-TE IRS -file Signature Authorization for a Tax Exentipt Entity For calendar year 2021, or fiscal year beginning _ _ — _ _ _ , 2021. and ending— T _ _ _ 20 Uopaunmol of I+.e 'rromov P- Do not send to the IRS, Keep for your records. Internal Revenue Servlsti ► Go to www.Us.gov1Fornr8879TE for the latest information. E114 or SSW Temecula Valley Alano Club Name grill 111W of after or person suhitd to tax Julie Michelle Perez Treasurer OMB No. 1545-0047 2021 80-0488892 'b "•fir '�G�...__---_ --. Chock the box for tine ►eturn for which you are using this Forin 8W879-Tip and enter the applicable amount, if any, am le re urn. orrt► and Form 5330 filers may enter dollars and cents. For all other forms, enter whote dollars only. It you check the box on line 18, 2a, 3e, 4a, 5a. Ga, 7a, 8a, 9a, or 10a below, and the 31119011t an that line for the return being filed with this faun was blank, Ilion leave Iina 1b, 2b, 3b, 4b, 5b, bb, 7b, 8b, 9b, or 10b, whichever is apphcableI blank (do not enter -0•). But, tf yetI entered •0- o I i the fetus I1. 11ien enter -0- on the applicable line below. Do not complete more than one line in Part I. 1a Form 990 check here - . b Total revenue, if any (Form 990, Part VI11, column (A), Iine 12). 1b 2a Forrn 9WEZ check here. ■ X b Total revenue, if any (Form 990-EZ, line 9).... _ ..... .. Zb 84 597 3a Form 1120-POL check here. b Total tax (Form 1120-POL, line 22) ..... . ....................... .... .. 3b 4a Form 990-PF check here. . . b;Tax based on investment income (Form 990-PF, Part V, line 5)........... 4b 5a Form 8868 check here ..... b "Balance due (Form 8868, line 3c) ............. . ......... . ............. , . 55 6a Form 990-T check here.... ► b Total tax (Form 990-T, Part 111, line 4). ..................... 6h 7a Form 4720 check here ..... b ;Total tax (Form 4720, Part III, line 1).................................... 7b 8a Form 5227 check here . , ... b 'FMV of assets at end of tax year (Form 5227, Item D).................. . . 8b 9a Form 5330 check here , .... b ;Tax due (Form 5330, Part II, line 19)............ . ........ . ........... 91) 10a Form 8038 CP check here.. b Amount of credit payment requested (Form 8038-CP, Part 111, line 22). 10b Part II 10gcIaration and Signature Authorization of Officer or Person Sub ect to Tax Under penalties of perjury, I declare that LI I am an officer of the above entity or11 1 am a person subject to tax with respect to (liifne of entity) (EIM and that I have examined a copy of the 2021 electronic return and accompanying schedules and statemenis, and, to lire best of lily knowledge and belief, they are true, correct, and complete. I further declare that the amaunll in Part I above is the amount shown on the co ppy of the electronic return. I consent to allow my intvrenediale service provider, transmitter, or electronic re#urn originator (ERO) to send (a return to the IRS and to receive ham the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) ille dale of any refund. if applicable, I authorize the U.S- Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the federal taxes owed on this return, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1.888-353.4537 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 electronic return and, if applicable, the consent to electronic funds withdrawal. PIN: check one box only I authorize Financial Accounting Services, Inc. em__ _- to enter my PIN �10625 ] as my signature nX ERO fim na Enter five numbers but do not enter all zeros on the tax year 2021 electronically, filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, i also authorize We aforementioned ERO to enter my PIN on the return's disclosure consent screen: As an officer or person subject to tax with respect to the entity, I will enter my PIN as my signaltaP on the lax year 2021 electronically filed return. If I have utdtcatird willllri tins return that a copy of the return is being filed with a state agenr:y(ies) regulating charities as (:ati of the IRS Fed/State program, I will enter my PIN on the return's disclosure consent screen, Signature of officer or person subject to tax ► Dale ► Part III I Certification and Authentication _ ERO's EFINiPiN. Eitier your six -digit electronic filing identification number (F_FIN) followed by your five -digit soil-seleeled PIN. 81474611252 Do not enter all zeros i ceilily that (tie above numeric entry is my PIN, which is my signature on the 2021 electronically filed return indicated ahuve. I confirm that I am submitting this return in accordance with the requirements of Pub.4163, Modernized e•File (MeF) Information for Authorized IRS a-Ne Providers for Business Returns. ERO'Ssignature ► Frederick J. Karma Data . ERO Must Retain This Form — See Instructions Do Not Submit This Form to the IRS Unless Requested To Do So BAA For Privacy and Paperwork Reduction Act Notice, see Instructions. TEEASBOOL 11129n1 Form 8879•TE (2021) Form 990-EZ (2021) Temecula Valley Alano Club 80--0488892 Page 2 ert U1 Balance Sheets (see the instructions for Part li) Check if the or rinw.ation used Schedule 0 to respond to any question in this Part 11.................... . .................. .. . (A) Beoinrnna of year I (M End of near 22 Cash, savings, and investments ... . ........... 22 23 Land and buildings ................................ 23 24 Other assets (describe in Schedule 0)......... •.... ............................ 24 25 Total assets. . . . . ................. ......................... 0. 25 _ 0. 26 Total liabilities (describe in Schedule 0). _.. , ................ . . . 0 , 26 0 , 27 Net assets or fund balances (line 27 of column (B) must agree with line 21) p _ 27 Pam lit Statement of Program Service AccomFllsllments (see tale instr(Ictions for Part Illy Expenses Check if the organization usedher Srlu e 0 to resporr_(I to any question in this Pat! III...... (Required for section 501 What is [foe erganizafton's ppmary exempt purpose? i4ee Schedule 0 (c)(3) and 501(c)(4) Describe the organizafion's program sei-vice.accomp Is ents or ear, ti o its ! fee faraqost proUrarn se vtres, as or{iaturations; opltional moastired by expenses. In a clear a114 concise manner, describe the services provided, the number of persons for others.) benclited, and other relevant informaltoWfor each program (tile, 28 Facilitate meetings to assist lneubers_a>ad others to assist those with alcoho_lie and abler problems_______________________- {Grants f — — — — — — — — — r j If this amount includes foreign grants, checkitnre .. ^ — �►F1 28 a 29 Sales of refreshments .and novelty itipms to_ra §jq money to assist __ those --------ieandother�ro}alems__________________ !Grants - - - ) If this amount includes foreign grants, check here. r _► 29a 30 Fundraisers to accumulate_moneyr to complete exempt_purposes and___ ,acquire a location _fox -those with alcoholic and other -problems. ___ {Grants , - _ _ - - - _ - _ - - If this amount includes foreign giants, rtieck�iere .� r I- - �0. 30 a 31 Other program serviros (describe in Scherluls ......... .......................................... {Grants $ } If this amount includes foreign grants, check here.. , .. , , . , " 31 a 32 Total program service expenses {add lines T6 through 31a}.. 32 z1art IV List of Officers, Directors, Trustees, and Key Employees (list each one even if not compensated - see the instructions for Part IV ❑ Check if the organization used Schedule O to respond to any question in this Part IV, ..... (a) Name and title ro) ern, a toms per wcelt davatcrl to position (e)rralwita�to coon risdSlWf fFunrs WA Mi51 Ip9p HE1) [lf ncr pall, errlsr •f}) d rloaltFr henalits, 4 ) wifi lJ pl qlt , Zp GOP y}l0jK p rM}IIAI,I pIAIrS, 1111If:k, I r:nmpRnsaUnn (0) Estimated amaml of other componsaliao t,ti Chet le Marie Lawhing_ _ _ _ Vice President 0 0. 0. 0. kngexa_Christi.ne Treat Secretary 0 0, 0. 0. Julie Michelle Pezez " — Treasurer ---------^---- 0 0. 0. 0. ---------------------- ---------------------- ---------------------- ---------------------- ---------------------- ---------------------- ---------------------- ----------------------- $AA Tr r•,nolit2r W2.112l rot 930»tZ (2021) Form 990-EZ (2021) Temecula Valley A1ano Club 80-0488892 Page 3 Torl V C}th r lnforr otn (Note the Schedule A and personal benefit contract statement (equirerirents in See Sch 0 [� the instructions for Part V.) Check if the organization used Schedule O to respond to any r,tuestiun in this Part V. , , ..... u 33 Did the organization engage in an significant activity not previouslyy reported to the IRS? Yes No If 'Yes,' provide a detailed description of each activity in Schedule O............................ 33 X 34 Were any significant changes made to the organizing or governing documents? if 'Yes,' attach a conformed copy of the amended documents if they reflect a change to the organizabon's name. Otherwise, explain the change on Schedule 0. See instructions .............. . .... ... . . . . . ......... 34 X 35a Did the organization have unrelated business gross income of $1,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)7................................ ; ....... , ........... 35a X b It 'Yes' to line 35a, has the organization filed a Form 990-T for the year? If 'No,' provide an explanation in Schedule O. 35b c Was the organization a section 501(c)(4), 501 {{c)(5), or 501 [c)(G) organization subject to section 6033(e) notice, reporting, and proxy tax requirements during lire year? If'1�os,' complele Schedule C, Part III , ........ .............. 35 c X 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 M .............. • • ........ 36 X 37a Enter amount of political expenditures, direct or indirect, as described in the instructions. "I 37al 0. b Did the organization file Form 1120-POL for this year? ................... . .. . . . ................ 37b X 38a Did the organization borrow from, or make any loans to, a0 y officer, director, trustee, or key employee-, or were any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?. 38a X b If 'Yes,' complete Schedule L, Part II, and enter the total amount involved, .... _-_ ...... . ....... . .. . .... . ....... . ... ............... 38b 0. 39 Section 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 9 ... . . . . .... . ..... . . .... . ...... 39a 0. b Gross receipts, included on line 9, for public use of club facilities ... . .... ... .. ........ 39b 0. 40a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under section 4911 ► 0. ; section 4912 ► 0 , ; section 4955 6- 0. b Section 501(1,2{), 501 (c)(4), anti 5D1(c)(29) arganizatiosis. ❑id the organizalion engage in any seclion 4950 excess benefit transaction during the year, or did it engage in an excess benefit Iranse'ictioo in a prior year Ihat has not been reported on any of its prior Forms 990 or 990-EZ? If 'Yes,' corrmptete Schedule L, Part I . , ...... ........ b X c Seclion 501(c)(3), 501 c)(4), and 501(c)(29) orgamzralwns. Enter amount of tax imposed on organization' managers cr disquah ied persons during the year wider sections 4912, 4955, and 495t3, ....... ! 0. d Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax on line 4Dc reimbursed r bythe organization ................................................. ...... .............. e All organizations. At any time during the tax year, was the organization a party to a prohibited tax X shelter transaction? If 'Yes,' complete Form 138td15-T.................... . ................ . ..... : . . .... ...... ,...... 40e 41 List tha states with which a copy of this return is filed ► None 42a Ilarurganization's Telephone no. ►_ 951 551-4786 lmhs are in care of Peter D_as_ca_1os_ ( �_________ Locatedat- 2_74_7_0_Catl iterCe_C_eriter Suite C_'emecul.a CA _- __ ZIP+411 92590__ b At any Bonin durin the calendar year, did the organization have an interest in or a signature or other aulho+ily over a — — Yes Ho financial account in a foreign country (such as a bank account, securities account, or other financial account)? .. _ ..... 42 b X If 'Yes,' enter the name of the foreign country 11 See the instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). c At any time during the calendar year, did the organization maintain an office outside the United Stales?.... 42c X If 'Yes,' enter the name of the foreign country ► __ _ 43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 — Chock livre .......:...... .. . ► [] N/A and enter the amount of tax-exempt interest received or accrued during the tax year...... , .... .....1 43 J NIA 44a Dirt the ownization maintain any donor advised funds during the year? If 'Yes,' Form 990 must be completed instead ofForm 9RR-EZ.......................................... ...... _.. _ .. ........,......... organizationp g year? If 'Yes,' Form 990 must be completed b instead ad of Form 0 EZ to one or more hospital facilities during the ear. c Did the organization receive any payments for indoor tanning services during the year?. .... ............ . . ..... . d If 'Yes' to line 44c, ties fire organization filed a Form 720 to report these payments? If 'No,' provide an explanation in Schedule 0............. ................................. £............ ....... 45a Did the organization have a controlled entity within the meaning of section 512(b)(13)?.... . . ................. . b Oui Iho onptnizalion receive nny Icayinent from or enilpngo in any transaction with a controlled entity within the meaning of section 512(b)(13)? If 'Yes,' Form SM an Schedule it may nt etl to lie rnmpleled :nsteatt of Form 9N-EZ. See instructions ........... . .. . . — , — .. _ - - - - _ _ ...... , 44 a X 44 b X 44c X 44 d 45a _ X 45 b X corm 990•EZ (2021) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 53 TEMECULA VALLEY CONSERVATORY ARTS CITY OF TEM11 CtJ1A FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 C PROJECT/PROGRAM INFORMATION Amount Requested: $ _ 4 IDO o MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Temecula Q1kgoi"g Project/Program Title: qnt� Project _Start Date: I � ao a End Date: Physical Address of Project/Program- INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Temecula Valley Conservatory Of the Arts Mailing Address: 28780 Old Town Front St., C1 Temecula, CA 92593 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of ApplicantArks Organization: "-+�sc-L& t Ur-��� . ',ns��va�p ' Year Founded.2014 Website: tvartsconservatory.a g Social Media Number of Paid Staff: 0 Number of Volunteers: 7 Geographic Area(s) the OrganizationServes: Temecula Valley_ Geographic Area(s) the Proiect/Pro ram Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Susan Miyamoto Title/Position: President Contact Person's Direct Telephone:951.506.2479 Contact Person's Email: miyamotomusic@icloud. fNONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 2014 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 47-3595763 State Identification Number: PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. gl Attach IRS Deductibility Status using this link: littr):Iiaops.ifs.gov/app/eo:s/ 2. CR Attach State Entity Status Letter using this link: I►tt s://www.hb.ca. ov/uiilinelself serve entity status letter/index.asp 3. N Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: Litt -NC t_dn -ca, vvlVeiiliCallori�W� u15c arri�.as x'?facllit r City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ■W Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ff Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's Executive Committee ❑ Board of Directors [j Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Mission Statement: "To enrich the lives of students through performances, education, and community partnerships. To engage the broader community through arts outreach. " Our other objective is to promote arts education to ensure that every student in the Temecula Valley has access to a quality, standards based arts education. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes ■ IF YES, PROVIDE BELOW NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP The Temecula String Project $1,000 June 2022 Council member CSFG I I$ I _ I$ I$ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ■ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. V ITY MONTH + YEAR FUNDING RECEIVED I City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Temecula Valley Conservatory of the Arts (TVCA): The "Temecula Band Project" is an expansion of the "Temecula String Project" and will offer a free band class to 5th grade students at 2 elementary schools in the Temecula Valley Unified School District. The class will be held during non -school hours and taught by an experienced and qualified instructor. It will be open to all students who want to participate. Districts with 5th grade instrumental music programs are more likely to have strong and successful middle and high school programs. Murrieta Valley Unified School District is a good example. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. TVCA would use the grant funds to purchase band instruments for students in the program. We plan to purchase: 7 flutes, 7 clarinets, 7 saxophones, 7 trumpets and 2 trombones. A small amount of the funds wold be used to rent a climate -controlled storage space to store the instruments during the summer months when the instruments are not in use. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. The program would directly benefit families in the Temecula Valley Unified School District. Studies have shown that students who play a musical instrument are more successful and engaged in school and the community. Starting programs, in the elementary schools would also help grow band programs in middle and high schools. Successful music programs create better school environment for all students. The community would benefit by providing our youngest citizens with additional skills to become more successful, happier and productive members our local and global community. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 40 students/yr 4 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. TVCA is requesting funds to purchase band instruments for student use in our 5th grade elementary band class which will be offered free of charge at several schools in the Temecula Valley Unified School District. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. The pandemic prevented TVCA from conducting in -person fundraising events which reduced our revenue for 2 years. It also restricted our ability to do string classes in -person and so instruction was done on Zoom. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. TVCA is applying for funds in the amount of $1'j,000 to purchase instruments (flutes, clarinets, saxophones, trumpets and trombones) for our beginning band program. This is an expansion of our instrumental music program which for the past 5 yrs. has been a string program. These instruments are expected to last for many years. We currently partner with TVUSD to provide string classes at 4 elementary schools and the purchase of band instruments will enable us to offer instrumental music at 6 schools. Our 5 year goal is to make the 5th grade instrumental music program more equitable by offering either strings or band at levery elementary school in the district. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 17,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any $16,400 f i $0 In -Kind match amount or volunteer credit hours estimated amount $1,600 TOTAL REVENUE $35,000 LIST OF EXPENSES FOR PROJECT/PROGRAM EXPENSES Tools/Equipment $15,000 Facilities/Rent/Insurance $5,400 Supplies $200 Marketing $0 Services $0 Food $0 Other $0 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $14,400 TOTAL EXPENSES $35,000 TOTAL BUDGET $35� 000 $35 C),00 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 I ACKNOWLEDGEMENT/SIGNATURE PAGE I The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME:-TMZwurL VO Vty �r'�`,Cf V(XJc r 0A 4hC_A(j5 MAILING ADDRESS: a?_N o NA-TOL130 rron 5t . PHONE: (91 ) 5-0 (o - n 1 EMAIL: PRESIDENT / AUTHORIZED OFFICER: JuSC(Iti PRINT NAME F SIGNATURE: �,Uk)d" IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: to -Jf IAr q TITLE DATE: 1 anaa MON TH, DAY, YEAR PRINT NAME TITLE SUBMIT ORIGNAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MA I N jTD `CT TCRAcri 11 A rA 01COn Oupstions: Starey.BrownaTemecuiaCA_oov (951) 694-641" RofQ%1 I n%Airav rrivlTomwr11Inr..A nnv /QF11 RQ'�_3QFQ City of Temecula Community Service Funding Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 INTERNAL REVENUE SERVICE P. 0. BOX 2500 CINCINNATI, OH 45201 Date: C' �� 0112015 TEMECULA VALLEY CONSERVATORY OF THE ARTS C/O RAYMOND W JOHNSON 26785 CAMINO SEGO TEMECULA, CA 92590-3518 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 47-3595763 DLN: 17053155325005 Contact Person: JOSEPH R KENNEDY ID# 31647 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170 (b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: January 28, 2015 Contribution Deductibi3ity: Yes Addendum Applies: No 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. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 • 'r 1 rya ik�:s * lv all y sir n� California Secretary of State Electronic Filing Secretary of State State of California Corporation - Statement of Information Entity Name: TEMECULA VALLEY CONSERVATORY OF THE ARTS Entity (File) Number: File Date: Entity Type Jurisdiction Document ID Detailed Filing Information 1. Entity Name: 2. Business Addresses. a. Street Address of Principal Office in California: b. Mailing Address 3. Officers: a. Chief Executive Officer: C3751189 01/16/2022 Corporation CALIFORNIA H116996 TEMECULA VALLEY CONSERVATORY OF THE ARTS 28780 Old Town Front St, C1 Temecula, California 92590 United States of America 28780 Old Town Front St, C1 Temecula, California 92590 United States of America Susan Ann Miyamoto PO Box 2312 Temecula, California 92593 United States of America b. Secretary: Mark Alton Masters PO Box 5716 Pasadena, California 91117 United States of America cD rn rn T 2 C N E I U O rid Use bizfile. sos_ ca qov for online filings, searches. business records, and resources. California Secretary of State zK: Electronic Filing Officers (Cont'd): c. Chief Financial Officer: 4. Agent for Service of Process: Mimi Chang 31537 Rancho Pueblo Rd., STE 201 Temecula, California 92592 United States of America Susan Ann Miyamoto 28780 Old Town Front St., C1 Temecula, California 92590 United States of America By signing this document, I certify that the information is true and correct and that I am authorized by California law to sign. Electronic Signature: Susan Ann Miyamoto Use bizfile.sos.ca.gov for online filings, searches, business records, and resources. c� rn rn co r- 2 T N E V O 0 STAM OF CALIFORNiA CT-TR- I (Ong (WI2017) MAIL TO Registry of Chante die Trusts P O Box 903447 Sacramento, CA 94203-4470 STREET ADDRESS 1300 1 Street Sacramento, CA 95814 (916) 210-6400 VVEBSITE ADDRESS -- Qa!j-u OQVI013filles, ANNUAL TREASURER'S REPORT ATTORNEY GENERAL OF CALIFORNIA Section 12566, California Government Code 11 Cal. Code Regs„ Section 301 Temecula Valley Conservatory of the Arts (FORM CT-TR-1) OF.PAR I MLNI Or JUS7ICF FAL 1 1� 4 ,S.ti .a� For Registry Use Onty ,t)i „ ry of Chwlt`ble Trusts CT0267119 Name of Organization I State Charity Registration Number 128780 Old Town Front St., C1 Address (Number and Street) Temecula, CA 92590 City or Town, State and 21P Code ASSETS Corporation or Organization No. I Federal Employer I D, No. For annual accounting period ( beginning 01 / 01 / 21 BALANCE SHEET Cash $ 4,766.49 Savings $ Investment $ LandlBuildings $ Other Assets $ 6,000 TOTAL ASSETS sic f `j �-(' `'i 1� 1 REVENUE 3751189 47-3595763 ending 12 1 31 / 21 ) LIABILITIES Accounts Payable $ 0 Salary Payable $ 0 T Other Liabilities $ 0 TOTAL LIABILITIES $ 0 FUND BALANCE Total Assets less Total Liabilities $ p, 1 k (�, , REVENUE STATEMENT Cash Contributions $ ! r O it - .1q Noncash Contributions $ 5,633,00 Program Revenue $ 2,256.08 Investments $ n Special Events $ O Other Revenue $ 2,50 TOTAL REVENUE $ F NET REVENUE Total Revenue less Total Expenses $ _ 3 o q , EXPENSES Compensation of Offioers0rectors $ Compensation of Staff $ Fundraising Expenses $ 0 0 0 Rent Utilities $ $ 0 0 SuppItes/Postage $ 0 Insurance $ 1,294 Other Expenses $ 7,918.25 TOTAL EXPENSES $ 9, I hereby declare under penalty of perjury that I have examined this report, including accompanying documents, and, to the best of my knowledge and lot, the conga 6, correct atu mplety and I am authorized to sign. Susan Miyamoto President 5/2/22 Signature of Authorized Agent Printed Name Title Date STATE of CALIFOPNI , CT-1 R-1 long 09t2010 MAIL TO Registry ofChantaiieTrusls ANNUAL TREASURER'S REPORT P O Box 903447 Sacramento, CA 94203-4470 ATTORNEY GENERAL OF CALIFORNIA Section 12586, California Government Code STREET ADDRESS 1300 1 Street 11 Cal. Code Regs., Section 301 Sacramento, CA 95814 (916)210-6400 VV'ESSITE ADDRESS WATT OPCiGa g0vflhontirs Temecula Valley Conservatory of the Arts (FORM CT-TR-1) Name or Organization 28780 Old Town Front St., C1 Address (Number and Street) Temecula, CA 92590 City or Town, State and ZIP Code For annual accounting period ( beginning 01 1 01 1 21 BALANCE SHEET ASSETS Cash $ 4,766-49 Savings $ Investment $ Land/Buildings $ Other Assets $ 6,000 (it t•ARTMF,Ni a, r f:i l u For Registry Use Orlly) j 1 LQ ( iSfF�f U{ Chinli f IR Trusts CT0267119 I 'ate Charity Registration Number 3751189 ;orporation or Organization No 47-3695763 ederal Employer I.D. No. ending 12 / 31 / 21 ) LIABILITIES Accounts Payable $ 0 Salary Payable $ 0 Other Liabilities $ 0 TOTAL LIABILITIES - $y FUND BALANCE TOTAL ASSETS $ In 7 I,-(' `4 Total Assets less Total Liabilities $ REVENUE STATEMENT REVENUE Cash Contributions $ �' O 11 .a,? Noncash Contributions $ 5,633.00 Program Revenue $ 2,256.08 Investments $ n Special Events $ U Other Revenue $ 2.50 TOTAL REVENUE $ S q u, � R 4 — - EXPENSES Compensation of Officers/Directors $ 0 Compensation of Staff $ 0 Fundraising Expenses Rent $ $ 0 0 Utilities Supplies/Postage Insurance $ $ $ 0 0 1,294 Other Expenses $ 7,918.25 NET REVENUE TOTALEXPENSES Total Revenue less Total Expenses $ O C� , I hereby declare under penalty of perjury that I have examined this report, including accompanying documents, and, to the best of my knowledge Anti 719f. the contsioll canvct all mptete and I am authorized to sign. Susan Miyamoto President 5/2/22 SegnAturo of Atfthonza Agent Printed Name Title Dale Attachment to Ct-TR-1 List of "Other Expenses" Annual Treasurer's Report — 2021 Temecula Valley Conservatory of the Arts State Charity Registration No. CT026719 1. Website costs 2. Chamber of Commerce fee 3. Program instructor 4. Supplies (strings, rosin, bow) S. Piano donation TOTAL $ 112.34 $ 300.00 $ 2,400.00 $ 105.91 $ 5,000.00 $7,918.25 Attachment to CT-TR-1 Annual Treasures Report- 2021 Temecula Valley Conservatory of the Arts State Charity Registration No. CT026719 ASSETS Other Assets List — Musical Instruments 1. 21 violins - $2,120 2. 6 cellos — $2,400 3. 4 violas - $ 480 TOTAL = $ 6,000 OTHER REVENUE Checking Account Interest $2.50 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 54 TEMECULA VALLEY HIGH SCHOOL GOLDEN BEAR FOUNDATION CITY OF TEMECULA FISCAL YEAR 2022 - 2023 ' `��122p fil COMMUNITY SERVICE FUNDING - REINVESTMENT INFCC CA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12,201. PROJECT/PROGRAM INFORMATION i Amount Requested: . 10,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Amplify - le r tion. of'Blavk HistoryStart Date: 1/25/23 End Date: 1/26/2023 Physical Address of Project/Program 31555 Rancho vista Road. Tempeu)OLCa 92592 _ INCLUDE IF DIFFERENT THAN ORGANIZATION S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Mailing Address: PO Box 822072, Temecula, Cla 22582-2072 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant n-,-- `" Organization:-i TEMECULA VALLEY HIGH SCHOOLIGOLDEN BEAR FOUNDATION -car rounded: 2022 Website: Social Media: ,NA Number of Paid Staff; I Number of Volunteers: all student,2 staff Geographic Area(s) the Organization Serves: Tgmgcula Valley High Scheel Geographic Area(s) the Pr4)igc_t/Prougni Serves: Temecula Valley NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE E.XCLUSIVElY USED TO SERVE TEMECULA. Contact Name: a VomSteeg Title/Position: Drpadmj nuj lair Social Science Contact Person's Direct Telephone: 951-491-1326 Contact Person's Email: dyomst ..g@tyusd_us NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ❑ Date of Incorporation as a Nonprofit: _2009 No. [2 IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: EIN-26-1917730 State Identification Number: PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND S'lAfE (FTB) AS FOLLOWS: 1. ❑ Attach IRS Deductibility Status using this link: �:111 a �s.ir, rovl s/cns/ 2. ❑ Attach State Entity Status Letter using this link: ]litps:Uwww.f'tlz.c_a.&nv/onl,ilic/sclf_serVS, e0tily 51alus ICtter/ildca,I� 3 • ❑ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity S a R S a c T :cl.dcfj.c;I,gnulVeriIicRIion/W0 Soil rchausnx"ftuili[v Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION I Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No.[3 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No.[3 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER S NAME AND TITLE WITHIN THE ORGANIZATION: This A ca a b Executive Committee 0 a a Board of Directors ❑ Members -at -Large U MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION S MISSION/GOALS AND OBJECTIVES. Amplify is a school and community -wide event where guest lecturers, professional and student performances, poets, musicians and actors join their collective voices in a two-day celebrating the deep and rich heritage of the black community. Our goal is to bring students, families and community members to hear first, second and third person accounts of the struggles and successes of the black community during the Civil Rights movement to the present. Our hope is though authentic stories, shared through measured and compassionate tones, our community will understand and empathize with the black experience in our cities and neighborhoods. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT, DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No.® Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAMrPROt1 EC T MONTH +YEAR NAME OF CIIY GRANC FUNDIDBYTHECrrYGRANF0RSP0NSMH1P AMOUNT FUNDM RECEIVED ORSPONSORSHIP $ $ $ $ $ $ $ $ OTHER OUTSIDE SOURCES SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PRU.J[!'T//'RO(;RAM IN THIS APPLICATION,? No ❑ Yes® IF YFS, PROVIDE INFORMATION IN TABLE BELOW, AMOUNT MONTH +YFAR RECEIVED NAME OF ENr Y FUNDING RBZEIVM $ 0 We are seeking funding from Temecula Valley USD to match donations from City of Temecula. 1 Citv of Temecula Community Service Funding - Reinvestment in Temecula GRANTAPPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. This is our inaugural attempt at bringing students, families and community members to learn first person account stories from those who rode on the buses that we now refer to as the "The Freedom Riders." An organization from San Diego has artifacts, a life-size replica of the bus and will bring out the father -son team to speak about their experiences. The second night we will hear from Lee Sentell, Director of Alabama Tourism and author and expert on The Road to Birmingham. We will have speakers, music, poetry reading, dancing, re-enactments each eveninc program. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT, $10,000 to Gaidi Finni, Executive Director SDAAMFA for "The Buses are Coming" exhibit $2000. African Drum and Dancers from Los Angeles $500 Honorarium for Lee Sentell $500. Honorarium for Yolanda Franklin "A Poetic Tribute to the Freedom Riders" $3000. David Dennis Sr. and son David share experiences from Freedom Rider $1750 Flights, housing and food for all guest speakers �§i r 10.11 and 12th TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. We are going to encourage different clubs representing marginalized people groups from all TVUSD HS campuses to send dance, song, drama teams in addition to the paid speakers and performers for two nights at the Golden Bear Theater. Students will sell tickets to parents and community members that will go toward next year's Amplify event. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM_ 12000+ students 800+ community 20 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT SUMMARIZE ANSWERS 1 3 ABOVE IN 50 WORDS OR LESS. "What would you ride for?" When the Freedom Riders left their homes to challenge segregatio In the South they knowingly risked their lives. This two day exhibit will immerse community members in an augmented reality and hear authentic stories that will shed new light on the Black community experience. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. N/A Ir AFFLYINU FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. 1) This will be the first year TVHS has attempted to host a Black History Celebration that is intentionally serving our students and the community. 2) We aim to charge community members a minimal fee to access the evening programs so program can expand and aim toward self-sufficiency. 3) We aim to continue this program year-to-year and have students and community grow to value and respect the contributions and sacrifices of the black community. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROtIFGTI MGRAM BUDGL i' (do not fill in shaded areas) umnEmFORPROACUNDIGRAM— REVENUES LIST REVENUESWONE FM PR[]MM440GRAM Amount of money requested from this City of Temecula $. 10,000 1 Conununity Services Grant (Not to exceed $50,000) 1 Amount contributed to the Project/Program by the Applicant $ 0 Organization Other grants or funding already awarded for Project/Program, if any I $. 0 In -Kind match amount or volunteer credit hours estimated amount $• 2000.00 MEAL REVENUE $12,000.00 LLST OF FMENSIES FOR PROJEiCI'AW)G RAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food $ 500.00 $ 16,500.00 500.00 Other. (Housing, airfare) $.1,750.00 Staffing Expense THIS IS INELIGIBLETO BE FUNDED BYCITY S GRANT HOWEVER PLEASE INCLUDE. $ TOTAL EXPCNSES $19,750.00 — — — TOIAL BUDGET $ $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ► 1111 11 I Blob► e The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. Every Community Service Funding application is considered individually and on its own merit. Awards will be given to organizations and activities that directly benefit the residents of Temecula. Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts In be bmi ed on o befo e hi a lica ion d e da e o hi a lica ion may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGAWATION NAME: TV GB Fo ndatian MAR INGADDRESS: PO Box 892072 PHONE: (__) Temecula Ca 93589 EMAIL: dyomsteeg @tvtisd.us PRESIDENT /ALYI'IIORTLED OFFICER: Jennifer Nguyen President SIGNATURE: DATE: IF DIFI•ERENTT IANABOVE, APPLICATION PREPARED BY: Doug VoniSteeg Social Science Department Co -Chair „I y:trll; SUBMIT ORICINALAPPLICA110N 13Y MONDAY, SEffEMBER 12, 2022, TO: City of Temecula Community Service Funding An Ci Manage Office 41000 MAIN STREET TEMMJLA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD FTB ' PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/11 /2022 ESL ID: 8925509795 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 3058980 Entity Name: TEMECULA VALLEY HIGH SCHOOL/GOLDEN BEAR FOUNDATION 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d• ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information • This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). • The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) 0 Help News Language � Charities & Nonprofits Tax Pros File Pay Refunds Credits & Deductions Forms & Instructions Home > Tax Exempt orgaOj&aUOn Search > Temecula Valley High School Golden Bear Foundation c Back to Search Results Temecula Valley High School Golden Bear Foundation EIN: 26-1917730 1 Temecula, CA, United States > Other Names Publication 78 Data e Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 79 Data List: Yes Deductibility Code: PC Form 990-N (e-Postcard) e Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. > Tax Year 2012 Form 990-N (e-Postcard) > Tax Year 2011 Form 990-N (e-Postcard) > Tax Year 2010 Form 990-N (e-Postcard) Copies of Returns (990, 990-EZ, 990-PF, 990-T) e Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non -profits. > Tax Year 2020 Form 990EZ > Tax Year 2019 Form 990T > Tax Year 2019 Form 990 > Tax Year 2019 Form 990T > Tax Year 2019 Form 990 efile GRAPHIC rint - DO NOT PROCESS As Filed Data - DLN: 93492067009161 �O �� Short Form OMB No. 1545-1150 Form Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 2020 Dcpnrunen[ of the Treasury internal Revenue Renrice A For the 2020 calei 8 Check it applicable: ❑ Address change ❑ Nane change ❑ Initial return ❑ Final return/terminated ❑ Amended return ❑ Application pending ► Do not enter social security numbers on this form as it may be made public. ► Go to www._rrs.gov(, fornr990fZ for instructions and the latest information. r year, or tax near beginning 01-01-2020 r and ending 12-31-2020 C Name of orgamzanon Temrcula Valiey H:gh SchoolGolden Bear Foundation Number and street (or' P O. box, tf mail PO Box 892072 City or town, state or province, country Temecula, CA 925892072 is riot delivered to street address) or foreign Postal code u cmpfoyer wentmcatron number E Telephone number F Group Exemption Number ► G Accounting Method: RlCash ❑ Accrual Other (specify) ► H Check ► 21 if the organization is not required to attach Schedule B I 1Rfebslte: ►WwW.TVGBFAOM (Form 990, 990-EZ, or 990-PF). I Tax-exempt status (check only one) - 10 SQl{C]{3] © 501(c)( ) ■ (Insert no.) R 4947(a)(1) or ❑ 527 K Form of organization: 121 Corporation ❑ Trust ❑ Association ❑ Other L Add lines Sb, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B) below) are $SOO,000 or more, file Form 990 instead of Form 990-EZ . . . . . . . . . . . . . ► $ 117,751 Revenuer Expenses, and Changes in Net Assets or Fund Balances (see the instructions Check if the organization used Schedule 0 to respond to any question in this Part I , for Part 1 I) , ❑p 115,023 1 Contributions, gifts, grants, and similar amounts received . . . . . . . . . . . . . . . . 2 Program service revenue including government fees and contracts . . . . . . . . . . . . . . . . 2 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Investment income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Sa Gross amount from sale of assets other than inventory . . . . . . . Sa b Less: cost or other basis and sales expenses . . . . . . . . . . . . Sh c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line Sa) . . . . . . Sc 6 Gaming and fundraising events a Gross income from gaming (attach Schedule G if greater than $15,000) 6a 2,728 b Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) 6b c Less: direct expenses from gaming and fundraising events 6c 2,573 d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) 6d 1,155 7a Gross sales of inventory, less returns and allowances . . . . . . 7a b Less: cost of goods sold . . . . . . . . . . . . . 7b c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) . . . . . . . . . 7c 8 Other revenue (describe in Schedule O) . . . . . . . . . . . . . . . . . . . . 8 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 . . . . . . . . ► 9 116,178 10 Grants and similar amounts paid (list in Schedule O) . . . . . . . . . . . . . . . . 10 6,750 11 Benefits paid to or for members . . . . . . . . . . . . . . . . . . . . . . 11 12 Salaries, other compensation, and employee benefits . . . . . , . . . . . . , . . . 12 13 Professional fees and other payments to independent contractors . . . . . . . . . . . . 13 U m 14 Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . . . . 14 w publications, postage, and shipping . 15 Printing,. . . . . . . . . . . 15 173 16 Other expenses (describe in Schedule 0) . . . . . . . . . . . . . . . . . . . 16 134,454 17 Total expenses. Add lines SO through 16 . . . . . . ► 17 141,377 r 18 Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . . . 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with 18 -25,199 end -of -year figure reported on prior year's return) . . . . . . . . . . . . . . . . . 19 225,605 w Z 20 Other changes in net assets or fund balances (explain in Schedule O) . . . . . . . . . . . 21 Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . . . . . . . 20 1,940 21 202,346 For Paperwork Reduction Act Notice, see the separate instructions. Cat. No, 10642I Form 990-EZ (2020) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 15!5 TEMECULA VALLEY PLAYHOUSE CITY OF TE ECUTA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 47,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: TEMECULA TALENT REVIVED! Start Date: 7/1/22 End Date: 6/30/24 Physical Address of Project/Program: 42051 Main Street Temecula CA 92590 OTTCT INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Temecula Valley P a ho Temecula Vglley Players Mailing Address: ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Jemecula Valw PlayhoUse Year Founded: 6/10/1983 Website: temeculavalleyplayers.com Social Media: FaceBook, Instagram, YouTube Number of Paid Staff: 0 Number of Volunteers: 16 year round; 30 at ea. production Geographic Area(s) the Organization Serves: Temecula, Murrieta, Menifee, and surrounding areas. Geographic Area(s) the Pra"ect/Pro ram Serves: All of Temecula, incorporated and unincor rated. NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE LCL_USI JELY USED TO SERVE TEMECULA. Contact Name: Lisa Wunderlich Title/Position: Board Mernber/Dire t r Contact Person's Direct Telephone. 951-704-570 _ Contact Person's Email: I.wt�nderlich1 —vverizon.net NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 7/23/91 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0008806 State Identification Number: C1144097 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: htt ://a s.irs. ov/a /eos/ See attached. 2. ® Attach State Entity Status Letter using this link: litt s://www.Ftb.ca. ov online/self serve entity status letterlindex.asp See attached. 3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt ://rct.dli .ca. ❑v/Verification/Web/Search.as x?facilit =Y See attached. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: N/A. - - — This Application has been authorized by the organization's: Executive Committee ® Board of Directors Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The Mission of the Temecula Valley Players is to entertain, enrich, and educate our community and surrounding communities, especially our youth, through exceptional theatrical performance, education and appreciation for and of the arts in theatre. (https://temeculavalleyplayers.com/) Temecula Valley Players (TVP) includes youth and adults of all backgrounds, socio-economic statuses, and ethnicities, and provides them with the opportunity to be part of a Broadway -style show with high production values where they work with professional directors, voice teachers, choreographers, designers, and technical crews TVP is Diversity, Equity, and Inclusion committed. Educating and inspiring our youth is what we care about the most. Through live theater, we teach them core social values to help shape a brighter future. TVP recently implemented a new program for youth, the Guest Education Artist Program. Thus far, three youth have been a part of the program in order to learn more about an area of interest and gain hands-on experience. To see more about these youth, go to: https://temeculavaIleyplayers.com/tvp-youth/. Our objective is to showcase the incredible talent that is here in the Temecula community. Temecula residents need travel no further than Main Street in their own city to see a live performance Broadway -style show. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. FVP is able to provide Financial Statements upon request. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES 1 CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑X Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT NAME OF ENITY MONTH + YEAR RECEIVED _— J I �4 FUNDING RECEIVED $ N/A. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. the Project, TEMECULA TALENT REVIVED! will Focus on three areas for five productions annually performed in th-e 71d Town Temecula Community Theatre (OTTCT) during FYs 22/23 and 23/24: 1) Recruiting additional talent from remecula to the OTTCT stage in the form of actors, directors, musical directors, choreographers, stage managers, ighting and sound designers, set builders, prop managers, musicians, and all other aspects of theatre for productions. Ne will recruit talent from Temecula for all positions prior to selecting talent from outside; 2) Defraying all costs for tctors from Temecula cast in shows so that paying membership fees, libretto deposits, portions of costuming, etc, will iot preclude actors from any socio-economic background from performing; and 3) Offering discounts of 15% to all Femecula residents, and free tickets to Temecula Foster Youth and Group Home Youth. TVP has been enriching the Femecula Valley with live productions since 1983. We have been a resident theatre company at OTTCT since its )pening in 2006. Temecula is incredibly rich in talent. With this project, our goal is to increase the number of actors, :restive team members, other crew, and attending audience from Temecula by 20%, Our productions for this season nclude West Side Story, A Christmas Carol, Daddy's ❑ in Who's Got the Will, Godspell, and Oliver. A proximate) 2.000+ attendees see our productions annually; we want to expand our reach In Temecula with this project. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. VIECULA TALENT REVIVED} grant funding will be spent on: 1) Advertising and Community 0 trea& to Temecula !dents via social media. local newspapers, local radio, show Production Bills, at the box office, and in -person visits to iior and Group Home communities; 2) Subsidizing the loss of TVP ticket revenue for residents of Temecula, and for drenlyouth in Foster Care and Group Homes given discount rates and free tickets; 3) Paying all production costs for Temecula actor cast in productions; 4) Renting equipment and facilities for OTTCT performances from Temecula inesses whenever possible (this includes but is not limited to: using Temecula Penske truck rental for load-in/load-out, tal space at the OTTCT for rehearsals, rental of the OTTCT stage and their special equipment for performances, and Dr rental and equipment; 5) Purchasing set building items (lumber, paint, brushes, rollers, nails, screws, casters, etc.), decorating items, batteries (for microphones), props, costumes (TVP often uses thrift stores such as Salvation Army fabric from JoAnn's) from Temecula businesses whenever possible; and 6) Providing food and drinks (no alcohol) to cast after their last production performance at their cast party in a Temecula establishment; and 7) Renting rophones as needed for Temecula actors. Please see the List of Project Expense on page 10 for a breakdown. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. I emecula residents will benefit from the project as they will be recruited/selected first for the Creative Team, crew, and performers in our season productions. When TVP has two or more equally qualified persons for a position. a Temeculan will be selected when available. This will highlight talent in Temecula and encourage Temeculans to share their talent in their own community. Performers in TVP productions learn from professionals as our creative teams are active in the industry TVP actors, especially youth, learn professionalism in every aspect of theatre whether they want to build sets„ sew costumes, or manage a stage. Please note: many Temecula youth who called TVP their home have gone on to become industry professionals themselves. Again, there will be no costs for Temecula actors removing financial impediments to performing. Temecula residents will benefit as their ticket costs will be reduced or free; they need only show ID with a Temecula address at the box office. This also serves to acquire accurate numbers for residents who benefit from the. program for grant auditing/reporting purposes- We have designed a system to gather accurate information for auditing and reporting. Research has proven that theatre benefits the community by teaching empathy, creating strong communicators, encouraging creative thinking/problem solving, building collaboration and teamwork, relieving stress, and more. Temecula businesses will benefit as needs for shows will be purchased in Temecula. Restaurants and -other businesses -close to ffTfE-T will -benefit -from theatre -goers. 12500 FROM THIS PROJECT/PROGRAM:# based on attendance for disc/free tickets, business, creati 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: # based on persons who volunteer during productions and does not include Board Members, Conn members, and Creative team who also volunteer during this time. team, actors, etc. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. TEMECULA TALENT REVIVED! benefits the Temecula Community by recruiting local talent first, making ticket prices more affordable for local residents, and spending funding In the Temecula businesses community for production needs TVP is a non-profit organization and has been a presence in the Temecula Valley for four decades. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. F TVP completely shut down 3/20 through 8/21 during the pandemic. Our ability to serve the community was nearly non- existent and remaining shows for the 19120 season were canceled. All five productions for our 20/21 season were canceled. Our revenue comes predominantly from ticket sales and the financial loss was devastating (see attached 990 from 2020). Revenue was reduced from a $190,000 annual average to $17,881. If requested, TVP will provide prior 990s to demonstrate pre -pandemic revenue To remain solvent, we closed our warehouse and rented local storage for items required in future productions. Warehouse inventory was donated, or stored at the private residences of Board Members. TVP has performed in the Temecula Valley since 1983 and hopes this longevity confirms our ability to manage finances well. We have a substantial volunteer base and all Board Members volunteer 10-15 hours per week year round; we have no salaried employees. Although tickets for TVP quality shows (see numerous ITL awards at: inlandtheatreleague.orgl) are priced lower than any local theatre group, we have not recovered pre-COVID attendance numbers. An article in the NY Times addresses this lack of post-COVID theatre attendance on a national level (see: nytimes.com/2022/08/21/arts/performing-arts-pandemic-attendance). After receiving small SBA and CAC grants, TVP successfully reopened and served the Temecula community again with a full (5 shows) 21/22 season, but with an 8% attendance decrease. We are kicking off our 22/23 season with West Side Story on 9/2. We feel that inflation is decreasing-dL%cr-P-tion any-i n come-for-theatre-attendance--Through-TE M EC U LA -TAL ENTREV.Iu1=Di-wr�hn❑a-tase.tm- 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. TVP is applying for more than $5,000 to create the project, TEMECULA TALENT REVIVED! The residents and businesses of Temecula will benefit as detailed in Sections 1 through 3. Temecula actors will learn from industry professionals (local whenever possiblel committed to cultivating quality theatre performers by offering an experienced level of training in a safe and supportive environment. Actors will receive intensive instruction in all areas of theatre: direction, musical direction. and choreography. TVP will measure the positive impact of the activities proposed via quality assessments completed at regular intervals by the director, musical director, and choreographer of each production. By production end, actors will receive an evaluation detailing their individual growth in the three areas described above. As part of the evaluation, actors will receive feedback on their individual work, teamwork, and any independent reviews received from audience members, as appropriate. Audiences will be encouraged to provide feedback on all aspects of productions including- actor quality (acting, vocal, and dance capabilities), direction. musical direction, choreography, and technical features such as lighting, costumes, sound, and set. TVP receives audience feedback directly, or via email, FaceBook, and Instagram. TVP Board Members are present at each show and make themselves personally available for audience feedback. Audience feedback is used for continuous improvement fi5r�tar�mmtmitr�Tt/P�vi1f activsl�t�ltNate part��ers�trrtlrg-trtt5UrnMT-A"tlslrTVlJrrdralsln5 F,-and oirrer grant opportunities in order to sustain the project after grant funding has ended. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill In shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula I $ 47,000 Community Services Grant (Not to exceed $50,000) ' Amount contributed to the Project/Program by the $ 85,000 Applicant Organization: stipends to Creative Team ($40K per season), Stage Labor at OTTCT ($45K per season) Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount _ i_ .. 5,700 hours TOTAL REVENUE 1 $132,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Microphone rental, other rental equipment for 5 shows from Temecula businesses whenever possible. $12,800 At OTTCT: Rehearsal space rental, stage rental, FOH Facilities/Rent/Insurance Fees, Ticket Office Fees, Stage Equipment Fees $55,800 Supplies Set building: lumber, paint, brushes, nails, screws, etc. Set decorating items, props, etc. to be purchased from Temecula businesses. $ 24,500 Ads in: local papers, local radio, show bills, at the box office, and Marketing visits to senior homes and centers, $ 10,000 Subsidize TVP loss of revenue for discount/free tickets. Estimate 2,400 Services discount tickets at 15% x $25 = $9,000.00 and 50 free at $25 = $1,250.00 $ 10,250 Food For cast parties at show closure to be held at Temecula establishments. Estimate $600/production. $ 3000 Truck Rental (Temecula Penske), mic batteries, costuming, production fees, Other and misc. (Temecula actors only). $ 15,650 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ 0 TOTAL EXPENSES $ 132,000 TOTAL BUDGET $132,000 $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper rack -up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approvedlawarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office— CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: _Temecula VallPv Pl.a.vers Name of Project/Program: _NIA FY 2021-2022 Amount of $ 0 CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not i have precise number): E Date on _ Expenditure Name of Company Receipt/Invoice 1i1I Description Purpose a .. on Receipt or Invoice MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1. 2021 - JUNE 30. 2022 $ 2 3 4 5 6 EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT_ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the C ity of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approvedlawarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation Including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page, 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To recr,ivu qi ant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (lout no less than $10.000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" Organization: 1 TOTAL FY 2022-2023 Amount of Grant Fund Awarded: EXPENDITURE REPORT DATED Name of Project/Program; Month & Year FIRST $5,000 check was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ _ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this ProgramlProject (approximate number of beneficiaries if you do not have precise number) E E a Name of Company E on Receipt or Invoice aZ I 1 2 I-- 3 Date on Receipt/Invoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, 2024 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER EXPENDITURE TOTAL $ Amount Description I Purpose EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval, Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: —TemQgula Valle PI housedba Temecula Valley Players MAILING ADDRESS: po Box 1293 Temecula CA 92593 PRESIDENT / AUTHORIZED OFFICER: Lisa S Vsluh2erlich SIGNA IF DIFFERENTT�N ABOVE, APPICATION PREPARED BY. PHONE: ( 714 ) 932-2215 EMAIL: Imunderlich1(Mverizon.net Board Member/Director TE: 8 3A 22 MONTH, DAY, YEAR PRINT NAME T'r' E SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD FTB PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/8/2022 ESL ID: 2128036581 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1144097 Entity Name: TEMECULA VALLEY PLAYHOUSE ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d, ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone. 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) f3 Clem wnvmevu�y -s x 0 wun:rar .me oa+mz. x } _ O X E C e apps irs govPoppieos/uiiSearh t 15l A 7M 0 a W l cmrtarna a ao.c ;comet ,ae s nx. © wnam 1— j] to otn oew a tk=> 10fdJUil dUta > Tax Exempt Organization Search Results for Tax Exempt Organization Search Select Database B Search By 9 Search Term 6 Search All v Empinyer ldemihcation Number" 330OOR906 city State Country Temecula AIIStates v United5tates r i t� Reset SiT;p,5 Showing 1-1 results oft Sort by: Names-z v Additional Information • Fr�sle2l!SlY.dl�`x9.A2C5LPi.5- Fxempt Organizo[lnns.5elrrt Check Woot�rl�g Wlayers • p.ra.z•,c«,.��yfcll7l fir.: narnn. EIM:33-000bab61 Temecula, CA, United States flUS4Y0i:7IIL_RlLfLJLL0ISC� Pub 79 Data Copies afRetums Sect=5R1 91. L=QLQfgAPUljRasm.dnesa { tAffseas.tMrersaMI: a Ilst oforganieations rerugnired as —rupr by the IRS Itemsperpaga: 25 v • Ia.F�emra°r6AalrAiAia=k tt X o � L�J 0 0 0 In m 12 LL 2 N ti 0 N N N ry N Y r 9 O O x a u W u LLI LU Ln O W J E g m Z w N s a� w to m 12 L Y � a b E G v I p N' ' 44 inY C m 4-0 N � C W W C W v 0. < � q .o INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY DISTRICT DIRECTOR 2 CUPANIA CIRCLE MONTEREY PARK, CA ?1754 Employer Identification Number: 33-000ET06 Date: JUL. 23, 1991 Case Number: 951162039 3U77ERIELD STAGE PLAYER, Contact Person: PO BOX 74 AHMFP AHMFP 7EM ECULA, CA 92390 Contact Telephone Number: (213) 725-7876 Accou.ritina Period Endings pccemher 31 Foundation Status Classification: S09ia)(27 Advance Ru1inn Period Begins: Der. 13, 1990 Advance Ruling Period Ends: Dec. 31., t994 Addendum Applies: Y fr s Dear Applicant.: Based on information supplied, and assuming your operations will be as e.tated i,ri ,your application for ron cnnition of e�xemotion, we hive determined You are exempt from Federal income tax under section 501(a) of the internal Rev,anik.e Cods as 111 r,rilanizati,n descrih(rd in r:�r.tion 501(c)(3). Because you are a newly created organization, we are riot now making .a final ne+ermi.n� tion of your foundMion state_• r.indr:r ar ctiori `109(a) of the mode. however, use nave ceter.mined that you can reasonably be expected to be a nlshl.ir.l.y nrgaiiizat.ion deicri.hed in -',actinn 509(.1)(2.). Accordingly, you wil: be treated as a publicly supported organisation, and not as a private fnLlnddtion, durinp. an advance rUlirin of'ricid. Thi advance ruling period begins and ends on the dates shown above. i,'ithin 90 days after the end _�f your advance ruling period, you must S-uhrii t to urn i nfortgat i or1 T1eOded to drtr-rmirir whether You have mei the rF..,C�, ' re- ments of the applicable support test during the advance ruling period. If you k• t.ahlish thak you have hp?n i nublir:ly suodort?d orn-3ni7ation, v,nu will be classified as a section 509(a)(1) or 509(a)(2) organization as long as you con- tinur• to meat the rFn_lirwment-- ;,f this aonl.irahle sunnort test. Tf you do not meet the public support requirements during the advance ruling period, you will h:a r_lagsified a•, a 'irivat>I found<tion for futures neriods. Al.o, if you ars classified as a private foundatior;; you will be treated as a private foundation from they date of your lnrpption f(If nuToosos, nf sections 507(d) and 4940. Grantors and contributors may rely on the determination that you. are not a private foundati,i)n n.nfil. 94 day after the end of your idvanco ru.lil5q or:rlod. if you submit the required informetion within the 90 days, grantors and contri- butors moy continLre to Fely nn thc• advance dPterminat.icni until the' Service Letter 1045(CG) _2- BUTTERFIELD STAGE PLAYERS vanes a final determination of your foundation status. If rjotice that ,vou 41i1i no loriger CIE' treated as a publicly S,UPPC,rteO Dr- til�n).7.afir�n l�. nUh)7. hE'ri )n tllr Jrltrrrlal, F'�'vQilil�' Fullatin., cir.-ITitort. .1nd CU-z- tr:outors may not rely on this determination after the date of such publica- tiQll, In .iiiiii-ti.nn, '•.h yr)l.l ln,:? ,,our statU,•- aS •4 oublicly ',uogorfed orllaniZd- :1�n arld a grantor or contributor was responsible for, or w'ss aware of, the act or failure to act, the=t resulted in vnur lo_s of :.u.cfil st'(tWs th_I, r,e,rs,tln m.a: rot rely on this determination from the daTe of the act or failure to act. Ak;o, i.'i a 7rani'Or or I'nnti-i.butur le•irll:ali th•it the S,rv.rn harl nii5n v)Fice that you, vioul0 be removed from cIaa.sification as i pubIicIy supported orgarlila- tin'i1; thlrn that die-c-cln may ncnt. 'rr,lti' i,rl JhIjF. drtcrmi.il?ticrl a, of the date ':• lch Y._r1%oso ee ge Was a g1Ai red. If yaur •sourceS of Support, or your purposes, character, or method of operati•nn chaTi(ie, n)e,;FP Iet us i:r•:-iu) so we can consider the. effect of the change on )four exempt status and foundation status. In the case of an amend- ment to yOl.lr nYgani.Zatinn,31• dorument or byl.riw,, ole.3s, `iOrld 11'5 a c'MV of t`!'-' amended docuf,ient or byl;)Ws. ;iIso, you should inforn us of all changes in your name: or addre iks-. A:: of .ianuary 1, 1984, you are liable for taxes unaer the Federal Insu.r- 3nl;c? Contribul ions Act (,inr_i,jl• cr.cijrity t):«5) or, romliner.ation of $t00 fir mOT9 you- pay to eacn of your employees during a calendar year. You are not liable for the. tax innsa•'d under the' Fedr-rnl Untmoinyme'nt Tax Art (FUTA), Org:anizacion= that are not private foundations are not subject to the pri- vate 'faun atirn exri'.ir- t.j;<(:s n.nliev Ch ioto.r 42 of tilt Cr�de. Hawfiver, `iou are not automatically eYempt from othc,r Federal excise taxes•. If you have arl-, qur>tinnt• about vxriG.e, ennjoyment, or othl,r Federal taxF m, Ole<:`.F )at L=s know. Donors rlay deduct contributions to you as provided in .ection 170 of the Code. Penue<.-t-., lend:riBE., LiPvlS•t", transfers, or clifis, to 'roll Or for YCJ.1 i se are aeductible for Federal estate and gift tax purposes if they meet the appli- cable, nrovi=,ion•; cif ior7tian :7455. ?T.!)", -ann 232-2 of th.. fode. i:-onorributiort oeltuctions are allowable to donora only to the extent that their contributjor,�. are gift= -, (with no con0derotion receivr-d. Ticket our- crlaSes a)it •,irliia'i payments in conjunction with fundraising events may not nwresc i.iri,ly qu-i11fy .35 ii2J1,(rtihl.t I ont'ri.hution`:, rleoanrli.nq on the r rr um - stances. See RE'verlue Ruling 67-246, published in Cumulative Bulletin 1967-2, on ll;.ne, 104. which FF-tc• forth �ujdr@lines rpnardillg tht deductibility', ar. Chari- table contributio'ri., Of payments made by taxpa,vers for admission to or othe-i fid'rtl.ci4atilon in funrl'r.ii,:ina .,rti' iti rs for charity. You are required to file Form 990, Return of Organization Exeript From Jncnme Tay., o111v If rnur Qrn s rece•ints e,]Ch ffl+r , , riclrm81.1)` Vlore th•�rl b215,000. However, if you raceive a Form 990 package in the mail, please file th,4 re-turr evon i.f ,u dr not exceod `h,? gross rec�i.ots }�>+.. if you are ;.ot Letter 1095(CG) -3- 8UTTERFIELD STAGE PLAYERS required to file, simply attach the label provided, check the box in the head- ing to indicate }hat your 4nna,;1 :grog-; rFr_=iot; era normally $25.000 ni• less. and sign the return. If a return is required, it must be filed by the i5th day of tii� Fifth month after the end of your iuniA-il •a,:count.inn period. A oerialty of `' W o day is charged when a return is filed late, unless there is reasonable cause for the delay. However, the, maximun nF,nelty rharaed cannot rxcved V5.000 or 5 per- cent of your gross receipts for the year, whichever is less. This penalty may al,n he: charged ).f a return is not comolet.e., ,so pl?a3A be lure your return is complete before you file it. You are not required to file Federal income tax returns unless you are suh jert to the tax on unrelated income under sar_t,ir)n 51l of thr load?. if ycu are sunject to this tax, yOu mu=..t file an income tax return on Form 990-T, Exempt Organi7atiOn Ati•si.nf-s•r• Income Tax Return. Jn this IF-tter we are not oetermining whether any of your present or proposed activities are unre- lated trade or husin?•3S :as d?fined in sei:tion S13 of the Code. You need an employer identification nur;jer even if you have no employees. Tf an employer identification number wos noS entered on Your aoulic.ation, number will be assigned to you ano you will be advised of it. Please use that number on all returns ynu fi•l.i .and in all corro;nonrirnce with th•? intprnal ,rvenue Service. ,+;e iro:iceted in ;:o:- h.=adinq of this letter that an addendum An g 1.i_e? _. Fhe iddendijm ''nr 1.05.;r1 '. i in i nt iaril oa rt of thin, IF.'ttnr. Secause t:hi 'Letter could help resolve any questions about your exempt 1:A,itus-, ;rid fcovi6?t)nn �Jt itus, you '•hOLLlii 41-PO it In Your Dermaiient rF•cDrd. we �d'v'N Sent a copy of thi=. letter to your representative as indicated in ynlir power of attornriv. If you nave ariY OU.e!Sti0n5-, plE'a•ae contact ine person whose name and tolep)one nurrlbr-r re, ?�hown in the hpadinr of thi- letter. Enclosure(s): Addendum -orm 872-C Sincerely yours, .,r, Michael J. Quinn District Director Letter 1045(CG) -4- i;UiTER'rIELD STAGE PLAYERS Due to the notification requirements of section 508(a) of the Code, the effiactive date of thi,-a 10,ker t.> D�?r.. 13. 19^0. thu d.ato coon which vjE- received your appiication. Contributions to you are deductible only if made on or aftE?r that date. Yo!t havp nrevinur-]y eorced to that r'ffective, date. Letter 1045(CG) Short Form I ome,:.1__.::::>: Form 990-EZ Return of Organization Exempt From Income Tax 2020 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) — -- ► Do not enter social security numbers on this form as it may be made public. Open to Public Department of the Treasury 0-Go to wwwJrs.gov1Form990EZfor instructions and the latest information. Inspection A For the 2020 calendar year, or tax year beginning 0 9-01 2020, and endin 08-31 12023. B Check If applicable: C Name or organization D Employer identification number ❑ Address change T]i CULA VALLEY PLAYHOUSE 33-0008806 ❑ Name change Number and street (or P.O, box if mail is not delivered to street address) Room/suite E Telephone number ❑ Initial return ❑Finalretum/terminated PO BOX 129A 00rI►ce0_a"o V Amended return 11AppllcallonpondlN y or town, state or province, country, and ZIP or foreign postal code bemecula,CA 92593 F Group Exemption 1 Number ► G Accounting Method: N Cash Accrual Other (specify) ► H Check ► 0 if the organization is not 1 Website: ► WWw, TEMECULAVALLEYPLAYERS . CON required to attach Schedule B J Tax-exempt status (chock only one) • W501(�gsL sflt ■ nsettna. ❑ ,+s,s�s1 or 527 (Farm 990, Form of organization: ® Corporation ❑ Trust Association Other 990-EZ, or 990-PF). K L _ Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets Part Part II, column B are $500,000 or more, file Form 990 instead of Form 990-EZ I Revenue, Expenses, and Changes in Net Assets or fund Balances(see the instructions Check if the or anization used Schedule O to res oonnd to anyquestion in this Part I ................ 1 Contributions, gifts, grants, and similar amounts received . .. ............ .......... . ► $ 17,881 for Part 1) , . . 1 5 911 2 Program service revenue including government fees and contracts ....... . ... . . . . . ...... 2 3 Membership dues and assessments .. .. . ... .......... . .... I .... ...... 3 830 4 4 Investment income .. ...... .... .. ....... . . . .. •' . .. . ... . . 5a Gross amount from sale of assets other than inventory .... .. . .... CD CC _5a b Less: cost or other basis and sales expenses . ....... , ...... .. 5b c Gain or (loss) from sale of assets other than inventory (subtract li A 5b from Ifne 5a) ...... ... 6 Gaming and fundraising events: a Gross income from gaming (attach Schedule G if greater than ff $15,000) .. .. ... . .. . ... ...... 6a 1 b Gross income from fundraising events (not including $ of contributions An, from fundraising events reported on line 1) (attach Schedfslo G 4 the fir080 sum of such gross income and contributions exceeds $15,000) ......... H6c c Less: direct expenses from gaming and fundr�ising events • ...... .... 12,479 d Net income or (loss) from gaming and fundrr5ising events (add lines 6a and 6b and subtract Sc line 6c)............. ... .................... ' • . ......... sd ----(6,,399) 7a Gross sales of inventory, less relurnsand allowances ....... , ...... 7a b Less: cost of goods sold . .. r. . I .. - ........ .. .... 7b c Gross profit or (loss) from sales of inventory (subtract line 7b from line 7a) • . ................ 7c 8 Other revenue (describe 1n Scfseduie o') ... .......... . . . . . . . ...... . . . .... . 8 5,000 9 Total revenue, Add lines f, 2, 3, 4, 5c, Ed, 7c, and 8 . .... . ► 10 Grants and similar.amounts pajd (list in;Schedule O) .. . . . . . . ..... ....... ...... 9 5,402 10 11 Benefits paid to or for members .. . . . . . . . . . . . . . . . . . . . ... . . ... . . . ... .. . 11 7,000 H v, C w 12 Salaries, other compensatton and employee benefits . . . . . . . . . .. . .. . .. .. . . . ...... 13 Professional fees and other payments to independent contractors ...... ................ 14 Occupancy, rent, utilities, and maintenance ............. ... ............... 15 Printing, publications, postage, and shipping . ............................... 12 13 14 _500 _ is 109., 15 3,721 16 Other 9xpenses (describe in Schedule O)................................ 17 Total expenses. Add lines 10 through 16. . . ► 16 3 325 17 is 32555 27 253) N! a Z20 18 Excess or (deficit) for the year (subtract line 17 from line 9) ......................... 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end -of -year figure reported on prior year's return) . ...... ..... . ..... . . . ......... Other changes in net assets or fund balances (explain in Schedule O) ... . . . . .. . . ... . . . . . . 21 Net assets or fund balances at end of year. Combine lines 18 thr h 20 .. IN. 19 27 018) 20 21 (54,271) For Paperwork Reduction Act Notice, see the separate instructions. Form 990-EZ (2020) EEA r 2949226800916 Short Form OMB No 1545-0047 Form 990-EZ Return of Organization Exempt From Income Tax �01 - Under section 501(c), 527, or 4947ta)(1) of the Internal Revenue Code (except private foundations) Oepartmonl of the Treasury Inferno! novenue sarime A For the 2019 calendar S Check ifapplicable [ ❑ Aedress change T, ❑ Name change !; ❑ Initial return ❑ Final retundterrnmated �Pc ❑ Amended return ► Do not enter social security numbers on this form, as rt may be made publics `� IN, Go to www.irs.gov/Form99OEZ for instructions and the latest information, /1c 4 , or tax year beginning September 01 , 2019, and ending August 31 .20 20 no of organize Iion I D Employer identification number da Vall2y Pla house, dba Temecula Valley Players end Street (or P O box if mall is not delivered to street addressl I Roorru'sulle I E Teiephone " nar 6�tl►[IL or town, state or province, country, and ZIP or foreign postal rode F Group Exemption eculu, CA 02593.1293 1 Number ► G Accounting Method: ❑• Cash ❑ Accrual Other (specify) W H Check ► n If the organization Is not I Webslte: No. www.temeculavalle pla ers.com required to attach Schedule B J 'fax -exempt status {check only one) — E 501ie2C3 ❑ 501 c) }0 [4ttsert no ) ❑ 494 Ta 1 or ❑527 1 (Form 990, 990-EZ, or 990-PF) K Form of organization Z corporation Ef Trust ❑ Association ❑ Other L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts If gross receipts are $200,000 or more, or if total assets (Part 11, column (B)) are $500,000 or more, file Form 990 instead of Form 990-EZ ► $ 169 581 Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part 1) Check if the organization used Schedule O to respond to any question in this Part I . ❑ 1 Contributions, gifts, grants, and similar amounts received 1 2, Program service revenue including government fees and contracts 2 3 Membership dues and assessments . 3 1.622 14 Investment income . . . 4 5a Gross amount from sale of assets other than inventory 5a_ b Less: cost or other basis and sales expenses . . . , . . , . :it) _ c Gain or (loss) from sale of assets other than inventory (subtract line 5b from line 5a) 5c -- 6 Gaming and fundraising events: COVED a Gross income from gaming (attach Schedule G If greater than U' $15,000) . I sa _ FEB O 1 2021 ° b Gross income from fundraising events (not Including $ of contributions Q from fundraising events reported on line 1) (attach Schedule G If the �-_- sum of such gross Income and contributions exceeds $15,000) 1 6b 16,,gsg OGUEN, UT c Less- direct expenses from gaming and fundraising events' . Lee I145,056 d Net income or (loss) from gaming and fundralsing events (add lines 6a and 6b and subtract line 6c) . . . . . . . . . , . , . 6d 2Z.90i 7a Gross sales of inventory, less returns and allowances . . . 7a b Less: cost of goods sold . . . , . , 7b _ c Gross profit or (loss) from sales of inventory (subtract line 7b from line 7a) 7c 8 Other revenue (describe in Schedule O) . , . . . . . . . . 8 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 ► 9 24.525 10 Grants and similar amounts paid (list in Schedule O) 10 11 Benefits paid to or for members . . . . , . . . 11 cm 12 Salaries, other compensation, and employee benefits . . . . 12 71400 N c 13 Professional fees and other payments to Independent contractors 13 1,073 tt9 L 14 Occupancy, rent, utilities, and maintenance 14 27,025 r-a 15 Printing, publications, postage, and shipping 15 258 lm 16 Other expenses (describe In Schedule O) S E 4 Start: _W►�rl�, 16 6,132 l- 17 Total expenses. Add lines 10 through 16 ► 17 41,880 18 Excess or (deficit) for the year (subtract line 17 from line 9) . . . . . . , 18 .17,363 ®l to 19 Net assets or fund balances at beginning of year (from fine 27, column (A)) (must agree with _ a end -of -year figure reported on prior year's return) . . . 19 .9.655 R. m 20 Other changes in net assets or fund balances (explain in Schedule O) . 20 `� Z 21 Net assets or fund balances at end of year Combine lines 18 through 20 ► 21 •27 018 C 7� (J) For paperwork Reduction Act Notice, see the separate instructions. Cat No 106421 Form 990-iEZ (2019) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 56 TEMECULA VALLEY ROSE SOCIETY Gi CITY OF TEMI7CU11 A FISCAL YEAR 2022.2023 5F� ll� COMMUNITY SERVICE FUNDING - REINVESTMENT IN � E PROGRAM APPLICATION a (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 1 2, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 Project/Program Title: MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Start Date: 2022 End Date: 3/2023 Physical Address of Project/Program: 30592 Jedediah Smith Rd., Temecula, CA INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Temecula Valley Rose Society Mailing Address: PO BOX 890367 Temecula, CA ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Temecula Valley Rose Organization: Society _ Year Founded: 1990 Website: temeculavalleyrosesociety.org Social Media: Facebook Number of Paid Staff. -0- Number of Volunteers: 25 Geographic Area(s) the Organization Serves: Temecula Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Virginia Boos Title/Position: President Contact Person's Direct Telephone: 951-695-1689 Contact Person's Email: a rginiaboos@rocketem NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes E Date of Incorporation as a Nonprofit: 10-1990 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 330428167 State Identification Number: 1570446 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. p Attach IRS Deductibility Status using this link: httDJ/a17Ds.irs.aoylaapleosl 2. ® Attach State Entity Status Letter using this link: httos://www.ftb.ca.gov/onlinelself serve entity Status letter/indeX.ast] 3. I■D Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htp;//rot.doi.ca.govNerification/Web/5earch.aspx?faciijty=Y r..ifv of TamPrtda Communitv Service Fundina - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No (i ] Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No " Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors I!I Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The Temecula Valley Rose Society was originally founded to encourage local citizens to enjoy roses, planting a rose garden on borrowed land. We now own the 3.4 acre property which is so much more than a rose garden, with many events and activities benefitting Temecula residents. Composting and soil building is taught, the Tree of Life garden offers children and adults lessons in gardening and nutrition, Eagle Scout projects thrive, pollinator and native plant areas are planned, the garden is a designated wildlife area. The beauty and spectacular view are enjoyed by Temecula visitors. Life events are photographed both personally and professionally. Our Board and volunteers will preserve this garden for many years to come. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA's AUDIT, MAY BE NEEDED f UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. 1 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ■ Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT FUNDING RECEIVED OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ❑ Yes IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR NAME OF ENITY RECEIVED FUNDING RECEIVED $ -0- Roripaugh Family Foundation $ I� City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECTIPROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Program 1 - Peace and Friendship garden area, 6 peace poles with the message " May Peace Prevail on Earth", an effort begun in 1955 by a Japanese philosopher, after the destruction of WW2. The message is on each pole, in 42 languages, plus a Braille plaque. Program 2 - Replacement of the garden gazebo, deteriorated after 25 years. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Programl-Rose bushes, mulch, construction of pathways with maintenance, irrigation system and equipment with maintenance, 6 peace poles and shipping, addition of the message in 42 languages plus a Braille plaque, a display case to recognize donors. Program 2-Gazebo unit, shipping, labor to install. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. All citizens of Temecula, at whatever age, benefit from the Rose Haven Heritage Garden. From a simple family picnic, educational classes to learn about nutrition, gardening and composting, Eagle Scout projects, all the way to graduation celebrations and weddings, photography of life events, it's all here at this special place. Care and maintenance are done by local volunteers who enjoy the exercise and accomplishments. Our website encourages visits, tempting with many photos. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT 11500 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 125 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Program 1 - We join the world-wide Peace and Friendship movement, "May Peace Prevail on Earth", begun in 1955 by a Japanese philosopher, as a response to the WW2 destruction in Japan. Program 2 - Replacement of the gazebo unit, due to deterioration of this 25-year-old structure, used for rental income, as well as visitors' enjoyment. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC !COMMUNITY. FFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Covid involvement changed everything. Meetings and activities for both adults and children were shut down. Outdoor meetings were attempted with little participation. Annual dues were not collected for 2021 resulting in a loss of revenue and membership interest. I6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Program 1 - Our Peace and Friendship garden area was initiated in 2020. It will need constant maintenance by our volunteers. A REDI presentation was well received by City officials in March 2022. Program 2 - Our original decorative garden gazebo was installed about 25 years ago. It now needs to be replaced due to deterioration, as simple repair is not possible. This unit is important to us for income, as it is rented for family events, weddings, proposals. It is one of the main attractions for visitors, high on a hill for a spectacular view. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 12,657 Organization Other grants or funding already awarded for Project/Program, if any $ -0- In -Kind match amount or volunteer credit hours estimated amount $ 43,816 TOTAL REVENUE $ 106,473 LIST OF EXPENSES FOR PROJECT/PROGRAM Irrigation system, 6 peace poles, language Tools/Equipment plaques $ Facilities/Rent/Insurance $ Roses, mulch Supplies $ Marketing $ Services $ Food $ Other Pathways, donor recognition display case $ Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT, $_0_ HOWEVER PLEASE INCLUDE. _ / d 4'3 G u S a TOTAL EXPENSES $28,015 $107,729 $ TOTAL BUDGET City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022, In audition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit andlor require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Yoar 2021-2029 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1 _ Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receiptsJinvoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Temecula Valley Rose Organization: Society FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Name of Project/Program: _ Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): c Date on _ _ Expenditure E Name of Company Receipt/lnvoice on Receipt or Invoice MUST BE ON OR BETWEEN Amount I Description E ` JULY 1, 2021 - JUNE 30, 2022 ,ill, DESCRIBE THE EXPENDITURE 6 EXPENDITURE TOTAL Purpose PURPOSE OF EXPENDITURE EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page, 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Temecula Valley Rose Organization: Name of Project/Program:Society . TOTAL FY 2022-2023 Month S Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes, or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) Date on E Name of Company Receipt/Invoice 0.0 on Receipt or Invoice ! MUST BE ON OR BETWEEN E March 20, 2020 - JUNE 30. Q Z 2024 2 3 i EXPENDITURE TOTAL Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION $ AWARD LETTER 1 Description EXPENDITURE TOTAL Purpose City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Temecula Valley Rose Society MAILING ADDRESS: PO Box 890367 Temecula, CA PRESIDENT/AUTHORIZED OFFICER: Virginia Boos PRINT NAME PHONE: (951 695-1689 EMAIL: virginiaboos@rocketmail.com SIGNATURE: .t.t DATE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: TITLE 9/12/2022 MONTH. DAY. YEAR PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/20/2022 ESL ID: 7848128431 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1570446 Entity Name: TEMECULA VALLEY ROSE SOCIETY ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board, 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States ova a CrS / d o03 Department of The Treasury American Rose Society P.D. Box 30000 Shreveport, LA 71130 Dear Sir or Hadam,' Internal Revenue Service ED Croup 7401 Suite 11091 Stop 520 101 West Peachtree St. Atlantae CA 30365 Person To Contact: Kim Artis Telephone Numberl " W 331-1909 Refer Reply To: MAY 15 1992 E0 ! 7194: Ail EIN: 31-1397710 Date: MAY 111992 Re have received and reviewed the amended or3anizing documents that you submitted on behalf of your organization, in which the organizing documents were approved and/or adopted an 3/20/92 and 3/26/92. This inforr*ation has been made a part of Your file, Your organization shall continue to be recognized as exempt under Section 501(C)(03) of the Internal Revenue Coder effec- tive as of 06/83, You may continue to rely on this exemption until it is modifiedr terninated or revoked by the Internal Revenue Service, Please continue to let us know of any changes in the purpose, character, method of operations name or address of your organization, This is a requirement for retaining your exempt status, A copy of this letter should remain in your permanent records, as it may help resolve any question about Your exempt status, Thank you for your cooperation. 'Dine rely, Ai Y g nixations Coordinator . , ....v _. Li REC-D Le ■ In emal Revenue Service Deportment of the Treasury Aa -a- -, - 0 • f ' - /3 -jr- -( �--f District Director AMERICAN RASE SOCIETY Tls"'lEULA VALLEY RUSE sWCsTV P.O. Bilk 34U 017 TMIMU9 A. CIL 4259"367 Dear Tor ---payer 3tIO M_ Las Angers Street. MS 7043 Los Angeles. CA 90012 Peisoe to Coda& J6 aaxRAL:as e epbone N tuber. .Refer RePW to: E0 MMM ogle: PERRUAPLY 74, 1993 EI : 33- 41428167 T!'_-7 ietter iS 1ii ias;xorse t:.: our cep uesr ivr g�- ewm-'_ =catt:s =7-g--z-d-ing the orb:: ra _^_a -cam G C -6 ORS F�a records ind_eare th-a r this orgy __zaz_,n~ wasrecog=:iZ('d GJ �T x:UGC f rcm c e -ra i ] 3:wC:a� under Gt �K.^_al Revenue 501(C' t o3 - Group exemptio-a numbe'_r 7044 has The been as-; ;Igned so zhe nrganizatic:: and ars sabot&_hates - I 4I�t� .atioi3 ZZtter �-�s�ed i -itm 1.9a1 , conk imi- s Cn be --ct effect. a=- you need fu!:t:`r_er assi-sLarce, please cap_taa:t our offac az the above addr. ear. or teierhane wimber _ SIncereiy, risciostrre A-Lai9ta-Itt Confirmation Print this page for your records. The Confirmation Number below is proof that you successfully filed your 199N e-Postcard. We received your 199N e-Postcard on 415/20219:40:31 AM. Confirmation Number: 15TO44609509 Entity ID: Entity Name: 1570446 TEMECULA VALLEY ROSE SOCIETY Account Period Information Account Period Beginning: 1/1/2020 Account Period Ending: 12/31/2020 This is not your entity's first year in business. Your entity has not terminated or gone out of business. Your entity has not changed the account period. Gross Receipts:$78761 This is not an amended return. An IRS Form 1023/1024 is not pending. Entity Information FEIN: Doing Business As: Website Address: Entity's Mailing Address PO Box 890367 Florence Rafulowitz Temecula CA 92589 Principal Officer's Information Rebecca Weersing PO Box 890367 Florence Rafulowitz Temecula CA 92589 Contact Information Name: Phone: 330428167 Temecula Valley Rose Society temeculavalley rosesociety.org Florence Rafulowitz 9738733488 After we process your 199N e-Postcard, you may receive a bill if the three year gross receipt average is greater than the amount allowed for filing a 199N e-Postcard. ^Print j Log Out - Q1 ILrA _1 , f /w✓ �J -01 RS Confirmation Your Form 990-N(e-Postcard) has been submitted to the IRS • Organization Name: AMERICAN ROSE SOCIETY • EIN:330428167 • Tax Year. 2020 • Tax Year Start Date: 01-01-2020 • Tax Year End Date: 12-31-2020 • Submission ID: 10065520210954481754 • Filing Status Date: 04-05-2021 • Filing Status: Pending f `(60 6 3 0 ,�o ----x-_ Or/ --aS 10663f Note: FdW a copy of this filing for your records. Once you leave this page, you will not be able to do so. MANAGE FORM 990-N SUBMISSIONS a�aa-_o t-o5`loos/G Form 9WN Electronic Notice (a -Postcard) OMB No. 1545-2085 Deoartroent of the Rmesury internal Revondkf Servloo fbr TWExemM Organbadw not Required to File Form 990 or M-EZ 2020 A For Ole 2020 Calendar year, or fax year bagtnnknq =Q&1:0 and ending 2020- M B Owdt If available Q Termkwpd for Bwkwn Q Qum rMwPfs wa nwarty tiSO,m orIas E Websile: MM=wAyawyUMyMS*Q4y.VM C Name of Organtcation: POBaxWM Temenuiit. ",U. 92M F Name of Principal Ohioan. ItT+�[gs;gg 90-6y�INM. v TEME -lu & r•_s uc. 92589 Open to Public Inspecticin D Employee fdenti "Uon Number 34428167 Pr(vacyAct and Paperwork Red"'J m Act Nedca; We osk Ivr the inrormahan on (his forth to carry out the Internal Revenue laws of the United States. You era required to give)us the infarmafion. We need it to ensure that you We complying with these laws. The organlzatlon Fa not required to provide inromlailon Mquesied on a form that is subject to the PaPerwolk Reduction Act unless OW reran dlspiays a valid OMB cenvot number. desks Or records Waling to a farm or its instructions must be reta[nod as tong as their Contents may become material in uw adminisvatlon of any Intnmal Revenue law. Tha nrles govemIng the confidentiality of the Form OWN is Covered in node section 6104. The limo ndfoded to complete and file this form and related schedules wiN vary depending on the individual circumstances. The estimated average times Is 15 mmutos. Note: This Image is provided rear your rocord■ only. Do Not mall this pays to the IRS. The IRS will not accept this filing via paper. you must file Your Form 99" (u-p*%tcard) alactmnIcWIY. WIRS Contact Information �'© as-4 F"-G5-- / 06 33Y fiQ= I,«t� ,merle I >QMI e-Postcard Profile Select EIN Organisation Details Contact Infomaation Confirmation Electronic Notice -Form 990-N (e-Postcard) Organization Address and Principal Officer Information Organlzahon's legal name- l AMERICAN ROSE SOCIETY If your organization conducts busyness using another name (DBA), enter other name: = required field Organization: D9A Name Temecula Valley Rose Society DBA Name - continued ENTER ADDrmNAL DBA NAMES country US - United States v Number and street (or Po eox). PO Box 890367 City Orr~ Temecula State' CA - California v ZIP Code* 92589 oWntration'swebahawdreaa if.ppiicat,46 tem0u1avaIIayrris�,, ;81y gm a 1_09 _&:�— l v G Z,o -�— AMERICAN ROSE S P.O. Box 30,000 - Shreveport, Louisiana 71130-0030 8877 Jefferson Paige Road - Shreveport, Louisiana 71119-8817 Phone: 318-938-5402 - Fax: 318-938-5405 - www.ars.org Date: March 1, 2019 From: American Rose Society Chapter/Society Membership Services Re: Federal Employer Identification Number (EIN) The following information is for an affiliate of the American Rose Society, as assigned by the Internal Revenue Service. Chapter/Society Name: Temecula Valley Rose Society President: Virginia Boos, President (951)-695-1689; virginiaboos@roctcetmail.com. Treasurer: Bonnie Bell El Number: 33-0428167 CA FTB Number: 1570446 The Temecula Valley Rose Society is a subordinate of the American Rose Society and is in good standing with this organization. The Temecula Valley Rose Society is exempt from federal income tax under the Group Exemption Number (GEN) of 7044. The American Rose Society is recognized as a 501(c)3 organization by the IRS as are all of our subordinates in good standing. r TVRS 202Z oungE r. Jan - Dec 22 Jan - Dec 22 irdinary Income T Ordinary Expense Income Expense 4100 Interest -Savings 2.00 5100 Executive Committee ,4200 Member Donations 1 15103 Affiliate Insurance ARS 490.00 14230 Member Donations 400.00 $122 Insurance Directors & OfII 580.00 Total 4200 Member Donations 400.00 5123 P. O. Box rental 190.00 4300 Membership 5128 Supplies 70.00 1.4310 Membership Dues 1,500.00 5129 Telephone, Telecomm 300.00 4320 Nametags 240,00 .5135 Taxes and Fees 45.00 Total 4300 Membership 1.740.00 ,5138 Square Processing Fee 52.00 4500 Program Income Total 5100 Executive Committee 1,727.00 4515 Member Mtg Raffle Total 4500 Program Income 550.00 ,5200 Programs Committee 550.00 1 .5233 Member Meeting Room Rent 375.00 4600 Rose Haven Donations ;5234 Mbr Meeting Speaker Fees 200.00 4611 Photography/Photo Shoot 1.600.00 5235 ARS Programs Fee 125.00 4612 Reservation Donations 500.00 Total 5200 Programs Committee 700.00 4615 General Donations 1.250.00 5300 Membership Committee 4642 Landscape Maintenance Dona 15,350.00 21 Awards 60.00 4670 Visitor Donations 1,000.00 1!1�5330 22 Nametags 240.00 Total 4600 Rose Haven Donations 19.700.00 ARS Affiliate Dues 70.00 4700 Society Operations Donatio Total 5300 Membership Committee 370.00 4710 Board Pledges 1,500.00 5600 Finance Committee Total 4700 Society Operations Donatio 1,500.00 5540 Taz Preparation 250.00 4800 Ways & Means 'Total 5500 Finance Committee 250.00 4820 Stater Brothers Script 140.00 5700 Communications Committee 4822 Amazon -Smile 140.00 15710 Newsletter Print & Postage 300.00 Total 4800 Ways & Means 280.00 15730 Website - main TVRS 170.00 4840 Rose Haven Events 5740 Chamber of Commerce 300.00 4860 Special Events Proceeds 2.000.00 Total 5700 Communications Committee 770.00 4861 Garage Sales Proceeds 200.00 5800 Rose Haven Committee Total 4840 Rose Haven Events 2,200.00 5812 Benches, Tables 500.00 Total Ordinary Income 26,372.00 5831 Annual Backflow Testing 50.00 5832 Irrigation Repair 1,000.00 Other Income 5833 Minor Maintenance 750.00 6010 Tree of Life Project 1.000.00 15334 Miscellaneous Supplies 500.00 $ ffgFPZa,-e-and� a%i p�` j- -- -. --27,500:06 " 5835 Soil Amendments/Fertilizer 500.00 28,500.00 5836 Weed Supplies 400.00 5841 Non Rose/Tree Care 2,000.00 f Total Income 64,872.00 5847 Landscape Maintenance 7,200.00 5848 Pond Maintenance 3,930.00 5851 APGA Membership 150.00 5852 Garden Insurance 1.275.00 5853 Porta-a-Potty 980.00 160.00 15854 Property Taxes 5065 Utilitties Vactric 1.000.00 5856 Utilities Water 1,500.00 5858 Internet Provider 660.00 Total 5800 Rose Haven Committee 22.555.00 v Tote Ordinary Expense 26,372.00 Other Expense 701 RH Tree of life Exp 1,000.00 * 7019aPaace:arXd.rlendshlp•Exp -- '27,500.00 77 Total Expenses 28,600.00 12/17IZDZ 1 Net income 1 54,872.09 Q e Temecula Valley Rose Society Checks, Auto -Pay, to Ratify May 2022 Date Num I Name L- Account Amount -J JJ 12 Checks Issued from Check # 2940 to 2951, total $8.501.33 .06/0312022 2940 'White House Sanitation 15853 Porte -a -Potty 101.04 318.82 10510312022 2941 (Nancy Fitness 5834 Miscellaneous Supplies 105/10/2022 2942 Whisenhunt Communication 5670 Society bochures 325.00 05119/2022 2943 City of Temecula 5233 Member Meeting Room Rent _ 170.00 05/19/2022 2944 Agnardo Landscape 5847 Landscape Maintenance 600.00 05/19/2022 .2946 Temecula Trophy 5322 Nametegs 05/19/2022 2946 'Waterscape Creations. Inc. ;5848 Pond Maintenance 05/19/2022 2947 (Rolling Hills Construction 0f' �azalia'Project �' *490.0Q 05/19/2022 2948 �Agriscape05/20/2022 2949 White House Sanitation Park West 5853 Porta-a-Potty �,[17 :Paa a:atrd i:riends>1ip-> x� `� 05/24/2022 2950 .05/24/2022 2951 Forest Bees 5637 Bees and Other Pests Contr 360.00 8,501.33 Electronic Payment Omega Print 05/09/2022 .Pay 5670 Society bochures 222.94 222.94 AutoPays for Utilities: 05/23/2022 Autopay Frontier Communications 5858 Internet Provider 65.87 05/27/2022 Autopay Rancho California Water 5856 Utilities Water 126.39 05/03/2022 AutoPay Southern California Edison 1 1,5655 Utililtles Electric 103.26 295.52 TOTAL 9,019.79 9,019.79 Page 1 of Temecula Valley Rose Society Checks, Auto -Pay, to Ratify April 2022 Num Name Account Amount 5122 Insurance Directors & Offi 11 Checks issued: from check # 2929 to 2939, total = $4,874.14 .2929 Chubb 600.00 2930 'White House Sanitation 5853 Porta-a-Potty 101.04 2931 City of Temecula Library, Gen Meeting 5/22 5233 Member Meeting Room Rent 34.00 _ . 2932 2933 City of Temecula Library, Gen Meeting 6122 5233 Member Meeting Room Rent 34.00 Temecula Valley Pipe & Supply W •5832 Irrigation Repair 623.82 2934 ] Agnardo Landscape 5847 Landscape Maintenance 600.00 i Agnardo Landscape 5836 Weed Supplies 463.24 .2936 Waterscape Creations, Inc. 5848 Pond Maintenance _ 320.00 2936 .Agnardo Landscape, Reimb Stolen Battery Charger 5132 Other 118.54 2937 West —far mulch " 901_gP€aw9nd Rdendship•EV► 640:00 2938 The Hartford Insurance 5852 Garden Insurance 1,328.00 2939 American Rose Society for Tem CultureFest Ins Cart 5103 Affiliate Insurance ARS 11.50 .AutoPays for Utilities: 4,874.14 .AutoPay Rancho California Water 5856 Utilities Water 112.11 AutoPay Southern California Edison .5855 Utilllties Electric 45.48 ,AutoPay Frontier Communications ;5858 Internet Provider 65.87 223.46 AutoPurchas Amish Country 7017 Gazebo Project 1,262.00 TOTAL DISBURSEMENTS: 1 ,349.60 Vol Page 1 of 2 -08130/22 9.0 9-a--a�—C)9, 04 SOS�l Temecula Valley Rose Society Income vs Expenses January through December 2021 Page 3 of 3 Temecula Valley Rose Society Summary Income vs Expenses YTD —� January 1st throtrgh,DecembiDr'31, 2019 Jan - Dec 19 Ordinary IncomelExpense 4100 Interest - Say Ings. 1.82 4110 Investments ,4200 Member Donations 1,508.69 52.25 4300 Membership 2,269.50 4500 Program Income 697.00 4600 Rose Haven Donations 12,430.37 4700 Society Operations Donatlo 2,000.00 4800 Ways & Means 713.63 Total Income Expense 5100 Executive Committee 1,024.50 5200 Programs Committee 831.01 5300 Membership Committee 602.94 5500 Finance Committee 500.00 5600 Education&Outreach Comm 332.45 5700 Communications Committee 651.92 5800 Rose Haven Committee 0 9 r79, Total Exnense _.aadoh s ra Net Ordinary Income Other Income/Expense Other Income 6000 Other Income Total Other Income Net Other Income Net Income 2,438. Page 1 of 1 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 57 GFWC TEMECULA VALLEY WOMEN'S CLUB CM OF TEMECUI,rA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING M REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Fundraiser Cancellation Project/Program Title: ` Compensation Project Start Date 1/1/23 Date; 12/31/23 Physical Address of Project/ Program INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: GFWC -Temecula Valley Woman's Club Mailing Address: PO Box 1056 Temecula, CA 92593 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization' GFWC -Temecula Valley Woman's Club Year Founded;-1980 Fs, Temecula Valley Woman's Club Website; www.tvwc.com Social Media:rr�-at Number of Paid Staff: 0 _ Number of Volunteers: 80 Geographic Area(s) the Organization Serves _ The_Temcklla Vale Geographic Area(s) the Project)Prograrm Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE f� Serves; 7{C!_USIVELY USED TO SERVE TEMECULA. Contact Name: Patti Castillo Title/Position: Communciation & PR Chair Contact Person's Direct Telephone: 951-85()-Q498 Contact Person's Email: __plhcastillo QD a]Lpom NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 7/81,1982 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 95-3788376_ _ State Identification Number: 1119999 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ❑x Attach IRS Deductibility Status using this link: http:NapPs.ils,govla lees/ 2. ❑ Attach State Entity Status Letter using this link: WA tisL/www.ftbca.gov/oRli-ne/self serve entity status letter/index,asp 3. 21 Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htlp Mr do x'iFacilily=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑x Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors M Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION 1 BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The Temecula Valley Woman's Club is part of an International organization dedicated to the improvement of the educational, ethical and cultural life of the community through volunteer service. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT, DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES C CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR I NAME OF CITY GRANT Ij FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No 0 Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERr 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. For 35 years, the Temecula Valley Woman's Club (TVWC) hosted the Holiday Home Tour. The Home Tour is TVWC's largest fundraiser. A portion of Home Tour funds raised went toward local scholarships. TVWC dedicated an amount of the remaining funds to The President Project, local non- profits, and the remaining amount to TVWC's operational costs. TVWC's operational costs include the following: meeting and facility fees, public relations, advertisement, membership engagement events, training, and financing of the following year's fundraisers, the Holiday Home Tour & Mid -year Fundraiser. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Grant funding would pay for TVWC's operational costs of monthly meetings, fundraising events, membership engagement, public relations, and local non-profit projects. List of goods and services to purchase for the Home Tour Fundraiser; such as homemade soup supplies, gourmet food supplies, bakery food supplies, wrapping & packaging suppies, decorator expenses, craft supplies, booties (for guests to visit the homes), waste management rentals, van rentals, traffic control rentals, print advertising, brochure printing, ticket & poster printing, catering, table & chair rentals, portable toilet facility rentals, venue rentals, Insurance fees, licenses, and permit costs. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. For 42 years, TVWC has given back to the Temecula Valley by volunteering, supporting, and donating to local non -profits, schools, and public agencies. TVWC has donated over 3 million dollars to local non -profits and 1.5 million volunteer hours. From local public schools, food banks, public libraries, and park and building foundations to animal shelters, children at risk, helping the homeless, and women's breast cancer support, the Club has impacted tens of thousands of citizens in the community. This grant will allow TVWC to continue pursuing, engaging, and increasing membership, allowing us to volunteer, donate and support more non -profits, local schools and libraries, and organizations. It will also subsidize some of the income lost due to canceling fundraising events for the past two years. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 250,000 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINLIEII 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. undraiser Cancellation Compensation Project will increase membership and fundraising apabilities. With additional volunteers and funds, TVWC can return to hosting larger fundraisers wising funds to a pre -pandemic level. Increased volunteering, contributing, and donating to the immunity will result in an improved quality of life in the Temecula Valley and its citizens. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. At the end of 2019. TVWC had 120 members. In 2022, our membership declined to 80 members. Our members are the lifeblood of the organization. The decrease in membership reduced the number of charities supported, the dollars donated, and the hours volunteered to the community. In December, TVWC plans to host the 36th Annual Holiday Home Tour. The reduced membership and lack of income from the last two years will result in a smaller event, with the number of homes on tour reduced to two and ticket prices reduced. Overall cost increases resulted in cutting back on the number and variety of homemade soups to be sold, totally deleting the gourmet jams & jellies sold in the past, and the number and type of bakery items and crafts offered for sale at the Home Tour. The pandemic has impacted TVWC in many ways. This grant would assist TVWC in increasing membership and paying for fundraising costs. Getting back to pre -pandemic membership numbers will increase TVWC's ability to give back to the community, positively impacting residents and making Temecula and the surrounding communities a better place to live. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Grant funds would allow TVWC to CONTINUE and EXPAND our membership and fundraising abilities. The pandemic caused a reduction in attracting and maintaining members and limited fundraising efforts. TVWC had to cancel fundraisers in 2020 and 2021 and radically downsize the 2022 Home Tour. With this award, TVWC would have funds to cover the costs of maintaining and attracting additional members and assist in paying the price of hosting our fundraiser to the quality and level before the pandemic. In doing so, we can return our contribution to the community to the higher level performed in all the years before the pandemic. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM I REVENUES I EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 1 50,000.00 Amount contributed to the Project/Program by the Applicant $ Organization 26,950.00 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: ■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. ■ If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: L-1F WCr` 11r1-V1eL'VJCt V4 ` lie YY G.V1 �U.�D MAILING ADDRESS: l OK oo VJ PHONE: [ ' yj l eImelco ,0-6 1 j5i3 EMAIL: P1 kccos --fl one ,y rn PRESIDENT / AUTHORIZED OFFICER: -PRINT NAME SIGNATURE: IF DIFFERENTTH 80VE, APPICATION PREPARED BY:QT3 PRINT NAME TITLE DATE: 9 4&M2. MONTH, DAY, YEAR T- TITLE t SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Details about Gfwc-temecula valley womans club https://apps.irs.gov/app/eos/detai]sPage?ein=953788376&name=Gfw... CQ HELPO MENU Home > Tax Exempt Organization Search > Gfwc-temecula Valley Womans Club c Back to Search Results Gfwc-temecula Valley womans Club EIN: 95-3788376 1 Temecula, CA, United States Other Names Publication 78 Data e Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990,990-EZ, 990-PF, 990-T) e Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2019 Form 990EZ Tax Year 2018 Form 990EZ Tax Year 2017 Form 990EZ Tax Year 2016 Form 990EZ I of 9/10/2022, 12:39PM STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 09/11/2022 ESL ID: 7356915853 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1119999 Entity Name: GFWC - TEMECULA VALLEY WOMAN'S CLUB X1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 f. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) afite GRAPHIC]hint - I00 NOT PROCESS Aa Filed Data - DLN: 934921-96005040 Short Form OMB No. 1545-1150 FOrm990EZ Return of Organization Exempt From Income Tax IN Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 2019 Department of the Treasury Internal Revenue Service A For the 2019 tales B Check if applicable: ❑ Address change ❑ Name change ❑ Initial return ❑ Final return/terminated ❑ Amended return ❑ Application pending ► Do not enter social security numbers on this form as It may be made public. ► Go to w}vtyirs.aoy/Fornr9sOEZ for instructions and the latest information. Y_a5Zor tax year beginning 01-01-2019, and Name of organization GFWC - Temecula Valley Womans Club Number and street (or P 0. box, If mail is not dehvorod to street addro. PO Box 1056 City or town, state or province, country, and ZIP or foreign postal coda romecula, CA 92593 G Accounting Method: ❑ Cash ® Accrual Other (specify) ► I Website: ►www.tvwc.com Tax-exempt st4tus (check only one) - 0 501(c)(3] ❑ 501(c)( ) ■ (insert no.) ❑ 4947(a)(t) or C1 527 D Employer identification number E Telephone number (310)994-0155 F Group Exemption Number ► H Check ► ® If the organization is not required to attach Schedule B (Form 990, 990-EZ, or 990-PF). K Form of organization: O Corporation ❑ Trust ❑ Assoclatlon ❑ Other _ L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . ► $ 195,554 Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions Cheek if the organization used Schedule 0 to respond to any question in this Part I , for Part 1 I) . pl 102,006 1 Contributions, gifts, grants, and similar amounts received . . . . . . . . . . . . . . �.f . 2 Program service revenue including government fees and contracts . . . . . . . . . . . . . . . . 2 20,875 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . 3 4 Investment income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5a Gross amount from sale of assets other than inventory . . . . . . . Sa b Less: cost or other basis and sales expenses c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) . . . . . . Sc 6 Gaming and fundralsing events G a Gross Income from gaming (attach Schedule G if greater than $15,000) 6a Ixu b Gross income from fundraising events (not including $ 93,026 of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) 1) • - 6b 72,673 c Less: direct expenses from gaming and fundraising events . . . 6c 7r,673 _ d Net income or (loss) from gaming and fundralsing events (add lines 6a and 6b and subtract line 6c) 6d 7a Gross sales of Inventory, less returns and allowances . . . . . . 7a — b Less: cost of goods sold . . . . . . . . . . . . 71r� 0 c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) . . . . . . . . . 7c 8 Other revenue (describe in Schedule O) . . . . . . . . . . . . . . . . . . . . a 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 . . . . . . . . . ► 9 122,881 10 Grants and slmllar amounts paid (list in Schedule O) 10 11 Benefits paid to or for members . . . . . . . . . . . . . . . , . . . . . 11 12 Salaries, other compensation, and employee benefits . . . . . . . . . . . . . 12 ^ r 13 Professional fees and other payments to independent contractors . . . . . . . 13 J a 14 Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . . . . . 14 t'r 15 Printing, publications, postage, and shipping . . . . . . . . . . . . . . is 16 Other expenses (describe in Schedule 0) . . . . . . . . . . . . . . . . . . . 16 17 Total expenses. Add lines 10 through 16 . ► 17 18 Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . . . . . 18 n 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with a end -of -year figure reported on prior year's return) . . . . . . . . . . . . . . . . . 19 u Z 20 Other changes in net assets or fund balances (explain in Schedule 0) . . . . . . . . . . . 20 21 Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . . . . . . 21 For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 10642I 1,580 1,489 102,731 105,800 17,081 123,216 2 140,299 Form 990-EZ (2019) Temecula VAIr wnman's C]iub a w Cc�iGtsiliu,l ,mm�niIII un Z�uli[s tiiien, Ms. Patti Castillo Temecula Valley Woman's Club (951)-850-5498 I castillo@,qmaii.com September 12, 2022 Community Service Funding: REINVESTMENT IN TEMECULA Attn: City Manager's Office City of Temecula 41000 Main Street Temecula, Ca 92590 DEAR SIR/MADAM, The Temecula Valley Woman's Club (TVWC) is part of an International Organization dedicated to the improvement of the education, ethical and cultural life of the community through volunteer service. TVWC has been serving the Temecula Valley for the past 42 years. TVWC has given back to the Temecula Valley by volunteering, supporting, and donating to local non -profits, schools, public libraries, and museums. TVWC has donated over 3 million dollars to local non -profits and volunteered over 1.5 million hours. For the past 35 years, TVWC has hosted our largest fundraiser, the Holiday Home Tour. A portion of the proceeds from the home tour go toward scholarships, and the remaining proceeds go toward funding our non-profit support projects and TVWC's operational costs. Sadly, because of the Pandemic, TVWC canceled the 2020 and 2021 Home Tours and mid -year fundraiser, impacting our fundraising income and membership. At the end of 2019, TVWC has 120 members. In 2022, our membership declined to 80 members. This reduction in funds and members reduced the number of charities supported, the dollars donated, and the hours volunteered to the community. This grant would assist TVWC in increasing and engaging membership and expand our fundraising abilities to pre -pandemic levels. Getting back to pre -pandemic membership and funding capabilities will increase TVWC's ability to give back to the community, positively impacting residents and making Temecula and the surrounding communities a better place to live. Tax ID #95-3788376 • Find us at Temecula Valley Woman's Club o no P.O. Box 1056, Temecula, CA 92593-1056 • (951) 302-1370 •www.tvwc.com TVWC would like to thank you for your consideration throughout this process and for providing organizations like ours with opportunities to give back more to the community, which will result in an improved quality of life for the Temecula Valley and its citizens. Sincerely, i Patti Castillo Temecula Valley Woman's Club Communications and PR Chair ENCLOSURE FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 58 THE EMPOWERMENT CENTER CITY OF TEMECUTA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 I PROJECT/PROGRAM INFORMATION Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Youth Mental Health Community Health Worker Program Physical Address of Project/Program: Start Date: Jan 1, 2023 End Date: Dec3t, 2023 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: The Empowerment Center Mailing Address: 27262 Via Industrial Temecula, CA 92592 I ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization. The Empowerment Center Year Founded: 2005 Website: www.theempowermentcenterintl.com Social Media: `ww,facebook.com/theempowermentcenter Number of Paid Staff: 4 Number of Volunteers: 8 Geographic Area(s) the Organization Serves: Riverside County Geographic Area(s) the Proiect/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA, Contact Name: Teresse Lewis, L.C.S.W. Title/Position: Executive Director Contact Person's Direct Telephone: 951-514-2939 x107 Contact Person's Email:tlewls@theempowermentcenterintl.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ■❑ Date of Incorporation as a Nonprofit: 2005 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 56-2497243 State Identification Number: C2588343 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ■❑ Attach IRS Deductibility Status using this link: htto:/Iai)ps.irs.gov/aoa/eos/ 2. N Attach State Entity Status Letter using this link: httos://www.ftb.ca.gov/online/self serve entity status letter/index.as 3. 9 Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.doi.ca.00vNerificationMebtSearCh.aSOY?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No [J Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No Al Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee IN Board of Directors [t] Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES The Empowerment Center's mission is to help youth and families develop the resilience necessary to overcome challenges, discover the best of themselves and create healthier, happier patterns of living. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENTAND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes EN] IF YES, PROVIDE BELOW, NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Breakthrough Family Wellness Program $ 5000.00 1 January 2021 Community Services Grant 1$ —L$ I � $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No ❑ Yes Q IF YES, PROVIDE INFORMATION IN TABLE BELOW, AMOUNT MONTH + YEAR NAME OF ENITY RECEIVED FUNDING RECEIVED $ 650,000 California Workforce Development Board April 2023 $ 100,000 Morgan Stanley Foundation_ 1January 2023 $ 100,000 Temecula Valley Unified School District March 2023 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 11 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT I The Empoworrneni Canter's Youth Mental Heallrt Worker PraW.1 is an niruwalive Grow -your -own approach to training up the youth in the cily of Temecula to address The manlsil heallh conoorns of romecula's youth population. The purpese of Ih4 prntecl is to create an ecosystem that trains and deploys a front-line army of youth mental heallh workers to gaar emmpetentia9 that craalevlahlrt career palhwnya upon high school graduation Youth participants ages 17-24 will receive comprehensive training provided and aupervised by licensed menial heallh professionals to pmparn them for the workforce. Curriculum will include Mental Health Assessment Skills, AtWorecy Skills, Corear Readiness Skulls, knowledge of M la! and bohaivloral hk4(h referral systems, and skills to become trusted messengers to connecl youth and families to mil heallh Supports In times of need The rota+sf ".19)nitt Prngavn ir+eludes components in training, menlorship, supportive services, and case management to Osial with youth paniripant3 wtlhtnb plarmmi 1. Tuts program has a special emphasis on youth at -risk for homelessness, foster youth, youth from rao181 minority POP01111tflnS.8rid youth idnnhly1riq as LGB'rp. upon rnrRpreGnrl of the program, participants will be able connected to employment opportunities within fatal educatremal Inalitullons, mepl0l t+aaklh aprxtcres, aedcvnimunity bawd organizations to address health equity gaps and improve youth population mental health oultomes Ihmnttghout Temecula and acrmt;a the tNan4 Empire. Gradualhr s of tlae program will receive a state -recognized certificate of completion, providing an ecaaleroted opfrarlunity In gain a lain; lahla indaslryroqugni,ted skill sal to meat youth mental health needs without the barrier of a 4-year degree traditionally needed to work in the Wd of mental health TiSH rnolw alrre pruGram also inCludu supportive services for participants in need, including flexible training opportunities (after school. nights, and woskende), tor.1 mololly assr;tWncu, short•lanrr financial suplialll. As an organization that embraces youth and young adult development, The Empowerment Cenler ts~ this orej�el to mir•.reasa the avAiiat lUly of ail lino anR oompassl"ate mental health supports of the youth populations. TEC is inviting the City of Tsmoruta to oarlirar with us in Ih c very qXrklkty and rnMvatkve programming fmr our youth 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED, ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Grant funds will be used to cover the costs of youth mental health training, curriculum materials, and program participation incentives including meal provision for evening and weekend trainings and gift cards. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. This grant funding will specifically benefit Temecula residents through focused participant recruitment efforts to Temecula youth ages 17-24. The participants will receive career readiness skills, mental health job skill certification, and employment opportunities to serve other local youth residents in need of mental health and community supports. This will improve the overall mental wellbeing of Temecula youth and families, strengthen and equip the youth workforce within the city, and directly boost Temecula's economy by creating viable local career pathways for high school graduates within the school district and local community based organizations. Tragically, it was recently reported that two Great Oak High School sludents died by suicide. The program's purpose is to increase hope and improve the life outcomes of teens and young adults here in our own backyard by raising up Youth Mental Health Workers by equipping them to not only recognize and address their awn needs but effectively and compassionately address the mental health needs of their peers as well. In addition, through a partnership with the Temecula Valley Uniried School District, the district is on board to refer their students and former graduates to participate in the project, and in turn, program participants will provide local students and families in need with mental health supports and connection to community based resources. 3b ESTIMATED M FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT 100 PROGRAM 3c , ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM. 15 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT— SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. The Empowerment Center's Youth Mental Health Worker Project is an innovative approach to providing peer -to -peer mental heath support for Temecula's youth population. Grant funds will be used to cover the costs of training, curriculum, and supportive services. Temecula residents will benefit by receiving effective mental health support and job opportunities. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. I The COVID-19 pandemic allowed The Empowerment Center to pivot their services to virtual platforms, removing the barriers to attendance. Although we had to shut our doors to in -person programming, the pandemic allowed us to reach the most youth and families through virtual programming that we have reached in the last 5 years. This pivot has allowed us to expand our services across the county, state, and country. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. These grant funds will create a new programming for The Empowerment Center. The Empowerment Center has been invited by the California Workforce Development Board to provide Mental Health Worker training and employment preparation services to the adult workforce. We recognize that youth are in just as much of a need of these same skills, supports, and experiences, and it is our goal provide youth with the same opportunites through this Youth Mental Health Worker Project. This grant will help us to create this opportunity for youth population and want to partner with the city of Temecula to deploy this new and innovative program for our residents. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 { PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM i REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 20,000 Organization Other grants or funding already awarded for Project/Program, if any I $ 650,000 In -Kind match amount or volunteer credit hours estimated amount $ 55,000 TOTAL REVENUE $ 775,000 LIST OF EXPENSES FOR PROJECT/PROGRAM EXPENSES Tools/Equipment $25,575 Facilities/Rent/Insurance Supplies Marketing Services Food Other Staffing Expense $ 54, 000 $142,500 $ 65, 500 $175,000 $ 25, 000 _ $25,000 THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $295 000 HOWEVER PLEASE INCLUDE. , TOTAL EXPENSES $807,575 TOTAL BUDGET $775,000 i $807,575 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021. and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit andlor require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be reel! II red to return the amount of funds to the City, To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receiptslinvoices, must be submitted to the City as outlined on this page - I. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. (If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1,A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed forthe remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10.000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: Organization: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED TOTAL FY 2022-2023 Amount of Grant Fund Awarded: $ Name of Project/Program: Month & Year FIRST $5,000 check was received from City: _ 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number)- E Name of Company d E on Receipt or Invoice Q Y I Date on Receipt/Invoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30. 2024 — Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER $ Amount I Description $ XPENDITURE TOTAL $ EXPENDITURE TOTAL Purpose City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: The Empowerment Center MAILING ADDRESS: 27262 Via Industria Temecula, CA 92592 PHONE: ( 951) 51 4-2939 EMAIL: tlewis@theempowermentcenterintl.com PRESIDENT/AUTHORIZED OFFICER: TereSSe Lewis, LCSW Executive Director SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Iv� •I - II I I i P,. Ir DATE: September 9, 2022 SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELPO MENU Home > Tax Exempt Organization Search > The Empowerment Center < Beck to_SeaRch Rcsu t. The Empowerment Center EIN: 56-2497243 1 Temecula, CA, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Form 990-N (e-Postcard) 8 Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. Tax Year 2007 Form 990-N (e-Postcard) Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2019 Form 990EZ Tax Year 2018 Form 990EZ y Tax Year 2017 Form 990EZ Tax Year 2016 Form 990EZ Page Last Reviewed or Updated: 20-November-2020 - r* Share 1 $ Print STATE OF CALIFORNIA FRANCHISE TAX BOARD FT'B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/9/2022 ESL ID: 8908301590 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 2588343 Entity Name: THE EMPOWERMENT CENTER 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information • This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. ■ If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) 90 Return of Organization Exempt From Income Tax No, 1545-0047 Form n0MB Under section 50i(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 0 1 Department of the Treasury ► Do not enter social security numbers on this form as it may be made public. OPen Internal Revenue Service ► Go to www.irs.9ov1Form990 for instructions and the latest information. Inspection A For the 2021 calendar year, or tax year beginning January 01 , 2021, and ending December 31 2O 21 B Check if applicable: C Name of 22EIzation THE EMPOWERMENT CENTER D Employer identification number ❑ Address change Doing business as 56-2497243 ❑ Name change Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Telephone number ❑ Initial return 27262 VIA INDUSTRIA 951414-2939 ❑ Final return/terminated City or town, state or province, country, and ZIP or foreign postal code ❑ Amended return Temecula, CA 92590 0 Grossraceipts $ 3162,974 ❑ Application pending F Name and address of principal officer: LaKeshia McClanahan H(al Is this a group return for subordinates? 0 Yes ®No 27262 VIA fNDUSTRIA, Temecula, CA 92590 Hlb) Are all subordinates included?d Yes ❑ No I Tax-exempt status: 0 501(c)(3) SC ( )-4 (insert no.) 4947(a)(1) or 13527 It "No," attach a list. See instructions. J Website: I. WwW.theampow@rmenteentarintl.cam H(a) Group exemption number ► K . Form of mg "ITIAVOMOCorparatlon []Trust Association EjOther►I L Year of formation: 2005 M State of legal domicile; CA d Vl e W `o b 13 14 15 16a b 17 1s 19 Briefly describe the organization's mission or most significani activities: our mlegsa Is to halp yearn an Iemillaa ilevetep tha realllsnca nacascary to eye rc*me elsrtlanpoe, dfacnwr4iuiieef offFieinoeive"s, ana-crea(ehee(il"oi; _"""' happier _ ........ ama or - - -- - Che......._❑ oga_.......o......................------......------...........------..._........_..__.......... ..._._.._inued its operations or disposed of more than 25% of its rlet assets. Number of voting members of the governing body (Part VI, line 1 a) . . . Number of independent voting members of the governing body (Part Vl, lin Total number of individuals employed in calendar year 2021 (Part V, line 2a Total number of volunteers (estimate if necessary) . . . . . . . . Total unrelated business revenue from Part VIII, column (C), line 12 . . Net unrelated business taxable income from Form 990-T, Part I, line 11 Contributions and grants (Part VIII, line 1h) . . . . . . , . , . . Program service revenue (Part VIII, line 2g) . . , . . . , , , . Investment income (Part VIII, column (A), lines 3, 4, and 7d) Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 110) . Total revenue -add lines 8 through 11 (must equal Part _Vill, column (A), line 1 Grants and similar amounts paid (Part IX, column (A), lines 1-3) . - Benefits paid to or for members (Part IX, column (A), line 4) . . . . , Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-1 Professional fundraising fees (Part IX, column (A), line 11 e) . . . . . Total fundraising expenses (Part IX, column (D), line 25) ► 9,1E Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) Revenue less expenses. Subtract line 18 from line 12 p 20 Total assets (Part X, line 16) 21 Total liabilities (Part X, line 26) . 22 Net assets or fund balances. Subtract line 91 n line 20 a1b) . . . . 4 1 5 . . . . . at] 7b Prior Year I a 2 O Current Year 283,674 352,549 9,000 10,375 64 50 0 0 ?L 29ZT38 362,974 10,132 2,000 0 0 �) 0 0 O 269,710 0 0 292,011 279,842 294,011 12,894 66,963 Beginning of Current Year End of Year 94,161 1'J4.923 8,200 0 as." 1 164.923 Under penalties of herihry, I declare that I have examined this return, including accompanytng schedules and statements, and to the best of my knowledge and belief, it Is true, carWi, and 000pfete. Declaration of preparer (other than officer) Is based on all information of which preparer has any knowledge. Sign Here Paid Preparer 8lgtwltrro of officer Dale AlK9ghILMc_Cianshan. Treasurer -_ Type or print name and lido Print/Type preparer's name Preparer's signature Date Check J if TIN self-employed Use Only Firm's name ► FirnVe El ► Firm's address ► Phone no. May the IRS discuss this return with the preparer shown above? See instructions Yes No For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 11282Y Form 990 (2021) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 59a THE SALVATION ARMY (A: CHILD SPREE) CITY OF'1`EMECULA. FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $13 500 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Temecula Child Spree Start Date: May 2022 End Date: Aug 2023 Physical Address of Project/Program: Promenade Temecula I JC Penney• 40820 Winchester Rd, Temecula INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: The Salvation Army Mailing Address: 40270 Los Alamos Rd Murrieta, CA 92562 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: The Salvation Army, a California corporation Website: murrieta.salvationarmy.org Year Founded: 1865 (England) Social Media: facebook.com/SalArm Murr€eta Number of Paid Staff: 3 Number of Volunteers: 15 Geographic Area(s) the Organization Serves: Southwest Riverside County Geographic Area(s) the Prolect/Prograrn Serves: Requested project funding will serve Temecula residents only NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Major Jessyca Carr Title/Position: Corps Officer Contact Person's Direct Telephone: 562-480-2654 Contact Person's Email. lessyca.carr@usw.salvatlonarmy.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 1.0/19/1914 (CA core) No ❑ IF NO, THEN INELIGMLE TO RECEIVE CITY FUNDING Federal Identification Number: 94-1156347 State Identification Number: 0078321 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTS) AS FOLLOWS: 1. El Attach IRS Deductibility Status using this link: htt ://a s.irs. ov/a /eos/ 2. ® Attach State Entity Status Letter using this link: https://www.fib.ca.gov/online/self serve entity status letter/index.as 3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.do'.ca.gov/VerificationMeb/Search.aspx?facilitv=Y City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, Investments, or interests In real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ® Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Since the founding of The Salvation Army in 1865 In London, England, The Salvation Army has fulfilled its mission to "meet human needs without discrimination." The Salvation Army Is a Christian church and leading provider of programs and services for low-income, homeless, and at -risk individuals and families. Nationwide, The Salvation Army serves approximately 30 million individuals annually. The Southern California Division, which oversees activities in nine counties in the southern and central coast regions, currently operates 53 Corps Community and Service Centers offering a variety of programs based on community needs. These services include food pantries and hot meals; childcare centers, after -school programs, and summer camps for low-income children; homeless prevention services (including rental and utility assistance); emergency disaster relief, seasonal/holiday assistance; and services for military veterans. For persons experiencing homelessness, The Salvation Army provides food, hygiene, and other essential items; street outreach; emergency and interim housing; and permanent supportive housing, offered in conjunction with case -managed supportive services. Additionally, for individuals struggling with substance use, The Salvation Army's Adult Rehabilitation Centers offer a 180-day residential work -therapy program. The Salvation Army is also a major developer/operator of affordable housing (Sllvercrest Residences) for low-income elderly persons. In sum, The Salvation Army exists to meet human need wherever, whenever, and however it can. The proposed project - Child Spree - falls within The Salvation Army's Family Services programs targeting low -Income families with children in need of essential back -to -school Items. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. NAM PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT $ MONTH +YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP $ $ $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTJPROGRAM IN THIS APPLICATION? NO ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT NAME OF ENITY MONTH +YEAR RECEIVED FUNDING RECEIVED $ 2 year total Pechanga Casino - Any childen June 2021/2022 14,000 $ 1,500 Milguard Windows - Any Childen June 2022 $ 2 year total 8,050 Murrieta Rotary Club - Murrleta Children only July 2021/2022 $ 10,000 City of Lake Elsinore - Lake Elsinore Children February 2021 $ $ $ City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT-RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT Each year, typically in early August, The Salvation Army helps low-income children in Southwest Riverside County start the school year off with new clothes, shoes, and school supplies - a program called Child Spree. This support is critical to families whose children would otherwise be unprepared for the new school year. For many years, The Salvation Army has partnered with JC Penney at the Promenade Temecula, and will again In 2023- School aged children are given the opportunity to pick out $125 worth of new clothes and shoes and then pick out a back pack and school supplies. New books and breakfast are also given to the children. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAMIPROJECT. The Salvation Army requests funding from the City of Temecula to assist with August 2022 expenses as well as next year's (August 2023) expenses related to its Child Spree back -to -school event, serving children residing in Temecula. Requested grant funds will be used for the purchases of school supplies (approximately $25 per child) as well as 90 $125 JC Penny gift cards for Temecula children. The gift cards are purchased and spent on the day of Child Spree. Volunteers and staff hand the gift cards to the cashiers and carefully monitor the event to ensure that only children's school clothes and shoes are purchased with the gift cards. Prior to the event, back packs and school supplies are purchased for distribution at Child Spree. Children are permitted to select their own backpack and school supplies, as the element of choice reduces waste and increases dignity for the families. Receipts for JC Penney and school supplies are retained by The Salvation Army for audit purposes. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. This grant will be used specifically for children of the city of Temecula. Targeted beneficiaries are low - Income families with school -age children who, without this assistance, may begin the school year unprepared, without the essential school supplies and and confidence that a new set of clothes and shoes brings to a child. The Salvation Army works with the school district liaison to identify the children who could benefit most from this event and live in Temecula. Additionally, this funding spent within the city will generate increased tax revenue, ultimately benefiting all residents of Temecula. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 90 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 60 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. The Salvation Army requests City of Temecula funding to purchase school supplies, clothing, and shoes for Temecula children participating in the annual Child Spree back -to -school event. The program assists children in need with essential items for a positive start to the school year. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Over the course of the COVID 9 pandemic, The Salvation Army was called upon to serve significantiy higher numbers of people with food, clothing and financial ass}stance more than any other time In its 25 years in Southwest Riverside County. While service needs - and as a result program expenses - Increased dramatically, private donations have begun to decrease. The Salvation Army was compelled to stretch every dollar to meet the needs that arose throughout the pandemic. Additionally, due to Inflation and the skyrocketing costs of items such as food and vehicle fuel (to transport food and other essential program Items), The Salvation Army has been challenged in operating its programs at a level that meets the high demand for services and financial assistance. The pandemic further affected the ability to utilize volunteers in carrying out the programs and services in Southwest Riverside County, including Child Spree. In years past Volunteers took the children shopping while parents waited outside. These last few years parents have shopped with their children. The reduction in volunteers also meant a reduction in donations. With children having returned to in -person learning on school campuses, and the rising cost of basic essentials, requests for back -to -school assistance has increased greatly. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. 2. The requested funding will allow The Salvation Army to expand the existing Child Spree program to serve a higher number of Temecula children in need of assistance. With the requested funding, the number of Temecula children served will increase by an annual average of 15 to 50 (and an over all a total of 200 to 250 children each year). In addition 2023 will be the 25th year of Child Spree so we anticipate a big event with news coverage and more participation from Temecula children. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula Community Services Grant (Not to exceed $50,000) $ 13,500 Amount contributed to the Project/Program by the Applicant Organization $ 22,350 Other grants or funding already awarded for Project/Program, if any $ 33,550 In -Kind match amount or volunteer credit hours estimated amount _ $ 6,300 TOTAL REVENUE $ 75,700 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ 0 Facilities/Rent/Insurance $ 0 Supplies $ 100 Marketing Banner awknowledging donors Services Shopping spree, backpack & school supplies $ 300 $ 67,000 Food In -kind donation from McDonald's and Starbucks 1,800 $ 4,500 Other Inkind volunteers & reading books Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ 2 OOO TOTAL EXPENSES $ 75,700 TOTAL BUDGET $ 75,700 $ 75,700 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT *IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant In Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receiptsAnvoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of recelptslinvoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Name of Project/Program: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries If you do not have precise number): E Date on Ex anditure EName of Company Receipt/invoice Description Purpose a« i on Receipt or Invoice MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1, 2021-JUNE30.2022 1 $ 2 3 4 5 6 EXPENDITURE TOTAL Q EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization Is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these Instructions_ If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 fay the City of Temecula, all grant funds received must be expended anylirne on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent In accordance with the approved/awarded appllcat Ion, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. (If you were awarded less than $5,000, submit Expenditure Report for that amount.) R. It awarded grant funds exceeding $5,000. A) Follow #1.A above first. 13) To receive grant funds exceeding $6,000 (between $5K••$50K), submit the following Expenditure Report to be reirnbursed for the remaining balance of award to demonstrate funds were spent In accordance will) the Application. This report can be submitted In $10,000 increments (but no less than $10.000 unless the remaining grant award funding amount Is less than $10K). This report must be submitted to the City no later than June 30. 2024 to receive remaining grunt funds. 2. Attach copies of receipts/Invoices (in the same order listed In table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Name of Project/Program: TOTAL FY 2022-2023 Month a Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is thfe Expenditure Report Is to provlda documentation for first $5,000 awarded and recaived? You_ or No (already submitted). 2. My organization has already recolvod $ of the total FY 2022-23 Grunt Fund awarded by the City 3. Is this Expenditure Report Is submitted to request reimburaemunt of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living In 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise ntttnbery m Date on Expenditure Name of Company Receiptllnvoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER E on Receipt or Involce MUST BE ON OR BETWEEN March 20, 2020-JUNE 30. Amount Description Purpose 2024 1 $ 2 $ 3 $ EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on Its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. 0 Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. a Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately, • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete, I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: The Salvation Army MAILING ADDRESS: 16941 Keegan Avenue Carson, CA 90746 PRESIDENT / AUTHORIZED 0 • JZebel, T NAME SIGNATURE: PHONE: (562) 264-3620 EMAIL: cas.divisional,commander usw.salvationarm .or - Divisional Secretary for Business TITLE DATE: opyv ?rL/ N10N 111, DAY, YEAR IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Major Jessyca Carr, Corps Officer, The Salvation Army Murrieta Corps PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Department of the Treasury Internal Revenue Service Tax Exempt and Government Entities IRS PO Box 2508 Cincinnati, OH 45201 THE SALVATION ARMY TERRITORIAL HEADQUARTERS TERRY 0 HUGHES 30840 HAWTHORNE BLVD RCH PALOS VRD, CA 90275 Dear Sir or Madam; Date: August 30, 2021 Employer ID number: 94-1166347 Form 990 required: 990, No Person to contact: Name: Mr. Flammer ID number: 0203064 We're responding to your request dated November 17, 2020, about your tax-exempt status We issued you a determination letter in June 2011, recognizing you as tax-exempt under Internal Revenue Code (IRC) Section 501(c)(3). We also show you're not a private foundation as defined under IRC Section 509(a) because you're described in IRC Sections 509(a)(i) and 170(b)(1)(A)(i). Donors can deduct contributions they make to you as provided in IRC Section 170. You're also qualified to receive tax-deductible bequests, legacies, devises, transfers, or gifts under IRC Sections 2055, 2106, and 2522. In the heading, we indicated whether you must file an annual information return. If you're required to file a return, you must file one of the following by the 15th day of the 5th month after the end of your annual accounting period. Form 990, Return of Organization Exempt From Income Tax . Form 990-EZ, Short Form Return of Organization Exempt From Income Tax . Form 990-N, Electronic Notice (e-Postcard) for Tax -Exempt Organizations Not Required to File Form 990 or Form 990EZ . Form 990-PF, Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation According to IRC Section 60330), if you don't file a required annual information return or notice for 3 consecutive years, we'll revoke your tax-exempt status on the due date of the 3rd required return or notice. You can get IRS forms or publications you need from our website at www.irs.gov/fortns-pubs or by calling 800-TAX- FORM (800-829-3676). If you have questions, call 877-829-5500 between 8 a.m. and 5 p.m., local time, Monday through Friday (Alaska and Hawaii follow Pacific time). Thank you for your. cooperation. Sincerely, __+.4" a.. AozFC' Stephen A. Martin Director, Exempt Organizations Rulings and Agreements Letter 4168 (Rev. 09.2020) Catalog Number 6666BG STATE OF CALIFORNIA FRANCHISE TAX BOARD T g PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 7/8/2022 ESL ID: 3734826934 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter, Entity ID: 0078321 Entity Name: THE SALVATION ARMY ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. X❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) 8/26/22, 3:29 PM Details 1-10ME ABOUT MEDIA CAREERS REGULATIONS RESOURCES PROGRAMS CONTACT Registrar{3t El.--�etails Entity type: Corporate Class as registered with the Secretary of State or based on founding & registration documents. Organization Name: THE SALVATION ARMY IRS FEIN: 941156347 Entity Type: Religious SOS/FTB Corporate/Organization Number: 0078321 Registry Status: Exempt - Religious Renewal Due/Exp. Date: RCT Registration Number: EX565010 Issue Date: 12/31/1990 Record Type: Charity Registration Effective Date: 12/31/1990 Date of Last Renewal: DBA: Mailing Address Street: 30840 HAWTHORNE BLVD. Street Line 2: City, State Zip: RANCHO PALOS VERDES CA 90275 Filings & Correspondence No Related Documents Annual Renewal Data No Annual Renewal Data Related Registrations &. Event Reports The related records shown below depend on the record type being viewed: • Charity Registrations relate to Professional Fundraising Events which relate to Professional fundraiser Registrations, • Raffle Registrations relate to Raffle Reports. • Click on the RCT Registration No to navigate to the related record. Prereq Type: Prerequisite Relationship: Charity Registrant: ART14UR ALLEY ASSOCIATED Registration No: FfL )0262 j Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/16/2016 Association Date: 10/3/2016 Expiration Date: 3/31/2016 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: E0021256 Registration Type: Fundraising Event Registration Status: Complete Date Established: 7/28/2014 Association Date: 7/16/2014 Expiration Date: 1/18/2015 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: E0022749 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/11/2015 Association Date: 1/19/2015 Expiration Date: 7/17/2015 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: > 0024763 Registration Type: Fundraising Event Registration Status: Complete Date Established: 8/21/2015 Association Hate: 7/18/2015 Expiration Date: 7/14/2017 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: F0032387 Registration Type: Fundraising Event Registration Status: Complete hftps:Hrct.doj.ca.gov/Vedfication/Web/Details.aspx?result=el O7b9bf-6594-4ab2-8b64-de1B411723ef 114 8/26/22, 3:29 PM Details Date Established: 2/8/2018 Association Date: 1/8/2018 Expiration Date: 4/7/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: E0032764 Registration Typc: Fundraising Event Registration Status: Complete Date Established: 2/27/2018 Association Date: 1/8/2018 Expiration Date: 4/27/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: E0034365 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/23/2018 Association Date: 11/1/2018 Expiration Date: 10/31/2020 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: E0011232 Registration Type: Fundraising Event Registration Status: Complete Date Established: 6/27/2011 Association Date: 11/30/2009 Expiration Date: 5/31/2010 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: 1-0(0700 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/12/2016 Association Date: 10/I/2015 Expiration Date: 12/31/2015 Prereq Typc: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: 1,0029414 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/2/2017 Association Date: 10/1/2016 Expiration Date: 12/31/2016 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: E0035295 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/13/2019 Association Date: 9/4/2018 Expiration Date: 9/28/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: E0037408 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/1/2019 Association Date: 1/2/2019 Expiration Date: 5/31/2019 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: E0038800 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/28/2020 Association Date: 3/2/2020 Expiration Date: 2/24/2023 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO„ LLC Registration No: 1�0t it} Registration Type: Fundraising Event Registration Status: Complete Date Established: 12/17/2020 Association Date: 8/3/2020 Expiration Date: 1/31/2023 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: E0040391 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/11/2022 Association Date: 1/3/2022 Expiration Date: 12/31/2022 Prereq Type: Prerequisite Relationship: Charity Registrant: GATEWAY COMMUNICATIONS INC Registration No: E0030815 Registration Type: Fundraising Event Registration Status: Complete Date Established: 7/17/2017 Association Date: 8/1/2017 Expiration Date: 12/31/2017 Prereq Type: Prerequisite Relationship: Charity Registrant: GATEWAY COMMUNICATIONS INC Registration No: E0033634 Registration Type: Fundraising Event Registration Status: Complete Date Established: 5/30/2018 Association Date: 6/20/2018 Expiration Date: 12/3 l/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: INNOV81VE DEVELOPMENT Registration No: E0035517 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/21/2019 Association Date: 3/9/2019 Expiration Date: 3/9/2019 Prereq Type: Prerequisite Relationship: Charity Registrant; LESTER CONSULTING GROUP, INC. https:/Irct.doj.ce.govNerificafion/Web/Details.aspx?result=el 07b9bf-65944ab2-8b64-del8411723ef 2/4 8/26/22, 3:29 PM Details Registration No: E0019177 Registration Type: Fundraising Event Registration Status: Complete Date Established: 1/23/2014 Association Date: 1/1/2014 Expiration Date: 11/30/2015 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0031101 Registration Type: Fundraising Event Registration Status: Complete Date Established: 8/31/2017 Association Date: 9/15/20t7 Expiration Date: 12/31/2017 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0031258 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/28/2017 Association Date: 10/1/20t7 Expiration Date: 9/30/2019 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0031360 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/20/2017 Association Date: 11/l/2017 Expiration Date: 4/30/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0i�U Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/9/2018 Association Date: 10/15/2018 Expiration Date: 12/31/2019 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0037233 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/6/2019 Association Date: 10/1/2019 Expiration Date: 9/30/2020 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0037445 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/9/2019 Association Date: 10/1/2019 Expiration Date: 9/30/2020 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0040453 Registration Type: Fundraising Event Registration Status: Complete Date Established: 8/4/2020 Association Date: 8/l/2020 Expiration Date: 9/30/2021 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0040828 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/11/2020 Association Date: 10/I/2020 Expiration Date: 9/30/2021 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE, MARKETING Registration No: E-0044914 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/15/2021 Association Date: 10/1/2021 Expiration Date: 9/30/2022 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0044015 Registration Type: Fundraising Event Registration Staters: Complete Date Established: 9/15/2021 Association Date: 10/1/2021 Expiration Date: 9/30/2022 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0044916 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/15/2021 Association Date: 10/1/2021 Expiration Date: 9/30/2022 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: IC0048164 Registration Type: Fundraising Event Registration Status: Complete Date Established: 8/24/2022 Association Date: 10/1/2022 Expiration Date: 9/30/2023 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0049205 Registration Typc: Fundraising Event Registration Status: Complete Date Established: 9/26/2022 Association Date: 10/l/2022 Expiration Date: 9/30/2023 Prereq Type: Prerequisite Relationship: hftps:Hrct.doi.ca.govNerifrcation/Web/Details.espx?result=e l 07b9bf-6594-4ab2-8b64-del 8411723ef 3/4 8/26/22, 3:29 PM Details Charity Registrant: MIRIAM HOUGHTON DBA EXPRESSIONS Registration No: E0018684 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/29/2013 Association Date: 1/l/2013 Expiration Date: 12/31/2012 Prereq 'lope: Prerequisite Relationship: Charity Registrant: MIRIAM HOUGHTON DBA EXPRESSIONS Registration No: E0018688 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/29/2013 Association Date: 3/2/2013 Expiration Date: 12/31/2012 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC, Registration No: E0030538 Registration Type: Fundraising Event Registration Status: Complete Date Established: 5/10/2017 Association Date: 5/15/2017 Expiration Date: 7/31/2017 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC. Registration No: LQQ3 t 124 Registration Type: Fundraising Event Registration Staters: Complete Date Established: 9/5/2017 Association Date: 10/l/2017 Expiration Date: 9/30/2019 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC. Registration No: E0036403 Registration Type: Fundraising Event Registration Status: Complete Date Established: 5/9/2019 Association Date: 1/1/2018 Expiration Date: 12/31/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC, Registration No: E0037371 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/27/2019 Association Date: 1/1/2019 Expiration Date: 9/30/2020 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC. Registration No: E0040826 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/11/2020 Association Date: 10/1/2020 Expiration Date: 9/30/2021 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC. Registration No: E 00 44910 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/15/2021 Association Date: 10/1/2021 Expiration Date: 9/30/2022 https://rct.doi.ca.govNerificationtWeblDetails.aspx?result=el07b9bf-6594-4ab2-8b64-del8411723ef 4/4 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 59b THE SALVATION ARMY (B: HOMELESS PREVENTION) CITY OF TEMECUI[A FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING • REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Prim or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 36,500 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Temecula Homeless Prevention Start Date: 1/1/2023 End Date: 12/31/2023 Physical Address of Project/Program: Lmailing address INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: The Salvation Army Mailing Address: 40270 Los Alamos Rd Murrieta, CA 92562 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: The Salvation Army Year Founded: 1865 (England) Website: murrieta.salvationarmy.org Number of Paid Staff: 3 Social Media: facebook.com/SalArm_yMurrieta I Number of Volunteers: 15 Geographic Area(s) the Organization Serves: Southwest Riverside County Geographic Area(s) the Project/Program Serves: Requested project funding will serve Temecula residents only NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA, Contact Name: Major Jess ca Carr Title/Position: Corps Officer Contact Person's Direct Telephone: 562-480-2654 Contact Person's Email: lessyca.carr@usw.salvationarmy.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 10/19/1914 (CA corp) NO ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 94-1.156347 1 State Identification Number: 0078321 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1, 91 Attach IRS Deductibility Status using this link: http://apl)s.Irs.gov/a[)D/Qos/ 2. ® Attach State Entity Status Letter using this link: https://www.ftb.ca.gov/online/self serve entity status letter/index.as 3, ® Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt :llrc .doi.ca. ovNerification/Web/Search.as x?faciilt =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, Investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee ® Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Since the founding of The Salvation Army in 1865 in London, England, The Salvation Army has fulfilled its mission to "meet human needs without discrimination." The Salvation Army is a Christian church and leading provider of programs and services for lowincome, homeless, and at -risk individuals and families. Nationwide, The Salvation Army serves approximately 30 million individuals annually. The Southern California Division, which oversees activities in nine counties in the southern and central coast regions, currently operates 53 Corps Community and Service Centers offering a variety of programs based on community needs. These services include food pantries and hot meals; childcare centers, after -school programs, and summer camps for low-income children; homeless prevention services (including rental and utility assistance); emergency disaster relief, seasonallholiday assistance; and services for military veterans. For persons experiencing homelessness, The Salvation Army provides food, hygiene, and other essential items; street outreach; emergency and interim housing; and permanent supportive housing, offered in conjunction with case -managed supportive services. Additionally, for individuals struggling with substance use, The Salvation Army's Adult Rehabilitation Centers offer a 180-day residential work -therapy program. The Salvation Army is also a major developer/operator of affordable housing (Siivercrest Residences) for low-income elderly persons. In sum, The Salvation Army exists to meet human need wherever, whenever, and however it can. The proposed project - Temecula Homeless Prevention - will be an expansion of The Salvation Army's Southwest Riverside County Family Services program, which currently provides rental assistance in the region and seeks to supplement this FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT FUNDED BYTHE CITY GRANT OR SPONSORSHIP MONTH + YEAR NAME OF CITY GRANT FUNDING RE I OR, SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTJPROGRAM IN THIS APPLICATION? NO ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW, AMOUNT RECEIVED NAME OF ENITY MONTH + YEAR FUNDING RECEIVED $ 24,000 FEMA-EFSP Emergency Food Shelter Program - Amount listed is what was used for Temecula Residents Only 11 /2021-11/2022 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. The Temecula Homeless Prevention program, a proposed expansion of existing services at The Salvation Army serving Southwest Riverside County, will provide up to two months of rental assistance to families and individuals in crisis and at risk of homelessness who reside in the city of Temecula. The program's purpose is to avoid eviction and prevent homelessness for these vulnerable households. As part of the screening process, the Case Manager will request verification of residence in the City of Temecula and proof of financial crisis. Rental assistance will be provided in conjunction with housing - focused case management, including the preparation of a housing stability plan for each household. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. City of Temecula grant funds will be used to deliver rental assistance payments directly to rental property owners and/or management companies on behalf of program participants with past -due rent. The Case Manager will utilize a landlord verification form (evidencing rent owed), current lease, and a late notice (or three day pay or quit notice). A maximum of two months of rent will paid per program participant, and the program will work with the participant to determine the amount of rent that the resident is able to pay. No payments will be given directly to program participants. The same assistance can be given for those with a past due mortgage, but only the principle and interest will be paid, not the escrow or other charges. The Salvation Army Case Manger will try to work with the loan servicer to assist the client. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. The proposed program expansion in Temecula will enable The Salvation Army to significantly increase the capacity and effectiveness of its existing homeless prevention program currently offered by The Salvation Army in Southwest Riverside County. The program will target individuals, couples, and families who are at high risk of homelessness without this assistance. Program beneficiaries will maintain their housing stability. The need for rental subsidies, particularly due to the COVID-19 pandemic, has risen greatly as a result of job losses, reduction of work hours, illness, inflation, and other factors, all of which have led to significantly increased numbers of households at imminent risk of homelessness. According to the County of Riverside Point -In -Time Count, 67 individuals were found to be homeless (sheltered and unsheltered). Through this program, The Salvation Army will prevent additional households from becoming homeless thus saving Temecula tax payers the burden of additional cost of 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 42 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 2 City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. Salvation Army requests a grant from the City of Temecula to provide up to two months of rental stance (paid directly to landlords) for Temecula residents experiencing financial crisis and are at of eviction, thus preventing homelessness, 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Over the course of the COVID-19 pandemic, The Salvation Army was called upon to serve significantly higher numbers of people with food, clothing and financial assistance more than any other time in its 25 years in Southwest Riverside County. While service needs - and as a result program expenses - increased dramatically, private donations have begun to decrease. The Salvation Army was compelled to stretch every dollar to meet the needs that arose throughout the pandemic. Additionally, due to inflation and the skyrocketing costs of everyday supplies and vehicie fuel The Salvation Army has been challenged in operating Its programs at a level that meets the high demand for services and financial assistance. The reduction in private donations and the increase everyday operating costs, reduces the amount of funding available to keep Temecula's struggling people housed. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. 2. Funding from the City of Temecula will allow the homeless prevention program to expand from serving approximately 18 Temecula Residents annually to 42 residents during the proposed program term. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 36,500 Amount contributed to the Project/Program by the Applicant $ I Organization 12,300 Other grants or funding already awarded for Project/Program, if any $ $24,000 anticipated from EFSP In -Kind match amount or volunteer credit hours estimated amount $ S00 TOTAL REVENUE $ 73,300 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment - No additional equipment needed $ 0 Facilities/Rent/Insurance $ 0 Supplies $ 100 $ 0 Marketing Services $ 65,500 Food 0 Other $ 0 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ 7,700 HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $ 73,300 TOTAL BUDGET $ $ 73,300 City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30. 2022. In addition, all grant funds must be substantiated with proper back-up documentatlon. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City, To substantlate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper hack -up documentation including the completed table below will) accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/Invoices (In the same order as listed to this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: Name of Project/Program: FLY Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living In 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries If you do not have precise number): E Date on Expenditure Description Purpose E Name of Company Receiptlinvoice Y x on Receipt or Invoice MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1. 2021 -JUNE 30. 2022 1 2 3 $ 4 $ 5 6 EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the Cf of Temecula, follow these Instructlons. If your organization Is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional bark -up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approvedlawarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation Including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A_ If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5.000 no later than June 30, 2024, to demonstrate grant funds were spent In accordance with the Application. (If you were awarded less than $5,000. submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000, A) Follow #1.A above first. 13) To receive grant funds exceeding $5,000 (between $SK-$50K), submit the fallowing Expendi lure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10.000 Increments (but no less than $10.000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds, 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Name of Project/Program: TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report Is to provide documentation for first 35,000 awarded and received? Yes or No (already submlttsd), 2. My orpanbtatlon has Already recoivod S of the total FY 2022.23 Grant Fund awarded: by the City 3. Is this Expandituro Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request S Number of beneficiaries living In 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries If you do not have precise number) Date on Expenditure u Name of Company Receiptllnvoice MUST SUPPORT PROJECTIPROGRAM IN APPLICATION a AWARD LETTER E on Receipt or Invoice MUST BE ON OR BETWEEN a Z nn�.e March 20, 2020-JUKE 30, Amount Description Purpose EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. 0 Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election In which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: The Salvation Army MAILING ADDRESS: 16941 Keegan Avenue Carson, CA 90746 PHONE: (562) 264-3620 EMAIL: cas, diyisiona€.commander@usw.salyationarmy.QM PRESIDENT ZAUTHIO R: J. Koebel, Captain - Divisional Secretary for Business PRINT NAME TITLE SIGNATUREDATE: Moen FI, nAr, ..i IF DIFFERENT THAN ABO , APPICATION PREPARED BY: Major Jessyca Carr, Corps Officer, The Salvation Army Murrieta Corps PRINT NAME TITLE. SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 7/8/2022 ESL ID: 3734826934 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 0078321 Entity Name: THE SALVATION ARMY 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Department of the Treasury ra Dear Sir or Madam: Internal Revenue Serv ice Tax Exempt and Government Entitles note: August 30, 2021 IRS PO Box 2508 Employer10 number: Cincinnati, OH 45201 94-1166347 Form 990 required: 990, No THE SALVATION ARMY Person to contact: Name: Mr. Flammer TERRITORIAL HEADQ[JART ERS ID number: 0203064 TERRY O HUGHES 30840 HAWTHORNE BLVD RCH PALOS VRD, CA 90275 We're responding to your request dated November 17, 2020, about your tax-exempt status. We issued you a determination letter in June 2011, recognizing you as tax-exempt under Internal Revenue Code (IRC) Section 501(c)(3). We also show you're not a private foundation as defined under IRC Section 509(a) because you're described in IRC Sections 509(a)(1) and 170(b)(1)(A)(i). Donors can deduct contributions they make to you as provided in IRC Section 170. You're also qualified to receive tax-deductible bequests, legacies, devises, transfers, or gifts under IRC Sections 2055, 2106, and 2522, In the heading, we indicated whether you must file an annual information return. If you're required to file a return, you must file one of the following by the 15th day of the 5th month after the end of your annual accounting period. . Form 990, Return of Organization Exempt From Income Tax . Form 990-EZ, Short Form Return of Organization Exempt From Income Tax . Form 990-N, Electronic Notice (e-Postcard) for Tax -Exempt Organizations Not Required to File Form 990 or Form 990EZ Form 990-PF, Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation According to IRC Section 60330), if you don't file a required annual information return or notice for 3 consecutive years, we'll revoke your tax-exempt status on the due date of the 3rd required return or notice. You can get IRS forms or publications you need from our website at www.irs.gov/forms-pubs or by calling 800-TAX- FORM (800-829-3676). If you have questions, call 877-829-5500 between 8 a.m. and 5 p.m., local time, Monday through Friday (Alaska and Hawaii follow Pacific time). Thank you for your cooperation. Sincerely, --h#— a.. 'n�' Stephen A. Martin Director, Exempt Organizations Rulings and Agreements Letter 4108 (Rev. 09-2020) Catalog Number 686660 8/26/22, 3:29 PM Details HOME ABOUT MEDIA CAREERS REGULATIONS RESOURCES PROGRAMS CONTACT Registra[rilt �,":,etails Entity type- Corporate Class as registered with the Secretary of State or based on founding R registration documents. Organization Name: THE SALVATION ARMY IRS FEIN: 941156347 Entity Type: Religious SOS/FTB Corporate/Organization Number: 0078321 Registry Status: Exempt - Religious Renewal Due/Exp. Date: I1t:71' Registration Number: EX565010 Issue Date: lecord Type: Charity Registration Effective Date: Date of Last Renewal: DBA: Mailing Address Street: 30840 HAWTHORNE BLVD. Street Line 2: City, State Zip: RANCHO PALOS VERDES CA 90275 Filings & Correspondence No Related Documents Annual Renewal Data No Annual Renewal Data 12/31/1990 12/3 l / 1990 Aerated Registrations & Event Reports The related records shown below depend on the record type being viewed: r Charity Registrations relate to Professional Fundraising Events which relnte to Professional Fundraiser Registrations, • Raffle Registrations relate to Raffle Reports. • Click on the RCT Registration No to navigate to the related record. Prereq Type: Prerequisite Relationship: Charity Registrant: ARTHUR ALLEY ASSOCIATED Registration No: U9029210 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/10/2016 Association Date: 10/3/2016 Expiration Date: 3/31/2016 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: E0021256 Registration Type: Fundraising Event Registration Status: Complete Date Established: 7/28/2014 Association Date: 7/16/2014 Expiration Date: 1/18/2015 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: E0022749 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/11/2015 Association Date: 1/19/2015 Expiration Date: 7/17/2015 Prereq Type: Prerequisite Relationship: Charily Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: E0024763 Registration Type: Fundraising Event Registration Status: Complete Date Established: 8/21/2015 Association Date: 7/18/2015 Expiration Date: 7/14/2017 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: E0032387 Registration Type: Fundraising Event Registration Status: Complete h;ps://rct.doj.ca.govNerification/Web/Details.aspx?result=el07b9bf-6594-4ab2-8b64-del8411723of 1/4 8/26/22, 3:29 PM Details Date Established: 2/8/2018 Association Date: 1/8/2018 Expiration Date: 4/7/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: E0032764 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/27/2018 Association Date: 1/8/2018 Expiration Date: 4/27/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: AVERILL FUNDRAISING SOLUTIONS, LLC Registration No: E0034365 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/23/2018 Association Date: 11/1/2018 Expiration Date: 10/31/2020 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: E0011232 Registration Type: Fundraising Event Registration Status: Complete Date Established: 6/27/2011 Association Date: 11/30/2009 Expiration Date: 5/31/2010 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: l.0025 Oil Registration Type: Fundraising; Event Registration Status: Complete Date Estab11she►1: 2/12/2016 Association Date: 10/l/2015 Expiration Date: 12/31/2015 Prereq Typo: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: E0029414 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/2/2017 Association Date: 10/1/2016 Expiration Date: 12/31/2016 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: E0035295 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/13/2019 Association Date: 9/4/2018 Expiration Date: 9/28/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: E0037408 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/1/2019 Association Date: 1/2/2019 Expiration Date: 5/31/2019 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: E0038800 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/28/2020 Association Date: 3/2/2020 Expiration Date: 2/24/2023 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: ;004173t1 Registration Type: Fundraising Event Registration Status: Complete Date Established: 12/17/2020 Association Date: 8/3/2020 Expiration Date: 1/31/2023 Prereq Type: Prerequisite Relationship: Charity Registrant: COMMUNITY COUNSELLING SERVICE CO., LLC Registration No: j,;¢0,1039I Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/11/2022 Association Date: 1/3/2022 Expiration Date: 12/31/2022 Prereq Type: Prerequisite Relationship: Charity Registrant: GATEWAY COMMUNICATIONS INC Registration No: E0030815 Registration Type: Fundraising Event Registration Status: Complete Date Established: 7/17/2017 Association Date: 8/1/2017 Expiration Date: 12/31/2017 Prereq Type: Prerequisite Relationship: Charity Registrant: GATEWAY COMMUNICATIONS INC Registration No: E0033634 Registration Type: Fundraising Event Registration Status: Complete Date Established: 5/30/2018 Association Date: 6/20/2018 Expiration Date: 12/31/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: INNOV81VE DEVELOPMENT Registration No: E0035517 Registration Type: Fundraising Event Registration Status: Complete Date Established: 2/21/2019 Association Date: 3/9/2019 Expiration Date: 3/9/2019 Prereq Type: Prerequisite Relationship: Charity Registrant: LESTER CONSULTING GROUP, INC. https:Hrct.doj.ca.govNerification/Web/Details.aspx?result=el07b9bf-6594-4ab2-8b64-dol8411723ef 214 8/26/22, 3:29 PM Details Registration No: EO019177 Registration Type: Fundraising Event Registration Status: Complete Date Established: 1/23/2014 Association Date: 1/1/2014 Expiration Date: 11/30/2015 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC, DBA TRUESENSE MARKETING Registration No: E0031101 Registration Type: Fundraising Event Registration Status: Complete Date Established: 8/31/2017 Association Date: 9/15/2017 Expiration Date: 12/31/2017 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: B0031258 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/28/2017 Association Date: 10/1 /2017 Expiration Date: 9/30/2019 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0031360 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/20/2017 Association Date: I1/1/2017 Expiration Date: 4/30/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC, DBA TRUESENSE MARKETING Registration No: - l 1 3 9 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/9/2018 Association Date: 10/15/2018 Expiration Date: 12/31/2018 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0037233 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/6/2019 Association Date: 10/1/2019 Expiration Date: 9/30/2020 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0037445 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/9/2019 Association Date: 10/1/2019 Expiration Date: 9/30/2020 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0040453 Registration Type: Fundraising Event Registration Status: Complete Date Established: 8/4/2020 Association Date: 8/1/2020 Expiration Date: 9/30/2021 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0040828 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/11/2020 Association Date: 10/1/2020 Expiration Date: 9/30/2021 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: I;Q094914 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/15/2021 Association Date: 10/1/2021 Expiration Date: 9/30/2022 Prereq Type: Prerequisite Relationshlp: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: F0044915 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/15/2021 Association Date: 10/1/2021 Expiration Date: 9/30/2022 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0044916 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/15/2021 Association Date: 10/1/2021 Expiration Date: 9/30/2022 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0048164 Registration Type: Fundraising Event Registration Status: Complete Date Established: 8/24/2022 Association Date: 10/1/2022 Expiration Date: 9/30/2023 Prereq Type: Prerequisite Relationship: Charity Registrant: MAILING SERVICES OF PITTSBURGH, INC. DBA TRUESENSE MARKETING Registration No: E0048205 Registration Type: Fundraising Event Registration Status: Complete Date Established: 8/26/2022 Association Date: 10/1/2022 Expiration Date: 9/30/2023 Prereq Type: Prerequisite Relationship: https:Hrct.doj.ca.govNerification/Web/Details.aspx?result=el O7b9bf-6594-4ab2-8b64-del8411723ef 314 6/26122, 3:29 PM Details Charity Registrant: MIRIAM HOUGHTON DBA EXPRESSIONS Registration No: EO 18684 Registration 1Typc: Fundraising Event Registration Status: Complete Date Established: 10/29/2013 Association Date: 1/I/2013 Expiration Date: 12/31/2012 Prereq 'ljpe: Prerequisite Relationship: Charity Registrant: MIRIAM HOUGHTON DBA EXPRESSIONS Registration No: E0018688 Registration Type: Fundraising Event Registration Status: Complete Date Established: 10/29/2013 Association Date: 3/2/2013 Expiration Date: 12/31/2012 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC. Registration No: E0030538 Registration Type: Fundraising Event Registration Status: Complete Date Established: 5/10/2017 Association Date: 5/15/2017 Expiration Date: 7/31/2017 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC. Registration No: it10'4 i 124 Registration Type: Fundraising Event Registration Staters: Complete Date Established: 9/5/2017 Association Date: 10/I/2017 Expiration Date: 9/30/2019 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC. Registration No: E0036403 Registration Type: Fundraising Event Registration Status: Complete Date Established: 5/9/2019 Association Date: 1/1/2018 Expiration Date: 12/31/2018 Prereq TI pc: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC. Registration No: E0037371 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/27/2019 Association Date: 1/1/2019 Expiration Date: 9/30/2020 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC. Registration No: OE 040826 Registration Type: Fundraising Event Registration Status: Complete Date Established: 9/11/2020 Association Date: 10/l/2020 Expiration Date: 9/30/2021 Prereq Type: Prerequisite Relationship: Charity Registrant: TSM DONOR ENGAGEMENT TEAM, INC. Registration No: E0044910 Registration Type: Fundraising Evcnt Registration Status: Complete Date Established: 9/15/2021 Association Date: 10/l/2021 Expiration Date: 9/30/2022 https://rct.doj.ca.govNerificationlWeblDetalls.aspx?result=el 07b9bf-6594-4ab2-8b64-del8411723ef 414 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION THE SHELLA FOUNDATIll CITY OF TEMMCUTA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 I PROJECT/PROGRAM INFORMATION I Amount Requested: $ 50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: In -Home Personal Care Respite Scholarship Start Date: 12/1/2022 End Date: 11/30/2023 Physical Address of Project/Program: 41593 Winchester Rd., Ste 200-440, Temecula, CA., 92590 INCLUDE IF DIFFERENTTHAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: THE SHELLA FOUNDATION Mailing Address: PO Box 263 Menifee, CA., 92586 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: THE SHELLA FOUNDATION Website: www.shellafoundation.org Number of Paid Staff: 0 Year Founded: 2004 Social Media: https://www.facebook.com/theshellafoundation Number of Volunteers: 13 Geographic Area(s) the Organization Serves: Riverside, San Bernardino, San Diego, and Orange Counties Geographic Area(s) the Prolect/Program Serves: Temecula, California NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Troy A. Small Contact Person's Direct Telephone: (951) 491-1200 Title/Position: Grants Manager Contact Person's Email: troy.small@shellafoundation.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 7/19/2004 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 20-1289365 State Identification Number: 2670022 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: hftD;11ar)r)s.iE§._qov/apD1eos1 2. 0 Attach State Entity Status Letter using this link: https://www.ftb.ca-gov/online/self serve entity -status letterlindex.as 3. 0 Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt:/Irct.do'.ca. avNerificationNVeb/Search.as x?facilil =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 J APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The Shelia Foundation mission is to provide comprehensive case management and assistance in all aspects of personal care, including financial assistance to community organizations and individual families affected by disabilities or functional needs. The Shelia Foundation Chief Executive Officer, Michael Foster was inspired to form the 501(c)(3) charitable organization because of his firsthand experience with caring for family members with a disability. "Shelia" was named after Mike's parents Shelton and Della Foster, who spent their fives assisting their daughter (Debbie) through multiple disabilities until Parkinson's Disease took the life of Shelton in 2005. and Della at the age of 86 due to natural causes. The Sheila Foundation offers In -Home Personal Care not only to seniors, but to individuals managing Autism, Down Syndrome, and Cerebral Palsy, as well as other disabilities. The Shelia Foundation provides financial assistance and personal care scholarships to populations needing in -home personal care services but are unable to receive the care through any other means. Over the last 17 years more than $50,000 in financial aid and scholarships have been provided to families in need of in -home personal FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH +YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP N/A $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ N/A $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT, The Sheila Foundation In -Home Personal Care Respite Scholarship program is essential to our community and the populations we serve. Local families and organizations reach out to The Sheila Foundation with needs to care for their family and loved ones. The individuals requiring care are either diagnosed at birth with disabilities or have been involved in an accident that caused a disability. The Sheila Foundation also helps families that are caring for a loved one in their golden years, who can no longer care for themselves, but want to remain in their home. We provide the means for families to receive the care they need, while remaining in their home and maintaining their independence. Individuals living with a disability and the elder community often require in -home, non -medical supports to maintain their i ndependence. There's often a lack of finances for this type of care. Programs may be available to these individuals, but The Shelia Foundation noticed "gaps" in coverage or their ability to pay. Individuals with resources and Medicaid can obtain the needed assistance. However, those in the financial "gap" are unable to obtain the in -home personal care service they need because some families don't have the means or money to pay for services. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED, ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The Sheila Foundation will use the grant funding to award Personal Care Respite Scholarships to populations within Temecula, California needing in -home personal care services but tackin the financiat means to receive the care. The Sheila Foundation wilt use the funds to provide approximately 1700 hours of in -home personal care and respite support to families within Temecula, California under The Shelia Foundation In -Home Personal Care Respite Scholarship Prog ram. Our goal is to serve up to 70 families, by providing each family with 24 hours of in -home personal care under the scholarship program. The Shelia Foundation will pay for caregiving support on behalf of the Temecula resident and award the service as a personal care respite scholarship to Temecula families who qualify. The family is not billed for any services. The specific goals of the program: 1. Provide1700 hours of in -home personal care to families within Temecula, California. 2. Serve up to 70 families within Temecula, California by providing each family with an In -Home Personal Care Respite Scholarship. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. The Sheila Foundation will use the grant funding to exclusively benefit populations within Temecula, California needing in -home personal care services but lacking the financial means to receive the care. Under The Sheila Foundation In -Home Personal Care Respite Scholarship Program, approximately seventy Temecula families will receive the benefit of twenty-four hours of in -home personal respite care with no out-of-pocket expense. This will greatly impact our Temecula community by helping these families to receive the care they need and maintain their independence and inclusion during important life moments. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 70 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 13 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT —SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. The Shella Foundation will award In -Home Personal Care Respite Scholarships to populations within Temecula, California needing in -home personal care services but lacking the financial means to receive the care. The grant funding will exclusively benefit 70 Temecula families with 24 hours of in -home personal care with no out-of-pocket expense. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. The COVID-19 Pandemic had a drastic effect on The Shella Foundation's ability to serve the Temecula Community. The Shelia Foundation's primary sources of funding are donations and fundraising. Shella receives 100% of its funding from donations. The Shella Foundation volunteers routinely hold fundraising events to increase the amount of donations received in order to serve more clients. The pandemic prevented us from holding fundraising events due to lockdowns and social distancing. The lockdowns and social distancing prevented The Shella Foundation from providing in -home care. 6 1F APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. The monies used from this grant will be used to continue an existing project/program. The in -home personal care respite program will be focused on the residents of Temecula, California and will provide an increase of support to our community. The Shella Foundation will reserve the grant funds exclusively for Temecula populations, awarding personal care scholarships to those who qualify. There will be no out-of-pocket expense for the family receiving care. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $ 0 Organization Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 0 TOTAL REVENUE $ 50,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing I Services Food Other Staffing Expense EXPENSES $0 $0 $200 $200 $47,600 $0 $0 THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ 0 TOTAL EXPENSES $50,000 TOTAL BUDGET $ 50,000 1 $ 50,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit andlor require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approvedlawarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropr{ately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures ) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: NSA Name of Project/Program- FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): E Date on Expenditure Name of Company Receeiptllnvoice Description _ Purpose aon Receipt or Invoice MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1, 2021 - JUNE 30, 2022 1 2 3 4 5 6 EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that arnount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92690, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Name of Project/Program: TOTAL FY 2022-2023 Month & Year FIRST'$5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $6,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report Is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) d Date on I Expenditure E Name of Company Receipt/invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER au E on Receipt or Invoice MUST BE ON OR BETWEEN pZ March 20.2020-DUNE30. Amount Description Purpose 202a 2 f 1 I$ EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. ■ The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. /we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: THE SHELLA FOUNDATION MAILING ADDRESS: PO Box 263 Menifee, CA 92586 PRESIDENT / AUTHORIZED OFFICER: Michael Foster v,tll11 P}rrvU &—Wffdl G f � SIGNATURE:rn�turia.ro�cuSs.r,a,ao��lfi3r�r)e; PHONE: (951) 723-8460 EMAIL: mfoster@shellacare.com CEO DATE: September 2, 2022 IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Troy A. Small troy.small@shellafoundation.org (951)491-1200 Grants Mana SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD tB)PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/7/2022 ESL ID: 5151771010 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 2670022 Entity Name: THE SHELLA FOUNDATION a1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States Q HELPO MENU - Home > Tax Exempt 0 ganixation Search > Shelia Foundation < Back Resu Its Shelia Foundation EIN: 20-1289365 1 Menifee, CA, United States Publication 78 Data v Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Form 990-N (e-Postcard) o Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. Tax Year 2021 Form 990-N (e-Postcard) Tax Period: 2021 (07/01/2021 - 06/30/2022) EIN: 20-1289365 Legal Name (Doing Business as): Shelia Foundation Mailing Address: PO Box 263 Menifee, CA 92586 United States Principal Officer's Name and Address: Michael Foster PO Box 263 Menifee, CA 92586 United States Gross receipts not greater than: $50,000 Organization has terminated: No Website URL: Shella Care Management Services, LLC Tax Year 2020 Form 990-N (e-Postcard) Tax Year 2018 Form 990-N (e-Postcard) Tax Year 2017 Form 990-N (e-Postcard) Tax Year 2016 Form 990-N (e-Postcard) Tax Year 2015 Form 990-N (e-Postcard) Tax Year 2013 Form 990-N (e-Postcard) Tax Year 2011 Form 990-N (e-Postcard) Tax Year 2009 Form 990-N (e-Postcard) Tax Year 2008 Form 990-N (e-Postcard) Page Last Reviewed or Updated: 20-November-2020 f'► Share $ Print x I�JS DEPARTMENT OF THE TREASURY ► INTERNAL REVENUE SERVICE j PHILADELPHIA PA 19255-002' 37 005537,132407.0022,001 1 NB 0.309 702 I II IIIIIIIIIII�IIIIIIIIIIIYIIIIIIIII YIIIYIII'IIOl llllllll'III' SHELLA FOUNDATION MICHAEL FOSTER 27626 ALTA VISTA WAY SUN CITY CA 92585 Date of this notice: 07-07-2004 Employer Identification Number: 20-1289365 Form: SS-4 Number of this notice: CP 575 E For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER 'Chank you for applying for an Employer Identification Number (EIN), We assigned you EIN 20-1289365, This EIN will identify your business account, tax returns, and documents even if you'have no employees. Please keep this notice in your permanent records. When filing tax documents, please use the label IRS provided. If that isn't possible, you should use your EIN and complete name and address shown above on all federal tax forms, payments and related correspondence. If this information isn't correct, please correct it using the tear off stub from this notice. Return it to us so we can correct your account. If you use any variation of your name or EIN, it may cause s delay in processing and may result in incorrect information in your account. It also could cause you to be assigned more than one EIN. If you want to apply to receive a ruling or a determination letter recognizing your organization as tax exempt, and have not already done so, you should file Form 1023/1024, Application for Recognition of Exemption, with the IRS Ohio Key District Office. Publication 557, Tax Exempt Status for Your Organization, is available at most IRS offices and has details on how you can apply . IMPORTANT REMINDERS; * Keep a copy of this notice in your permanent records. * Use this EIN and your name exactly as they appear above on all your federal tax forms. * Refer to -this EIN on your tax related correspondence and documents. Thank you for your cooperation. AIPCUi CrIFUI;t T1 "11 �I; _ Z°.: �;F� L• J I! eg,Y ;IYa S. "�., f PItirV tY1'r• h r 4 ...i ,. , I .t. /( I: rnln till: r, I ,I{ I I I , I, r, I . Organization Name: THE SHELLA FOUNDATION IRS FEIN: 201289365 Entity Type: Public Benefit SOS/FTB Corporate/Organization Number: 2670022 Registry Status: Delinquent Renewal Due/Exp. Date: 5/15/2021 RCT Registration Number: 125013 Issue Date: 12/31/1990 Record Type: Charity Registration Effective Date: 12/31/ 1990 Date of Last Renewal: 5/28/2020 DBA: It'"A Street: PO BOX 263 Street Line 2: City, State zip: C�Ay92586 �MENIFEE p Miscellaneous-Doetiments Return envelope - 27626 Alta Vista Way F'trrm RRF- 2017 Form RRF-1 2019 Form RRF-1 2014 Forlrt R K -1 2015 Form RRF-1 2016 Miscellaneo,u Upy.urnents Return envelope - 1745 W Katella Ave RCT 45 I-S_QeiinnucncyNgdey: - Ist Click on Document Type at the left to open PDF CT-451 1st UdjLnuency Notice 27626ALTA VISTA WY CT-45I 1st D:rlitlyuency Notice 30353 GULF STREAM DRIVE C 45 I I Sfl)[ linaUerlCy Nallc a PO BOX 263 C T-451 ,[S1,_Qclitlutlency-Ngd�& 1745 W KA ELLA AVE STE E l -,g jgor 2020 Form RItF-1 2019 0 547 MiSSing j2Q2U llt7flt5 Click on Document Type at the left to open PDF .Form RRF-1 2013 An nua F fie; ,ewa Da'.a Status of Filing: Accepted Acruunting. Period Begin Date: I/I/2013 Accounting Period End Date: 12/3 t/2013 Filing Received Date: 10/14/2011 Form RRF-I Reject/Incomplete Reason: Form CT TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: Ill/2014 Accounting Period End Date: 12/31/2014 Filing Received Date: 9/11/2019 Form RRF-1 Reject/Incomplete Reason: Form CTTR-1 Reject/incomplete Reason; IRS Form 990 Reject/Incomplete Reason; Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: I/ l/2015 Accounting Period End Date: 12/31/2015 Filing Received Date: 9/11 /2019 Form RRF-1 Reject/Incomplete Reason: Form CTTR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: StatuA of Filing: Accepted Accounting Period Begin Date: 1/1/2016 Accounting Period End Date: 12/31/2016 Filing Received Date: 9/ 11/2019 Form RRF-1 Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason; IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff. Status of Filing: Accepted Accounting Period Begin Date: 1/1/2017 Accounting Period End Date: 12/31/2017 Filing Received Date: 9/11/2019 Form RRF-1 Re.ject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason; IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: 1/1/2018 Accounting Period End Date: 12/31/2018 Filing Received Date: 9/1 1/2019 Form RRF-1 Reject/Incomplete Reason: Form CT-TR-1 Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: Status of Filing: Accepted Accounting Period Begin Date: 1/1/2019 Accounting Period End Date: 12/31/2019 Filing Received Date: 4/9/2020 Form RRF-I Reject/Incomplete Reason: Form CT-TR-I Reject/Incomplete Reason: IRS Form 990 Reject/Incomplete Reason: Notes From Registry Staff: III - . ,e-I Y� ..?I'. rr" , ,.!I;A, rt._III I I t •r• I. 1-41 L•I I ,: urrp ....I ir llr Lu 111',I i rI 'Ili". I I r i4 rl P 1,'rr,,2 ,1rI r "r i r•1Ifi �.i�rr.r %'r•,� ,1 (41 i,!1 4. J.i• r:lti" I r..Ir•.: i.1'r�.1 11..I III - .,,,1,... I: re.',., i r 1.Irrr I , u•sI . , I ■ IIrf nIr ttC'I Ile g is-tra Lion Na I.. i. r" •L. n I.:, rt .• I4•L r;.• 1 , No Related Records FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 61 THE TEMECULA VALLEY MASTER CHORALE CI'1'1 OF'11'-1�1 CCU LA. FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ $22,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Temecula Valley Master Chorale Project/Program Title: Season 22-23 Start Date: 12/1122 End Date: 11/30/23 Physical Address of Project/Program: 42690 Margarita Rd, Temecula, CA 92592-5462 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: The Temecula Valley Master Chorale Mailing Address: PO BOX 890204 Temecula, CA 92589-0204 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant The Temecula Valley Master Organization. Chorale Year Founded: 2001 Website: Ww`.temeculavalleymasterchorale.org Social Media: facebook.com Number of Paid Staff: two Number of Volunteers: 42 Geographic Area(s) the Orminization Serves: City of Temecula and surrounding area Geographic Area(s) the Project/Program Serves: City of Temecula and surrounding area NOTE. COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Geneva Krag Title/Position: Board Member Contact Person's Direct Telephone:951-505-5000 Contact Person's Email: geneva.krag@gmail.co 111 NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes E Date of Incorporation as a Nonprofit: No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 330928024 State Identification Number: CT0190938 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. 9 Attach IRS Deductibility Status using this link: 1711p:/lapps.irs.gov/apo/eos/ 2. K Attach State Entity Status Letter using this link: https.*//www.ftb.ca.gov/online/self serve entity status letterlindex.as 3. © Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: hti .//rct. o .ca. v/VerificationfWe /Search.as x?faciiit =Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: [This Application has been authorized by the organizations: Executive Committee ❑ Board of Directors #ij Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. Motto: " SHARING A LOVE FOR MUSIC WITH THE COMMUNITY AROUND US " The Temecula Valley Master Chorale was created to provide a repertory of choral music which seeks to nurture the public's appreciation of the life -enhancing qualities of the choral arts. Our mission is to provide local performances that will enrich the educational and cultural life of the community, to help and encourage young artists to expand their musical experience, and to demonstrate a professional attitude while performing quality musical literature. Chorale members come from all walks of life and professions. For some, music is their vocation as teachers and choir directors; but for many others it is their avocation, a great way to enrich their lives by coming together with others who love to sing and perform beautiful and challenging works of music. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA's AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT, DO NOT SUBMIT NOW, City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No E Yes ❑ IF YES, PROVIDE BELOW. OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO E Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW, AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. With a passion for the classics as well as modern masters, Temecula Valley Master Chorale is committed to excellence in the vocal arts. Through this grant opportunity, we are asking for support of season concerts while collaborating with Temecula schools and businesses with training, venues, music, and small equipment purchases. We hope to enhance our programs with local professional instrumentalists and soloists. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED, ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. To accomplish our mission, we will spend the grant funds by using local Temecula businesses for concert venues, competition venues, musical score purchases, program and flyer printing, independent contract instrumentalists, and food vendors. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. The Temecula Valley Master Chorale serves the community through encouraging a productive interaction for choir participants and audience through harmonious artwork. The audience is challenged to hear layers of art; the musicians practice to sing with others in harmony and share that with the audience. Regardless of age, gender, nationality, our organization spends our resources and time to create that connection. By involving Temecula venues, businesses, and supplemental musicians we can make an impact on the prosperity of the community. We also want to nurture the talent and love for music for future musicians in our community. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT lover 500 FROM THIS PROJECT/PROGRAM: 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: +45 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. Live music and art are fundamental to enhancing human experience. Choral music brings people together, builds relationships, and in its variety introduces the singer and listener to different cultures and styles. This grant opportunity helps brings value to the Temecula community through song and collaboration with Temecula businesses and residents. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. When the COVID-19 quarantine first started our season was cut short and we were not able to have our final concert and fund-raising event. For the next season, some of our members participated in " on-line " practices with no public performance, but a limited you -tube video performance. Last season (Sept. 2021- April 2022) we practiced with masks and had outdoor concerts, Not all our members were comfortable returning even with masks. Again, our fundraising activities were also limited, affecting us economically. We look forward to a new season of live performances and nurturing and developing new musicians, particularly those who live in Temecula. We would like to pass on our love of J music to the next generation. I._ 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Grant funds would expand our opportunities to reach more of the Temecula community through involvement in our Choir, in the audience capacity or as vendors of venues, supplies, or services. This creates an opportunity to collaborate with Temecula school choirs (public and private), and orchestras and their families. Our dream is to eventually host a fine arts festival at the Community Rec Center that would include school chairs, orchestras, and local vendors. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 22,000 Community Services Grant (Not to exceed $S0,000) Amount contributed to the Project/Program by the Applicant $ 22,624 Organization Other grants or funding already awarded for Project/Program, if any I $ 0 Supplies Marketing Services Food Other Staffing Expense THIS 15 INELIGIBLE TO BE FUNDED BYCITY'S GRANT; HOWEVER PLEASE INCLUDE, In -Kind match amount or volunteer credit hours estimated amount $187,068 TOTAL REVENUE 1 $ 231,692 LIST OF EXPENSES FOR PROJECT/PROGRAM / q p sound equipment, vlderk production T$1 ' 000 ools E ui ment Facilities/Rent/Insurance $7,500 $2,000 ___1 $1,500_ I $10,000 $14, 600 music scores Ayers, programs supplemental contract musicians TOTAL EXPENSES TOTAL BUDGET $ L$36,600 1 6,600 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21/22 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office — CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: The Temecula Valley Name of Project/Program: Temecula Valley Master MasterEherale GhGrale-Season� 23 FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): Date on Expenditure E Name of Company Receipt/Invoice U a on Receipt or Invoice MUST RF ON OR AFTWEEN Amount Description Purpose Q z JULY 1, 2021 • JUNE 30, 2022 I DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant Funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City, To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page, 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1 A above first. B) To receive grant funds exceeding $5,000 (between $51K-$501<), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (taut no less than $10.000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED The Temecula Valley Temecula Valle Master Organization: Name of Project/Program: y 'et1urafe--Stra5-0 TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022.23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) Date on Expenditure E Name of Company Receipt/Invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER U E on Receipt or Invoice MUST BE ON OR BETWEEN March 20. 2020 - JUNE 30, Amount Description Purpose Q Z qme 3 1 Is EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 I ACKNOWLEDGEMENT/SIGNATURE PAGE I The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit, • Awards will be given to organizations and activities that directly benefit the residents of Temecula. a Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete, /we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: The Temecula Valley Master Chorale MAILING ADDRESS: P O BOX 890204 PHONE: ( ) 832-368-7163 Temecula, CA 92589-0204 EMAIL: ann.mulder@icloud.com PRESIDENT / AUT ORIZED OFF ER: Ann Mulder, SIGNATURE: TVMC Treasurer DATE: Sept. 12, 2022 �'A('NI I :. IMY, YFn.r IF DIFFERENT THAN ABOVE, Geneva Krag Board member APPICATION PREPARED BY: r°R,iIf NAME T.r SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELPO MENU - Home > Ch@rities and Non -Profits > Search for �b.arities > Tax Exempt Organization Search Results for Tax Exempt Organization Search Select Database 0 Search All v Search By 0 Employer Identification Number (EIN) V Search Term 0 330928024 City Temecula State Country All States v United States r Search 1 Reset Search Tips Showing 1-1 results of 1 Sort by: Temecula Valley Master Chorale Name A-Z v EIN: 33-0928024 1 Temecula, CA, United States Pub 78 Data Form 990-N Items per page: 25 v Return to Tqp Additional information • Freauentl -skgd q 1 i -Exempt Organizations Select Check • v i s of 5 1(c}-(3) DeterDeterro i n a tj p ns • Suspensions Pursuant to Code Section 501(p), • Exempt Organizations Business Maggr File Extra_ot_(E BMF).: a list of organizations recognized as exempt by the IRS • Tax Exempt Organization Search: Bulk Data Downloads Page Last Reviewed or Updated: 20-November-2020 OIRS Our Agency About IRS Work at IRS Help Contact Your Local Office Tax Stats, Facts & Figures Know Your Rights Resolve an Issue f r* Share Print Other Languages Related Sites Taxpayer Bill of Respond to a Notice Espanol Rights Independent Office CO3Z (jjp�) Taxpayer Advocate of Appeals Service E'3Z (V_ Identity Theft Civil Rights Protection Ll-;T01 Freedom of Report Phishing PyccW Information Act Tax Fraud & Abuse Tieng Viet No Fear Act Kreyol ayisyen English Other Languages U.S. Treasury Treasury Inspector General for Tax Administration USA.gov STATE OF CALIFORNIA FRANCHISE TAX BOARD T PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/10/2022 ESL ID: 4197036411 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter Entity ID: 2268147 Entity Name: THE TEMECULA VALLEY MASTER CHORALE 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d, ❑ 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information • This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). • The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) PRICI.NO• PAC UPRICINO) 4 •VOUESTIONS) < Take me to my billing (lapplblllingl 9TATP FILING REOVIREMENTe (ISTAYE- Fit.INO-INFORMATl ON-FOR- NOHPROFITS) THANK YOU FOR FILING WITH SIMPLE 990. Your payment of $40.00 has been processed, CONTACT (CONTACT- tome ouiavelleymostarchoraI*agmIII-co US) Form 990 and 990-EZ returns undergo a quick technical revlew by our team. Our team will process your return as soon as this Is complete and email you regarding the results, Confirmation: OSIM P99OW U20SVOJQ7CGVXXYIJJSPRGJ August 3, 2022 E-Flied 2021 Form 990-N TEMECULA VALLEY MASTER CHORALE: 33-0928024 Total $40.00 USD $40.00 USD r(0A'ECAL1FOnNIR TRq. osrtol ry WAIL TO: Re®txtry of Ctsarstelsle Trusla P-0 Box 903447 Sacramento, CA 94203-1470 r.REET ADDRESS. J001 Siroet Sacramento, CA 95814 (916) 210.-A00 WEBSITE ADDRESS: wwNY Oagx,i g0vrcham,es ANNUAL TREASURER'S REPORT ATTORNEY GENERAL OF CALIFORNIA Section 12566, California Govemment Code 11 Cal. Code Regs., section 301 The Temecula Valley Master Chorale Name of Organization -- PO Box 890204 Address (Number and Street) Temecula, CA 92589 City or Town, Male and ZIP Code ASSETS (FORM CT-TR-1) DEPARMEW OF AW CE PAGE e d < - s') For Registry Liso Only CT0190938 Slate Charity Registration Number Corporabon or Organization No, 2268147 Federal Employer I.D. No. 330928024 For annual accounting period ( beginning 01 / 01 / 2021_ ending 12 / 31 / 2021 ) BALANCE SHEET Cash Savings $ $ 200 12342 Investment $ 0 Land/Buildmgs $ 0 Other Assets $ 0 TOTAL ASSETS $ I Z y REVENUE LIABILITIES Accounts Payable $ 0 Salary Payable $ 0 Other Liabilities $ 0 L TOTAL LIABILITIES $ O FUND BALANCE l Total Assets less Total Liabilities $ 2 �� Z REVENUE STATEMENT Cash Contributions $ 6547 Noncash Contributions $ 0 Program Revenue $ 9851 Investments $ 0 Special Events $ 1483 Other Revenue $ 3140 TOTAL REVENUE $ p Z NET REVENUE L otal Revenue less Total Expenses $ D EXPENSES Compensaton of Officers/Dlrectors $ 9985 Compensation of Staff $ Fundralsing Expenses $ 2115 Rent $ 2504 Utilities $ 0 Supplles/Postage $ 411 Insurance Other Expenses $ $ 716 330 TOTAL EXPENSES $ 16 Del eby declare under penalty of perjury that I have examined this report, Including accompanying documents, and, to the best of my knowledge belief, the content Is true, correct and complete and I am nut o►l:ed to sign, Steven C. Woodbury Treasurer 5/13/22 Slgrlature of Authorized Agent frile Prd Na- _ Title ' W Dale 330928024 TEMECULA VALLEY MASTER CHORALE Employer Identification Numbers Registry Employer Identification Number (EIN) is a unique identification number that is assigned to a business entity so that it can easily be identified by the Internal Revenue Service (IRS). The Employer Identification Number is commonly used by employers for the purpose of reporting taxes. The EIN is also known as a Federal Tax Identification Number. When it is used to identify a corporation for tax purposes, it is commonly referred to as a Tax Identification Number. 2022 TEMECULA VALLEY MASTER CHORALE EIN 330928024 An Employer Identification Number (EIN) is also known as a Federal Tax Identification Number, and is used to identify a business entity. Generally, businesses need an EIN. Business Name TEMECULA VALLEY MASTER CHORALE Conformed submission company name, business name, organization name, etc CIK N/S Company's Central Index Key (CIK). The Central Index Key (CIK) is used on the SEC's computer systems to identify corporations and individual people who have filed disclosure with the SEC. State of Incorporation N/S Company's State of Incorporation. The state of incorporation is the state where the entity has a domestic entity registration. Le. the entity was first registered, NOT necessarily where the entity does business. Phone N/S Business address telephone number BUSINESS ADDRESS Address Line 1 PO BOX 890204 Business Address Line 1 Address Line 2 N/S Business Address Line 2 City TEMECULA Business Address City State CA Business Address State ZIP 92589 Business Address Postal Code (ZIP) -2- Employer Identification Numbers Registry MAILING ADDRESS Address Line I N/S Mailing Address Line 1 Address Line 2 N/S Mailing Address Line 2 City TEMECULA Mailing Address City State CA Mailing Address State ZIP 92592 Mailing Address Postal Code (ZIP) -3- Employer Identification NUmbers Registry www. hipaaspace. cofn FEDERAL TAX IDENTIFICATION NUMBER: 330928024 (ADDITIONAL INFORMATION) IEIN IPOSTCARD - 4 - r,� Secretary of State Business Programs Division 1500 11th Street, Sacramento, CA 95814 Ann Mulder TVMC 31659 COUNTRY VIEW RD TEMECULA, CA 92591 Description Nonprofit Corp - Statement of Information Certified Copy - BE Payment - Web Credit Card C Receipt Detail Document/Payment No. BA20220949595 BA20220949595 42.......... 34381 Auth. No. 010033 Receipt Date: 10/06/2022 Receipt No.: 2704484 Total Amount Charged Total Payment Received Amount -$20 00 -$5.00 $25,00 -$25.00 $25.00 Page 1 of 1 California Secretary of State Business Programs Division 1500 11th Street, Sacramento, CA 95814 THE TEMECULA VALLEY MASTER CHORALE PO BOX 890204 TEMECULA, CA 92589-0204 Business Amendment Filing Approved October 6, 2022 Entity Name: THE TEMECULA VALLEY MASTER CHORALE Entity Type: Nonprofit Corporation - CA - Public Benefit Entity No.: 2268147 Document Type: Statement of Information Document No.: BA20220949595 File Date: 10/06/2022 The above referenced document has been approved and filed with the California Secretary of State. To access free copies of filed documents, go to b z_fileOnline.sos.ca.00v and enter the entity name or entity number in the Search module. What's Next? The most up to date records may be obtained by searching for the Entity Name or Entity Number in the Search module at bizfileOnline.sos.ca. ov. For further assistance, contact us at (916) 657-5448 or visit bizfile0niine.sos.ca, ov. Thank you for using bizfle California, the California Secretary of State's business portal for online filings, searches, business records, and additional resources. 0 FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 62 THESSALONIKA FAMILY SERVICES dba COMMUNITY MISSION OF HOPE CITY OF TF3MCU1 A, FISCAL YEAR 2022 M 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 122, 2022 j PROJECT/PROGRAM INFORMATION Amount Requested: $ $50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: CMOH Food & Housing Programs Start Date: 1/1/2023 End Date:6/30/2024 Physical Address of Project/Program: 41760 Rider Way Temecula, CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Thessalonika Family Services Mailing Address: 38950 Mesa Road Temecula CA 92592-8753 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Thessalonika Family Services Organization: dba Community Mission of Hope) Year Founded 1983 Website: -info@cmoh.net Social Media: https://www.facebook.com/ConnectedtoHope Number of Paid Staff: 4 Number of Volunteers: 400 Geographic Area(s) the Organization Serves: Temecula, Murrieta,_Wildomar, French Valley, Anza, Aguanga Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Allison Willits Title/Position: Executive Director Contact Person's Direct Telephone: 951-302-2317 _ Contact Person's Email: allison.willits ancmoh.net NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ❑x Date of Incorporation as a Nonprofit: 1983 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 95-3551068 State Identification Number: Q995764 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. 0 Attach IRS Deductibility Status using this link: htto:llaops,irs..gov/at)o/eos/ 2. © Attach State Entity Status Letter using this link: https://www.ftb.ce.gov/online/self serve entity -status tt/I d x.a 3. N Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http:Itrct.dol.ca.govNeriicatigr�lWeblSearch.aspx7facllitv=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE. - Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑x Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ❑x Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. For more than 12 years, Community Mission of Hope has served Temecula communities through programs that provide meals, housing stability, and individualized Case Management services to some of the region's most vulnerable populations. CMOH's mission is to provide hope through relationships and responsible compassion, meeting the tangible and emotional needs of our clients to help them on the road to self-sufficiency and a better quality of life. We empower our clients by providing food and resources for shelter, employment, and healthcare through a collaborative network of partners and volunteers, supporting our vision to eliminate hunger and homelessness in Southwest Riverside County. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑ Yes Nx IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Thessalonika Family Services, dba Rancho $ Community Improvement Damacitas; Empowerment Village Computers 5000 November 2021 Designation (CID) Fund Community Service Thessalonika Family Services, dba Rancho $ Damacitas; Empowerment Village Utilities 5000 December 2021 $ Funding Program Community Improvement Rancho Reformed Church dba Community Mission of Hope; new walk-in freezer 5000 December 2021 Designation (CID) Fund $ $ I OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT1PROGRAM IN THIS APPLICATION? No ❑ Yes ® IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT NAME OF ENITY I MONTH + YEAR fI RECEIVED FUNDING RECEIVED $ $7,500 Riverside County Nonprofit Assistance Fund August 2020 $ $10,000 State Farm Good Neighbor Application January 2021 $ $15,000 Sisters of St. Joseph Healthcare Foundation April 2021 $ $2,500 Soboba Foundation June 2021 $ $1,000 ALDI The Roripaugh Family Foundation August 2021 September 2021 $ $10,000 $ $2,500 Morongo Band of Mission Indians April 2022 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 11 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. I The goal of Community Mission of Hope's (CMOH) Food Distribution and Housing programs is to help the region's most vulnerable and marginalized populations obtain long-term stability. CMOH feeds over 500 at -risk families each month, distributing thousands of pounds of food per year including meal boxes, bread and pantry staples, hygiene and basic household items, and fresh produce to those experiencing food insecurity in Temecula. In addition, we connect families and individuals to job and housing opportunities, helping them navigate financial difficulties. Our Case Managers provide comprehensive, one-on-one assistance to solve a myriad of complex challenges — in the last year, over 5,000 individuals received housing assistance, food, and/or counseling at CMOH. Grant funds will support direct costs associated with our Food Distribution and Housing support programs. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Support from the City of Temecula will help CMOH maintain our food distribution warehouse in Temecula, as well as upkeep other equipment and continue to provide local food distribution services, including paying drivers, rental fees for food delivery vans, and purchasing workshop supplies and supplemental food items. A portion of this grant will cover direct service positions, supporting the staff who deliver key program initiatives, as well as volunteer training costs — we rely on over 100 volunteers who sort and distribute food to our community on a weekly basis. Finally, grant funds will also support CMOH's various Housing programs, including capital expenditures to improve our classroom and childcare spaces at Empowerment Village —a residential program for homeless single mothers and their young children. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. One of CMOH's greatest strengths is our commitment to the health and well-being of vulnerable families and individuals in Temecula, which is the cornerstone of our programs. CMOH serves 2,200 clients annually who are referred through several collaborative partnerships throughout the City, including partnerships with local churches, word of mouth, and via the Homeless Outreach Team at the City of Temecula. Our clients reflect the Counties' demographics, with approximately 35% being Caucasian, 30% Hispanic, 5% African American, and 8% Asian. 90% of those served are low-income; 33% have experienced homelessness; and 22% are veterans. Our programs offer services and resources to help these clients achieve long-term and sustainable success —to give them hope for the future and to change the trajectory of their lives. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 1 2000 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 400 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. $50,000 in support from the City of Temecula for CMOH's Food and Housing Programs will allow us to offer over 2,000 vulnerable community members in Temecula access to nutritious food, as well as connections to other valuable resources, including employment support and housing opportunities. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. Sadly, economic uncertainty and financial devastation is on the rise as homelessness, food insecurity, and rates of unemployment were exacerbated by the COVID-19 pandemic. CMOH clients continue to face difficulty paying for basic needs such as food, childcare, and transportation, resulting in significant setbacks toward achieving and maintaining financial and family independence. While the global health crisis had an immediate and devastating impact in high need communities across Temecula, the rising costs of food, housing, and transportation continue to take a toll. Today, more families than ever before are turning to CMOH as we remain steadfast in our commitment to helping those in need. This increase in demand coupled with rising costs, necessitates that we raise more funding to serve the community. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. $50,000 in support from the City of Temecula will allow CMOH to continue our Food Pantry and Housing Programs. These programs make a positive difference in Temecula by improving social conditions, promoting human welfare, and alleviating pain and suffering through vital safety -net services, which help our community's most at -risk populations. To provide services and create equitable and inclusive opportunities for our clients to thrive, CMOH annually spends over $2,700,000 on program costs, funded primarily through the generosity of the philanthropic community and in -kind donations. With your support, CMOH will be able to continue to provide comprehensive and crucial services, designed to help those in need build a pathway to lifelong self-sufficiency. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) $ 0 Amount contributed to the Project/Program by the Applicant Organization $ 1,056,050 Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount $ 1,636,378 TOTAL REVENUE $ 2,742,428 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ 78,286 Facilities/Rent/Insurance $ 144,820 Supplies $ 87,720 Marketing $ 2,000 Services $ 129,500 Food 1,500,000 Other $ 250,000 $ Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. 550,102 TOTAL EXPENSES $2,742,428 $2,742,428 TOTAL BUDGET $2,742,428 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following; ■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. ■ Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. ■ Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. ■ The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. ■ The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. ■ If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Thessalonika Family Services dba Community Mission of Hope) MAILING ADDRESS: 38950 Mesa Road Temecula, CA 92592-8753 PRESIDENT / AUTHORIZED OFFICER: SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Allison Willits PRINT NAME PRINT NAME PHONE: (951) 302-2317 EMAIL. allison.willits@cmoh.net DATE: Se Executive Director TITLE ber 12, 2022 MONTH, DAY, YEAR TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 INTERNAL REVENUE SERVICE District Director C/o McCaslin Industrial Park 2 Cupania Circle Monterey Park, CA 91754 Attn:EOG-4 Department of the Date,, iAVG 2 ® 1993 Treasury lri��'ii ��•%r t�ir l�•- f' �•� AUK 2 u 1993 Employer Identification Number, Thessalonika Family Services, Inc. 95-•3551068 P.Q. Box 890326 Case Number: Temecula, CA 92589-0325 953203009 Contact Person: R. Howard Contact Telephone Number: (213) 725-7002 Our Letter Dated: May 7, 1988 Caveat Applies: No Dear Applicant: This modifies our letter of the above.date in which we stated that you would be treated as an organization which is not a private foundation until the expiration of your 60 month termination of private foundation status period under section 507(b)(1)(a), Based an 'the information you submitted-, we have determined that you are not a private foundation within the moaning of section 509(a) of the Internal Revenue Code, because you are an organiza- tion of the type described in section 170(b)(1)(A)(vi), Your exempt status as an organization described in Section 501(c)(3) of the Internal Revenue Code is still in effect, Grantors and contributors may rely on this determination until the InternR) Revenue Service publishes notice to the contrary. However, a grantor or a contributor may not rely on this determination if he or she was in part responsible for, or aware of, the act or failure toact that resulted in your loss of section 509(a)(1) statue, 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. If we 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 reco rCds , I If you have any questions, please contact the person whose name and telephone number are shown above. Sincerely yours, n Mirzdin�9-1-11 C el District Director 1050(CG) L STATE OF CALIFORNIA FRANCHISE TAX BOARD F'B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 2/4/2020 ESL ID: 6357089984 According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 0995764 Entity Name: THESSALONIKA FAMILY SERVICES 0 1. The entity is in good standing with the Franchise Tax Board, 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d ❑ 4. We do not have current information about the entity. The above information does not necessarily reflect: The entity's status with any other agency of the State of California or other government agency. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or the entity did business in California at a time when it was not qualified or not registered to do business in California: o The status or voidability of any contracts made in California by the entity at a time when the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). o For entities revived under R&TC Section 23305b, any time limitations on the revivor or limitation of the functions that can be performed by the entity. Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 02-2019) Form 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Departme4 nt of 0 Treasury I- Do not enter social securily numbers on this form as it may be made public. Intdrrurl nevenuo Snrvlca ► Go to www,Irs.pov11`brri for instructions and the latest information. orna No,154s-ao4? 2020 Open to Public Inspection A For the 2020 calendar year, or tax year beginning 7/ 01 , 2020, and ending 6/30 , 202021 13 Check it applicable c D Employer identification number JE Address change Thessalonika Family Services Inc. 95-3551068 Name change 38950 Mesa Road E Telephone number Initial return Temecula, CA 92589 951 302-2317 r I I i na re urn temmnated Amended return G Gross receipts $ 537 362. Application pending F Name and address of principal officer. Nicole Albrecht H(a) Is this a group return for subordinates? yes No Same As C Above H(b) Are all subordinates included? Yes No I Tax-exempt status: X 50i C 3 501 C - IF "No," attach a list. See instructions P ()() () [ } (insert no.) 4947(a)(1) or 527 J Website: ► www.4kidsf1r8t.or %O Group exemption number ► K Form of organization: )C eorporalion LlTrust AssociationLl Other' L Year of formation: 1980 1 M State of legal domicile: CA Part. I I SItlTlmary t Briefly describe the organlrattlan's mission or most significant activities: To break the generational a ele of abuse �and_cverty�by_ em�owerir�g at_risk,_ sing b mothers with you�tg_ children and individuals with a history af_fnster care_or child abuse. -- - - - 5 2 Check this box ► if the organization discontinued its operations or disposed of more than 25% of its net assets. --_ _ — _ _ _ _ (7 3 Number of voting members of the governing body (Part VI, line la) ................................... 3 8 da v, 4 Number of independent voting members of the governing body (Part VI, line 1 b), - . .. . . . . . . ............. 4 5 Total number of individuals employed in calendar year 2020 (Part V, line 2a)........................... 5 8 6 Total number of volunteers estimate if necessary) . 6 0 .0 z Q 7a Total unrelated business revenue from Part VIII, column (),.,,......, line 12...... . . ................ . ........ 7a 0. b Net unrelated business taxable income from Form 990- f, Part I, line 1 1.. . . .. . . .... . . .... . ....... . ..... 7b D.- Prior Year Current Year ro 8 Contributions and grants (Part VI 11, line 1 h).......... -. , .. , .... , , .................. 406r637. 475 361. d9 Program service revenue (Part VIII, line 2g) .. ,... , . 55,910. 61 996. iu 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d)....... , .... _... _....... 324. ••2 gg6 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and l le) ................ -30 546. -4 206. 12 Total revenue — add lines 8 through 11 (7nust equal Part VIII, column (A), line 12)..... , 432, 325. 530 155. 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3).................. . .. . 18,462. 5,000. 14 Benefits paid to or for members (Part IX, column (A), line 4) , , , , ........... . . . ...... . 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) , , ... , 510,131. 373 521. N w 16a Professional fundraising fees (Part IX, column (A), line 11a). „ .. ..... . Lb b Total fundraising expenses (Part IX, column (D), line 25) 1 134, 434. 271 238. 306 167. 17 Other expenses (Part IX, column (A), lines 11a-11d, l lf-24e)— ....................... 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25):............ 799 831. 684 688. 19 Revenue less expenses. Subtract line 18 from line 12. ... . . . .. . .....:. , , ....... , ..... -367 506 . -154 533. ti 1 Beginning of Current Year End of Year '1120 Total assets (Part X,linel6).,,,.;:,,:,. 2,003,116. 1,774,370. le 11 21 Total liabilities (Part X, line 26).- ;;;;: :,,,.;::.,:„::,::;,,,;i„-i,,,- 22 Net fund 306, 733. 232, 520. assets or balances. Subtract line 21 from line 20............................ 1 696,383. 1 , 541 850. rpll 11 1 AI rlaturC ulvGR under pwaltios of penury, I declare [hat I harm dxamined this return, includ➢ng accompanying WhO Wes and statements, WW to the best of my knowledge and belief, it is true, correct, and cWnplele- Declaration of preparer (other thmi olfiCPr) is based on all 011110malion of which olreddrer has anv knnwletim. Sign 5"lure of aHwer 041u Here Nicole Albrecht_ Treasurer ypO or print name Arid uite Print/Type preparer's name Preparer's signature Check If PTIN Paid Michael Klein CPA Michael Klein CPA JDate sell -employed P01084572 Preparer Firm's name ► MPK Advisors & CPAs Use Only Firm-soddress ► 30141 Antelope Rd Ste D681 Firm'sEIN - 85-1568243 Menifee CA 92584 Phone no, 951-763-7970 May the IRS discuss this return with the preparer shown above? See instructions ......................................: JXJ Yes I I No BAA For Paperwork Reduction Act I11109cal see the separate instructions. rEEA01 oLL 0111901 Form 990 (2020) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 63 VETERANS SUPPLEMENTAL SUPPORT NETWORK (VSSN) CITY OF TEMECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION Amount Requested: $ 10.000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Storni2iici!l!p-Voteranou�fea�uStart Date: 1'Vt/2o22 End Date: i2w/202s Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: TERA u P Mailing Address: 41593 Winchester Rd Ste 200 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Year Founded: 2011 Website: Vetsuppgrtnetgra Social Media: tj=r rn T 1 Number of Paid Staff: 3 Number of Volunteers: 537 Geographic Area(s) the Organization Serves: Temecula, Murri t Wil m r Menfta Geographic Area(s) the Proiect/Program Serves: T-emecUll, Murrieta. Wildomar. Menifee NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Sue Kennedy Title/Position: Contact Person's Direct Telephone: _9E1-821-8776 Contact Person's Email: NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: NO ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: a-2705469 State Identification Number: CT0260255 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. 0 Attach IRS Deductibility Status using this link: http://apps.irs.pav/app/eos/ 2. 14 Attach State Entity Status Letter using this link: https://www.ftb.ca.apv/Qnline/self serve entity status letter/index.as 3. 0 Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.doj.ca.govNerification/Web/Search.aspx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 5d Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. is to end and prevent suicide and hard hi s within the military and veteran community. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP $ $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? NO ❑ Yes Pf IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ 10,0000 The Inland Empirgi FoLLn_gation 11.20 $ 20,000 4.20, 4.21 44 222 5.1.2022 LIE Cor ora a Fund $ 10.000 Event fUndraising $ 6.000 DCH Kia 7.1.2022 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT, VSSN's Stomp the Stigma hosts military and veteran family outreach resource events to include, the annual Winter Wonderland, Cards for Vets, Daisy Monument Walk, and the Hiring and Volunteer Fair. All events are designed to provide life-saving and transforming resources for military and veteran families living in Temecula. VSSN events provide direct food and toiletry support, mental health, job, business, and wellness coaching, toys, holiday meal boxes, appreciation cards from over 3000 Temecula students and residents in addition to direct connections to homeless prevention, mental health, housing, education, VA benefits, and local government resources. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. The funding if awarded would be used for.. Storage Unit Rental Space: $1812.00 Equipment Rental for Events (tables, chairs, linen, pipe and drapes): Average event cost $6800 Postcards Printing & Distribution (Cards for Vets): 10x10 canopies, sandbags, $1388 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. + EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Each VSSN outreach team tracks guest residencies and other verification data. All mentioned events are planned and organized with Temecula Valley School District's JROTC programs, an( school site leaders along with Temecula -based community organizations help to ensure that Temecula residents are shared information. 202V2022 guest attendance from Temecula Residents Daisy Walk 4/2022- 487 out of 601 Hiring Fair 10/2021- 5944 out of 7431 Cards for Vets 11/2021- 2880 out of 3200 (volunteers) Winter Wonderland 12/2021- 2387 out of 2532 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT l FROM THIS PROJECT/PROGRAM11698: 1 3c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED 1N THIS PROJECT/PROGRAM: I 520 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. For over 10 years VSSN has partnered with Temecula Valley schools and community partners to host its signature Veteran outreach resource events, including the annual Winter Wonderland, Cards for Vets, Daisy Monument Walk, and the Hiring and Volunteer Fair. These events provide engagement opportunities, direct aid, and resource connections to over 11,000 Temecula Valley residents. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. When the COVID-19 pandemic hit, VSSN, or Veteran Supplemental Support Network, serving low- to moderate -income (LMI) veteran families sprung to action to provide vital services. These services included food deliveries, virtual mental health readjustment, suicide prevention case management, and resource and referrals. Our core vertical or program is VSSN's Outreach Events. Outreach events fuel our service delivery however events were halted due to safety and budget restrictions. However, many volunteers continued to play key roles in regular services, as well as various pandemic -related ones, including vaccine education, without adequate funding. VSSN has funded a small Supplemental Targeted Advance by SBA m 2020 and a Riverside Counly IECF in late 2020, however, the awards were not enough. This created a challenging situation, especially during economic crises, where demand for such services increased while total revenue decreased. VSSN faced significant disruptions during the peak of the pandemic and throughout 20211. Since the pandemic VSSN experienced a 33% increase in demand and to add to the pie the cost of services has risen with inflation. Unfortunately, with the lack of funding resources we are unable to provide life-saving services (mental health, employment, outreach resources and referral resources). Ongoing challenges include increased demand for services without a similar affordable increase in the ability to provide services. One leading cause is the rising inflation rate that is continuously impacting in -kind and monetary donations, plus costs such as rent, salaries, gas, vendor costs, permits, and equipment costs. 6 IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM, We are applying for $10,000 in supplemental funds to help cover the costs of our well -attended outreach events and increasing warehouse storage fees. If granted the requested amount or any portion thereof the funds will be used to meet the following costs: Storage Unit Rental Space: $1812.00 (annual) Equipment Rental for Event outreach events that service Temecula military service -connected residents: (tables, chairs, linen, 10x10 canopies, sandbags, pipe, drapes, delivery fees): Average cost $6800 Postcards Printing and Distribution (Cards for Vets): $1388 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ Community Services Grant (Not to exceed $50,000) 10,000 Amount contributed to the Project/Program by the Applicant $ 5000 Organization Other grants or funding already awarded for Project/Program, if any $ 36,000 In -Kind match amount or volunteer credit hours estimated amount $ 122,699 TOTAL REVENUE $ 173,699 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment Facilities/Rent/Insurance Supplies Marketing Services Food (tyically donated or inkind) Other as cards transportation) $ 25400 $ 6048 $ 5490 $ 10513 $ 46848 77,000 $ 2400 Staffing Expense , THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $ 173,699 TOTAL BUDGET $ 173,699 $ 173,699 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS* FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 l(last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office— CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization. Name of Project/Program: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): E 1 Expenditure 0' Name of Company Rece pt/I voice Description Purpose a« = on Receipt or Invoice MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1, 2021 - JUNE 30. 2022 1 4 5 f I*I City of Temecula P EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant in FY2022-2023 b the Cit of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow AI A above first. B) To receive grant funds exceeding $5,000 (between S5K-S50K), submit the following Expenditure Report to be reunbursedforthe remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receipts/invoices (in the same order listed in table below). 3. Send to: Organization. City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Name of Project/Program: TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: 5 was received from City: 1. Is this Expenditure Report is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number) d Date on Expenditure E Name of Company Receipt/Invoice MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER E on Receipt or Invoice MUST BE ON OR BETWEEN + a Z March 20, 2020 - JUNE 30, I Amount Description Purpose 2024 :' R h 3 EXPENDITURE TOTAL $ EXPENDITURE TOTAL City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: ■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Veteran's Supplemental Support Network MAILING ADDRESS: 41593 Winchester Rd Ste. 200 Temecula,CA 92590 PRESIDENT / AUTHORIZED OFFICER: SIGNATURE:�te _ IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Daisy Tate PHONE: ( 951 ) 821 8776 EMAIL: dtate@vetsupportnet.org Executive Director DATE: 08/26/2022 Sue Kennedy Executive Director Admin SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/25/2022 ESL ID: 5205274751 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 3557670 Entity Name: VETERANS SUPPLEMENTAL SUPPORT NETWORK ❑X 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. El5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: EP 112013 VETERANS SUPPLEMENTAL SUPPORT NETWORK 23705 KATHRYN MURRIETA, CA 92562 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 46-2705469 DLN: 17053184319003 Contact Person: JERRY FIERRO ID# 31119 Contact Telephone Number: (877) 829-550D Accounting Period Ending: December 31 Public Charity Status: 170 (b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: April 2, 2013 Contribution Deductibility; Yes Addendum Applies: No 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. Enclosure: Publication 4221-PC Sincerely, �J Director, Exempt Organizations Letter 947 (DO/CG) Q HELPB MENU Home > Tax Exempt 0 ganization Se r h > Veterans Supplemental Support Network W.T.q%n. M-ma Veterans Supplemental Support Network EIN: 46-27054691 MuMeta, CA, United States Other Names VETERNS SUPPLEMENTAL SUPPORT NETWORK Determination Letter e A favorable determination letter is issued by the IRS if an organization meets the requirements for tax-exempt status under the Code section the organization applied. Final Letters Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2020 Form 990EZ Tax Year 2019 Form 990EZ Tax Year 2018 Form 990EZ Tax Year 2017 Form 990EZ Tax Year 2016 Form 990EZ Tax Year 2015 Form 990EZ Page Last Reviewed or Updated: 20-November-2020 & Share $ Print RECEIVED AUG 31 2022 L i i t .L. S OFFICE Short Form OMB+Jo V,*,Jn.ti Form 990-EZ Return of Organization Exempt From Income Tax 2021 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) ► Do not enter social security numbers on this form as it maybe made public. Open to Public Department of the Treasury Inspection t tqn* v n S ► Go to wwwJrs. ov1Forn199GE7. for instructions and the latest Information. A For the 2021 calandar year, or tax year beginning 2027 and ending .20 13 Check If applicable: C Name of organlzallon D Employer identification number ❑ Address change VETERNS SUPPLEMENTAL SUPPORT NETWORK 46--2705469 ❑ Name change Number and street (or P O box If mail is not delivered to street address) Room/suite E Telephone number ❑ Initial return ❑ Final return/terminated 23705 KATHRYN ST 951 821-8776 ❑ Amended return City or town, slate or province, country, and ZIP or foreign postal code F Group Exemption n Appdceuonpunding i iMURRICTp CA 92562 Number ► G Accounting Method: ® Cash ❑ Accrual Other (specify) No. H Check ► © if the organization is not I Website: ► required to attach Schedule B J Tax-exempt status check only one - x sor a a1 11501CON ) pnsonno.) 41E4I7(OXII)w s27 Farm 990 . K Form of organization: © Corporation ❑ Trust Association ❑ Other L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets Part it, column B are $500.000 or mom. file Form 990 Instead of Form 990•EZ . ► $ 31,659 Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part 1) Check if the organization used Schedule O to respond to any questIon in this Part I ....... . .. . ....... . 1 Contributions, gifts, grants, and similar amounts received . . . . . .... . ............... 1 31,859 2 Program service revenue including government fees and contracts. . . .. .. . ... . ... .. . . . 2 3 Membership dues and assessments . . . . . . . . . . . . . . .. . . .. .. .. ... ..... . . . . 3 4 Investment income . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .... . 4 5a Gross amount from sale of assets other than inventory . . . . . .. . . . . . . sa b Less: cost or other basis and sales expenses . . . . . . . . . . . . . . . . . . 5b c Gain or (loss) from sale of assets other than inventory (subtract line 5b from line 5a) . . . . . . . . . . . 5c 6 Gaming and fundraising events: a Gross income from gaming (attach Schedule G if greater than $15,000) . . . . . . I.6aaI b Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) ..... .... m6bl, c Less: direct expenses from gaming and fundraising events . . . . . . . . . . d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) ... . . . . . . . . . . . .. . .. . . . . . . 6d 7a Gross sales of inventory, less returns and allowances .... . 7a b Less: cost of goods sold . . . . . . . . . . . . . . . . . , . . . . . .. 7b c Gross profit or (loss) from sales of inventory (subtract line 7b from line 7a) . . . . . . .. . . . . . . . . . . 7c 8 Other revenue (describe in Schedule O) . . . . . . . . . . . . .. . . .... . . . .. .. . . . . . . . 8 9 Total revenue. Add lines 1, 2, 3, 4, 5c. 6d, 7c, and fl ......... ■ 9 3i 859 10 Grants and similar amounts paid (list in Schedule O} . . . . ...... . .......... . .. . . .. 10 11 Benefits paid to or for members . . . . . . . . . . ... ........ .. . . . . .. .. . . . 11 12 Salaries, other compensation, and employee benefits . .. . . ........ . . .... . . . .. . . .. 12 13 Professional fees and other payments to independent contractors .................... 13 14 Occupancy, rent, utilities, and maintenance . . . .. , . ............ 14 15 Printing, publications, postage, and shipping . . . . . . . ... . .. . . . . . ... . ....... . .. 15 16 Other expenses (describe in Schedule O). . . . . . ... ... . .. . .. ...... .. . ... ... 16 31,859 17 Total expenses, Add lines 10 through 16 . .► 17 31,859 18 Excess or (deficit) for the year (subtract line 17 from line 9) ........... . ............. 18 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with - end -of -year figure reported on prior year's return) . 19 z20 Other changes in net assets or fund balances (explain in Schedule O). . . . . . . . . . . . . . . . . . 20 21 Net assets or fund balances at end of vear. Combine fines 18 through 2a . . ► 21 For Paperwork Reduction Act Notice, see the separate instructions. Form 990-EZ (2021) EEA Form990-EZ 2025 VETERNS SUPPLEMENTAL SUPPORT NETWDRK 46-2705469 Page 2 Part IE Balance Sheets (seethe instructions for Part II) Check if the or anizallon used Schedule O to respond to any question in this Part II , . A 13e innin of year End of year 22 Cash, savings, and investments . . . . .. . . . . ... . ... ..... .. . .. ... .. 0 221 0 23 Land and buildings . . . . . . .. . . . .... . . ... .. .. ........... . . . , 0 23 0 24 Other assets (describe in Schedule O) ... . . .. . . . . ........ .. .... . , , 0 24 0 25 Total assets . . . . . . . . . . . . . . . ... . . ... .. . . ....... ... . . . . . 0 25 0 26 Total liabilities (describe in Schedule O) .... ...... .. ... .... . ...... .. 0 26 0 27 Net assets or fund balances line 27 of column H must a ree with line 2] . 0 27 0 Part Ill Statement of Program Service Accomplishments (see the instructions for Part III) Check if the or anlzation used Schedule ❑ to res and to an question In this Part III .. , , . Expenses What is the organization's primary exempt purpose? PROVIDE ]FOOD ANS SUPPORT FOR DIABLED VET (Required for section 501(c)(3) and 501(c)(4) Describe the organization's program service accomplishments for each of its three largest program services, organizations; optional for as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title. others.) 28 FEED AND SUPPORTED VETERNS 28a 29a p (Grants 5 if this amount includes form rants, check here ► 29 C3natts $ If this amount includes f rarils check here . ► 30 Grants $ If this amount includes fore rants, check here . ► 30a 31 Other program services (describe in Schedule O) . . . . . .. ........ ... ...... . . . .. ... . . Grants 5 If this amount includes foreign granils. check here . ► 31a 32 Total Rrograrn service expenses add lines 28a through 31a .. , ► 32 0 Part Id I List of Officers, Directors, Trustees, and Key Employees (list each one even if not compensated - see the instructions for Part IV) a. -M a urts VF1joiltzatrull useu acneouie V ID res (a) Name and title _ DEXTER JASPER CIiAIRMAN na to any question in (b) Average hours per week devoted to position this tart Iv (c) Reportable compensation (Fors W-2/1099-MISC/ 1099-NEC) (if not paid, enter -0-) (d) Health benefits, contributions to employee benefit plans, and deferred compensation (9) Estimated amount of other compensation 20.00 0 0 0 DAISY TATE PRESIDENT 15.00 0 0 0 CONSTANCE GLENN TREASURER/SECRETARY 10.00 0 0 0 RODNEY ROYSTER TRUSTEE 5.00 0 0 0 TAMIKA GALVIN TRUSTEE 10.00 0 0 0 Form 990-EZ(2021) Furm2MEz 2a2t VETERNS SUPPLEMENTAL St1PPORT NETWORK 46-2705469 Page 3 Part V Other Information (Note the Schedule A and personal benefit contract statement requirements in the instructions for Part V.) Check if the v anizalion used Schedule 0 to respond to any question in this Part V 1ye.1 No 33 Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule 0 . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .... .. 34 Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed 33 X copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain the change on Schedule 0. See instructions . . . . . . . . . . . . . . . . . _ 35 a Did the organization have unrelated business gross income of $1,000 or more during the year from business 34 X activities (such as those reported on lines 2, 6a, and 7a, among others)? . . . . . . . . . . . . . , . . . . . . . . . . . . . b If "Yes," to line 35a, has the organization filed a Form 990-T for the year? If "No," provide an explanation in Schedule Q . .. . , c Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, 35a X 35b reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III . . . . . . . . . . . . . . . . . . 36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets 35c X during the year? If "Yes," complete applicable parts of Schedule N. . . .. . . . . . . . . . . . . . .. ... .. 37 a Enter amount of political expenditures, direct or indirect, as described in the instructions . ... . . . ► 37a b Did the organization file Form 1120-POL for this year:? . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. .. 38 a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were 36 X 37b X any such loans made in a prior year and still outstanding at the end of the tax year covered by this return? . . . .. . .. . b If "Yes," complete Schedule L, Part II, and enter the total amount involved . . . . .. . . . . .. . . . 36b 38a X 39 Section 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 9. . . . . . . . . . . . . . .. . . ... . .. 39a b Gross receipts, included on line 9, for public use of club facilities . . ... . . . . . .. .. . ... .. 39b 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 ► b Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Partl . . . . . . .... c Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax imposed 40b X on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► _ d Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax on line 40c reimbursed by the organization ....... .. ... _ ► e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If "Yes," complete Form 8886-T . . . ... ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 List the states with which a copy of this return is filed No. CA 40al X 42 a The organization's books are in care of ► CONSTANCE GLENN Telephone no. ► 951-821-8776 Located at ► 23705 KATHRYN ST MURRIETA CA ZIP+4 ► 92562 b At any time during the calendar year, did the organization have an interest in or a signature or other authority over I Yes No a financial account in a foreign country (such as a bank account, securities account, or other financial account)? . . . . ... . 42b X If "Yes," enter the name of the foreign country 0- See the instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). c At any time during the calendar year, did the organization maintain an office outside the United States2 . . . . . , . . . . . .. 42c X If "Yes," enter the name of the foreign country ► 43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041-Check here. . . . . . . . . . .. .. ► El and enter the amount of tax-exempt interest received or accrued during the tax year . . . . . . . . . . . . . . . ► 1. 43 Yes No 44 a Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of Form 990-EZ . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . ... . . 44a X b Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . ...... 44b X c Did the organization receive any payments for indoor tanning services during the year? . . . . . . . . .. . . . . . . . ... . 44c X d If "Yes," to line 44c, has the organization filed a Form 720 to report these payments? If "No," provide an explanation in Schedule 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . .. . 44d 45 a Did the organization have a controlled entity within the meaning of section 512(b)(13)? . . . . . . . . . . . . . . . ... . .. 45a X b Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of Frxm 990-FZ. See instructions . . . . . . , . . . . . . . 45b x EEA Form 990-EZ (2021) ram, 990, EZ(2021; VETERNS SUPPLEMENTAL SUPPORT NETWORK 46-2705AF9 Pa © 4 Yes I No 46 Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition to candidates for ubile office? If "Yes," complete Schedule C. Part I 48 I y� Part VI Section 501(c)(3) Organizations Only All section 501(c)(3) organizations must answer questions 47 - 49b and 52, and complete the tables for lines 50 and 51. Check if the organization used Schedule 0 to respond to any question in this Part VI N - - - --. ....Yes �No 47 Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II .... , . . . .. . . .. . . . . . . . . . .. .. . ... , . , . . , . , . , 47 X 48 Is the organization a school as described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E . . . . . . . . . . 48 X 49a Did the organization make any transfers to an exempt norrcharitable related organization? .. .. . . .. .. .. . . . ... . 49a X to If "Yes," was the related organization a section 527 organization? . . . . . . . . . . . . . . . . . ..... .. .. . .... t 49b 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 comoensatian from the nrnarv7atinn If thprp is rrneva pnrcr "M— " (a) Name and title of each employee (b) Average hours per week devoted to position (c) Reportable compensation (Farms W-2/1099-MISC/ 1099-NEC) (d) Health benefits, contributions to employee benefit plans, and deferred compensation te) Estimated amount of other compensation NONE r r Uiai rn,rnunr ut otrrer employees pala over p-luu,uuu . . .. .. . ► 51 Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the oruarllzation. If there is none- enter "Nnnp (a) Name and business address of each independent contractor (b) Type of service (c) Compensation r— — d Total number of other independent contractors each receiving over $100,000 . . . . . . ► 52 Did the organization complete Schedule A? Note: All section 501(c)(3) organizations must attach a cam leted Schedule A •► Yes No Under penalties of perjury, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, It is Irua. oofraPM, and corn fate. Declaration of preparer (other than ofAcar) is based on all information of which preparer has "y knowledge. _ DAISY TATE 03-18-2022 Sign Signature ofaf0cer Data Here DAISY TATE OWNER Type or print name and title Print/Typo preparers name Preparees signature Date Check ID iF �PTIN Paid Louis Brockman outs Brockman �3-24-2022 self-employed 01294838 Preparer Flrm's name ► LB TAX SERVICES Firm's EIN ► Use Only Firm'saddress ► 514 NORTH COAST HWY STE BB Oceanside CA 92054 Phone no. 760-522-7129 Ma the IRS discuss this return with the re arer shown above? See instructions ► Yes No EEA Form 990-EZ (2021) SCHEDULE A I OMB No. 1545-0047 Public Charity Status and Public Support (Form 990) Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. 2021 Department of the Treaeu Internal Revenue Service Name of the orvanlzatlo ► Attach to Form 990 or Form 990-EZ. ► 00 to www.Irs.gov1Farm990for instructions and the latest Open to Public nation. I Inspection Employer Identification numbor VPTERNS SUPPL M NTAL SUPPORT NILTWORK 46-27OS469 Part I J Reason for Public Chari Status. All or anizaGans must com lets this art. See instructions. The organization is not a private foundation because It is: (For fines 1 through 12, check only one box,) 1 ❑ A church, convention of churches, or association of churches described In section 170(b)(1)(A)(i). 2 ❑ A school described in section 170(b)(1)(A)(11). (Attach Schedule E (Form 990).) 3 ❑ A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(I11). 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 ❑ An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.) 6 ❑ A federal, state, or local government or governmental unit described in section 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 II.) 0 ❑ A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.) 9 ❑ An agricultural research organization described in section 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non --land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or university: 10 ® An orgarfizalion that normally receives: (1) more than 33 113% 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 1131X of its support from grass 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.) 11 ❑ An organization organized and operated exclusively to test for public safety. See section 509(a)(4). 12 ❑ 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 in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g. a ❑ Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B. b ❑ Type II. A supporting organization supervised or controlled in connection with its supported organ izalion(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C. c ❑ Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E. d ❑ Type III non -functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V. e ❑ Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III norrfunctionally integrated supporting organization. If Enter the number of supported organizations . . . . . . . .. . . . . . . . . . . . . .... . .. p Provide the following information about the supported organzation(s). (1) Name of supported organization (li) EIN (III) Type of organization (described on lines 1-10 above (see Instructions)) (Iv) Is the organization listed in your governing document? (v) Amount of monetary support (see Instructions) (vl) Amount of other support (see instructions) Yes No (A) (B) (C) (D) (E) Total For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. schedule A (Form 990) 2021 EEA Schedule Farm990 2021 VETERN3 SUPPLF, MNTAL SUPPORT WETWORK 46-2705469 Pa n 2 Part If Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to ualif under the tests listed below, 2lease complete Part III. Section A. Public Support Calendar year (or fiscal year beginning in) ► _(a) 2017 (b) 2018 c 2019 _(d) 2020 a 2021 M Total 1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") 2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ...... _ 3 The value of services or facilities furnished by a governmental unit to the organization without charge .... . 4 Total. Add lines 1 through 3 ..... _ 5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .... . 6 Public support, Subtract line 5 from line 4. Section B. Total _Support Cal 7 8 9 10 11 12 13 ender year (or fiscal year beginning in) ► a 2017 b 2018 c 2019 d 2020 (a)2021 Total Amounts from line 4 ......... . Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources ........... . 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 VI.) ......... . Total support. Add lines 7 through 10 14 15 16a b 17a b 18 vrusb rcc;eiprs irorn reiateu activities, etc, (see Instructions) 1 121 First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................... ► an C. Computation of Public Support Percentage Public support percentage for 2021 (line 6, column (f), divided by line 11, column (f)) ...... 14 Public support percentage from 2020 Schedule A, Part II, line 14 ................. 15 % 33 1/3% support test - 2021. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization ..................... ► ❑ 33 1/3% support test - 2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization ................... ► ❑ 10%-facts-and-circumstances test - 2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the facts -and -circumstances test, check this box and stop here. Explain in Part VI how the organization meets the facts -and -circumstances test. The organization qualifies as a publicly supported organization ......................................................... ► ❑ 10%-facts-and-circumstances test - 2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the facts -and -circumstances test, check this box and stop here. Explain in Part VI how the organization meets the facts -and -circumstances test. The organization qualifies as a publicly supported organization .............. . . . . . . .. .... .. . .. . . . . . . .. . . .. . . .. . . . . . . . .. ► ❑ Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ► EEA Schedule A (Form 990) 2021 Schedule Farm99t1 2021 VET14RNS SUPPLEMENTAL SUPPORT NETWORK 46-2705469 Pirle3 Part III Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, lease complete Part II. Section A. Public Support Calendar year (or fiscal year beginning in) ► 1 Gifts, grants, contributions, and membership fees a 2017 b 2018 c 2019 d 2020 2021 (f) Total __Iej received. (Do not include any "unusual grants.") . 2 Gross receipts from admissions, merchandise _50,128 100,564 72,719 49,791 31 859 305, 061 sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose ... . 3 Gross receipts from activities that are not an unrelated trade or business under section 513 4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ...... 5 The value of services or facilities furnished by a governmental unit to the organization without charge .... . 6 Total. Add lines 1 through 5 . . . . . 7a Amounts included on lines 1, 2, and 3 50,128 100,564 72,719 49,791 31,859 305,061 received from disqualified persons b Amounts included on lines 2 and 3 T received from other than disqualified persons that exceed the greater of $5,000 or 1 % of the amount on line 13 for the year c Add lines 7a and 7b ........ . 8 Public support. (Subtract line 7c from f061 line 6.) . . . . . . . . . . . . . . . . . 305 Section B. Total Support Calendar year (or fiscal year beginning In)► a 2017 b 2018 c 2019 d 2020 a 2021 Total 9 Amounts from line 6 . . . . . . . . . 10a Gross income from Interest, dividends, 50 128 100 564 72,719 49,791 31,859 305,061 payments received on securities loans, rents, royalties, and income from similar sources b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 ... . c Add lines 10a and 10b . ....... 11 Net income from unrelated business _ activities not included on line 10b, whether or not the business is regularly carried on 12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ......... . 13 Total support. (Add lines 9, 10c, 11, and 12.) ......... ....... 50,128 100,564 72,719 + 49,791 31,859 305,061 14 First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here _ ► Section C. Computation of Public Support Percentage 15 Public support percentage for 2021 (line 8, column (q, divided by line 13, column (f)) . . . . 15 2,00. 00 % 16 Public su ort percentage from 2020 Schedule A, Part III, line 15 161 100.00 % Section D. Computation of Investment Income Percentage 17 Investment income percentage for 2021 (line 10c, column (f), divided by line 13, column (0) 17 0.00 18 Investment income percentage from 2020 Schedule A, Part III, line 17 .. ... . .. .. . . . . . 18 0.00 % 19a 33 113% support tests - 2021. If the organization did not check the box on line 14, and line 15 is more than 33 1 /3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ► b 33 1/3% support tests - 2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 113%, and line 18 is not more than 33 1/3%, 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 , . ► rl EEA Schedule A (Form 990) 2021 Schedule (Form 990) 2021 VETERNS SUPPLEMMAL SUPPORT NETWORK 46-2705469 Pi�o4 Part IV Supporting Organizations (Complete only,if you checked a box in line 12 on Part I. If you checked box 12a, Part I, complete Sections A and B. If you checked box 12b, Part I, complete Sections A and C. If you checked box 12c, Part I, complete Sections A D, and E. If you checked box 12d, Part I complete Sections A and D, and complete Part V.) Section A. All Supporting Or ag nnizations l YesE No 1 Are all of the organization's supported organizations listed by name in the organization's governing documents? if "No," describe in Part W how the supported organizations are designated. if designated by class or purpose, describe the designation. If historic and continuing relationship, explain. 1 2 Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes, " explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2). 2 3a Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes,"answer lines 3b and 3c below. 3a b Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? if "Yes," describe in Part VI when and how the organization made the determination. 3b c Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? if "Yes," explain in Part VI what controls the organization put in place to ensure such use. 3c 4a Was any supported organization not organized in the United States ("foreign supported organization")? If "Yes, " and if you checked 12a or 12b in Part 1, answer lines 4b and 4c below. 4a b Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If "Yes, " describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations. 4b c Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If "Yes," explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) 5a purposes. Did the organization add, substitute, or remove any supported organizations during the tax year? if "Yes," 4c answer lines 5b and 5c below (if applicable). Also, provide detail in Part V1, including (i) the names and E1N numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action b was accomplished (such as by amendment to the organizing document). Type I or Type II only. Was any added or substituted supported organization part of a class already 5a c 6 designated in the organization's organizing document? Substitutions only. Was the substitution the result of an event beyond the organization's control? Did the organization provide support (whether in the form of grants or the provision of services or facilities) to 5b 5c anyone other than (1) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or 7 benefit one or more of the filing organization's supported organizations? If "Yes," provide detail in Part Vt. Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor 6 8 (as defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If "Yes, " complete Part I of Schedule L (Form 990). Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7 9a 7? If "Yes, " complete Part I of Schedule L (Form 990). Was the organization controlled directly or indirectly at any time during the tax year by one or more 8 disqualified persons, as defined in section 4946 (other than foundation managers and organizations b described in section 509(a)(1) or (2))? If "Yes," provide detail in Part Vl. Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which 9a c 10a the supporting organization had an interest? If "Yes, " provide detail in Part Vt. Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If "Yes,"provide detail in Part Vt. Was the organization subject to the excess business holdings rules of section 4943 because of section 9b 9c 4943(f) (regarding certain Type II supporting organizations, and all Type III non -functionally integrated b supporting organizations)? if "Yes," answer 10b below. Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to 10a determine whether the organization had excess business holdin s.) 10b EEA Schedule A (Form 990) 2021 Schedule A(Folm99M2021 VETERNS SUPPLEMENTAL SUPPORT NETWORK 46-2705469 Page Part IV Syppa !rung organizations (continued) Yes No 11 Has the organization accepted a gift or contribution from any of the following persons? a A person who directly or indirectly controls, either alone or together with persons described in lines 11 b and 11c below, the goveming body of a supported organization? 11a b A family member of a person described in line 11a above? 11 b c A 35% controlled entity of a person described in 11a or 11 b above? If "Yes" to line Ila, 11b, or 11c, provide detail in Part VI. 11 c Section B. Ty e I SuRR5i ting ❑rganizations No 7 Did the governing body, members of the governing body, officers acting in their official capacity, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization's officers, directors, or trustees at all times during the tax year? If'No,"describe in Pail V/how the supported organization(s) effectively operated, supervised, or controlled the organization's acMiles. If the organization had more than one supported organization, describe how the powers to appoint and/or remove officers, directors, or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year. 2 Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If "Yes, " explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised, or controlled the supporting organization. Section C. Type II Supporting Organizations Yes No 1 Were a majority of the organization's directors or trustees during the tax year also a majority of the directors or trustees of each of the organization's supported organization(s)? If "No, " describe in Part Vi how control or management of the supporting organization was vested in the same persons that controlled or managed the suppoded o anizations _ 1 Section D. AILType 111 Su ortin Organizations Yes No 1 Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization's tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization's governing documents in effect on the date of notification, to the extent not previously provided? 1 2 Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No,"explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s). 2 3 By reason of the relationship described in line 2, above, did the organization(s supported organizations have a significant voice in the organization's investment policies and in directing the use of the organization's income or assets at all times during the tax year? If "Yes, " describe in Part VI the role the organization's su orted a anizations played in this Nord. 3 Section B. Type IiI Functionall!y Into rated Supporting Organizations 1 Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions). a []. The organization satisfied the Activities Test. Complete line 2 below. b The organization is the parent of each of its supported organizations. Complete line 3 below, c The organization supported a governmental entity. Describe in Part V1 how you supported a government entity (see instructions}, 2 Activities Test. Answer lines 2a and 2b below. I Yes No - a Did substantially all of the organization's activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities. 2a b Did the activities described on line 2a, above, constitute activities that, but for the organization's involvement, one or more of the organization's supported organization(s) would have been engaged in? If "Yes, "explain in Part VI the reasons for the organization(s position that its supported organization(s) would have engaged in these activities but for the organization's involvement. 2b 3 Parent of Supported Organizations. Answer lines 3a and 3b below. a Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? If "Yes" or "No," provide details in Part Vl. 3a b Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each of its supported ❑ anizations? if "Yes,"describe in Part VI the role played bthe organization in this rogsrri. 3b EEA Schedule A (Form 990) 2021 Sehod0oA Form990 2021 VETRRNS SUPPLZMENTAL SUPPORT NETWORK 46-2705469 Page Part V I Type III Non -Functional) Integrated 509 a 3 Supporting Organizations 1 ❑ Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non -functionally Integrated supporting organizations must complete Secl€ons A throunh E. Section A -Adjusted Net Income (A) Prior Year (B) Current Yearo (optional) 1 Net short-term capital gain 1 _2 Recoveries of prior -year distributions 2 3 4 5 _ 3 Other gross income see instructions 4 Add lines 1 through 3. 5 Depreciation and depletion 6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of ra eft held for production of income see Instructions 6 7 8 7 Other expenses see Instructions 8 Ad listed Net income subtract lines 5, 6, and 7 from line 4 Section B - Minimum Asset Amount 1 Aggregate fair market value of all non -exempt -use assets (see Instructions for short tax year or assets held for part of year): (A) Prior Year (B) Current Year (optional) a Avera a month) value of securities 1a b Average month) cash balances 1b c Fair market value of other non -exempt -Use assets I d Total add lines la, 1b, and 1a 1d e Discount claimed for blockage or other factors (explain in detail in Part V1: 2 Acquisition indebtedness applicable to non-exem t-use assets 2 3 3 Subtract line 2 from line 1d. 4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see Instructions). 4 5 6 7 8 5 Net value of non -exempt -use assets subtract line 4 from line 3 6 Multiply line 5 by 0.035. 7 Recoveries of prior -year distributions 8 Minimum Asset Amount add line 7 to line 6 Section C - Distributable Amount Current Year 1 Adjusted net income for prior year from Section A, line t3 column A 1 2 Enter 0.85 of line 1. 2 3 Minimum asset amount for pdor year from Section a, line 8, column A 3 4 Enter greater of line 2 or line 3. 4 5 Income tax Imposed in prior year 6 Distributable Amount. Subtract line 5 from line 4, unless subject to emeroemg temporary reduction see Instructions). 5 6 v unecx nere it the current year is the organization's first as a non -functionally integrated Type III supporting organization see instructions). EEA Schedule A (Form 990) 2021 2021 VETERMS SUPPLEMENTAL SUPPORT NETWORK 46-2705469 Part V Section D - Distributions Current Year 1 Amounts paid to supported organizations to accomplish exem t ur oses 1 2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations. in excess of income from activity 2 3 Administrative expenses paid to accomplish exempt puses of supported a anizations 3 4 Amounts paid to acquire exempt -use assets 4 5 Qualified set -aside amounts(prior IRS approval ra uired - pravkte details in Part VI 5 6 Other distributions describe in Part VI). See instructions. 6 7 Total annual distributions. Add lines 1 throw h 6. 7 8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions. 6 9 9 Distributable amount for 2021 from Section C, line 6 _ 10 Line 8 amount divided bv line 9 amount 110 Section E - Distribution Allocations (see instructions) (�) Excess Distributions Underdistributions pre-2021 Distributable Amount for 2021 1 Distributable amount for 2021 from Section C. line 6 _ 2 Underdistributions, if any, for years prior to 2021 (reasonable cause required - explain in Part VI). See instructions. 3 Excess distributions Car aver, if any, to 2021 a From 2016 b From 2017 c From 2018 d From 2019 a From 2020 If Total of lines 3a through 3e Applied to underdistributions of prior years h Applied to 2021 distributable amount t Carryover from 2016 not applied see instructions Remainder. Subtract lines 3 , 3h, and 3i from line 3f. 4 Distributions for 2021 from Section D, line 7: $ a A2plied to underdistributions of prior years b Applied to 2021 distributable amount c_ _ Remainder. Subtract lines 4a and 4b from line 4. 5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. For result greater than zero, explain in Part Vt. See instructions. 6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. For result greater than zero, explain in Part Vl. See instructions. _ 7 Excess distributions carryover to 2022. Add lines 31 and 4c. 8 Breakdown of line 7: a Excess from 2017 ---- b Excess from 2018 c Excess from 2019 ` d Excess from 2020 e Excess from 2021 EEA Schedule A (Form 990) 2021 Schedule A Form 990 202.1 171ano e Part Vll Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.) EEA Schedule A (Form 990)2021 SCHEDULE O Supplemental Information to Form 990 or 990-EZ OM6 No. 1545-0047 (Form 990) Complete to provide information for responses to specific questions on ^ � Form 990 or 990-EZ or to provide any additional information. L L Department of the Treasury ► Attach to Form 990 or Form 990-EZ. Open to Public Internal Revenue Service jw Go to www.lrs.gov/Form99O for the latest information. Inspection Name of the organization Employer identification number VETERNS SUPPLEMENTAL SUPPORT NETWORK �46-2705469 01. Descri tion of other expenses Part I line lfi DESCRIPTION AMOUNT ADVERTISING 2 4BO CONTRACTING FEES 794 DIGITAL SERVICES 2,035 EVENT PLANNING 19,689 FILED TRIPS 316 FOOD VOUCHER 405 GAS VOUCHER 186 INVENTORY 224 MAILING 39 MARKETING ADVERTISING 38 OFFICE ADMIN 8 PROPERTY MAINTENANCE 46 SOCIAL MEDIA 12 STORAGE 561 TRAINING 260 TRAVEL 3,312 UNIFORMS 143 VETERN SERVICES 57 VOLUNTEER APRECIATION 386 VOLUNTEER MEALS 512 WEB HOSTING 250 BANK FEES 100 For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule o (Form 990) 2021 EEA TAXABLE YEAR California Exempt Organization 2021 Annual Information Return ■ Calendar Year 2021 or fiscal year be InArI (mrrtlddlyyyy) _ and ending (mWddlyyyy) CorporatlonlOrganlzatlon name California corporation number VETERNS SUPPLEMENTAL SUPPORT NETWORK ir;;7r,7n FORM 199 Additional information. See instructions, FEIN .. 46-2705469 Street address (suite or room) PMB no. 23705 KATHRYN ST City Slate Zip code MURRIETA ICA 92562 Foreign country name Foreign provincelslalelcounty Foreign postal code A First return • • • . • • . . . . . . . . . . . . . . . . 0 Yes ❑ No I Did the organization have any changes to Its guidelines B Amended return . . • • • . . . . . . . • . . . . . . ■ Yes11 No not reported to the FTB? See instructions • • • . • • • . . . • Yes No C IRC Section 4947(a)(1) trust • • • . . . . . . . . . . . . .11 Yes ® No J If exempt under R&TC Socilon 23701d, has the organization D Final Information return? engaged in political activllles? See instructions • • . . . . . . • Yes El No 011 Dissolved 11 Surrendered (Withdrawn) ❑ MergedlReorganized K Is the organization exempt under R&TC Section 23701g? ■� Yes ❑ No Enter date: (mmlddlyyyy) ■ If "Yes,' enter the gross receipts from nonmember sources •$ E Check accounting method: (10 Cash (2) Accrual (3) ❑ Other L Is the organization a limited Ilabllky company? • • • • . . . . . 611 YesEl No F Federal return filed? (1) ■ ❑ 990T (2) ■ ❑ 99OPF (3) ■ ❑ Sch H (990) M Did the organization file Form 100 or Form 109 to report (4) ® Other 990 series taxable income? • . . . . . . . . . . . . . . . . . . . . ■ El Yes 1� No G Is this a group filing? See instructions . • . . . . . . . . • ❑ Yes ❑ No N Is the organization under audit by the IRS or has the IRS H Is this organization in a group exemption • . . . . . . . . . . ❑ Yes ❑ No audited in a prior year? • • • • . . . . . . . . . . . . . . ■i Yes ❑ No If "Yes," what is the parent's name? O Is federal Form 1023/1024 pending? • • • . . . . . . . . . ❑ Yes No Dale filed with IRS r•ari i Complete Part 1 unless notr"tilmd to file this form. See General Information B and C. 1 Gross sales or receipts from other sources. From Side 2, Part II, line a . . • . . . . . . . . . . . . . . . . . . . . . • 1 00 2 Gross dues and assessments from members and af¶llales . • • . . . . . . • . . . . . . . . . . . . . . . . . . . ■ 2 00 Receipts Furvenuoi 3 Gross contributions, gifts, grants, and similar amounts received • • • • • • • . • . . . . . . . . . . . . . . . . . . 4 Total gross receipts for filing requirement test. Add line 1 through line 3. • 3and 00 This line must be completed. If the result Is less than $50,000, see General Information B • • • . . . . ■ 4 00 5 Cost of goods sold • • . • • • • • . . . . . . . . . . . . . . . . . . . . . . • 5 00 6 Cost or other basis, and sales expenses of assets sold • • . • . . . . . . . . . . . . ■ g 00 7 Total costs. Add line 5 and line 6 • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Total gross Income. Subtract line 7 from line 4 • • • • . . . . . . . . . . . . . . ■ 5 00 irlepense 9 Total expenses and disbursements. From Side 2, Pert II, line 18 • • • • • . . . . . . . . . . . . . . . . . . . ■ g 00 10 00 10 Excess of recelpts overexponses and disbursements, Subtract line 9 from line 8 . . . . . . . . . . . • 11 Total payments • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■ 11 00 Filing 12 Use tax. See General Information K . . • • • . . . . . . . . . . • . . 72 00 13 00 Fee 13 Payments balance. If line 11 is more than line 12, subtract line 12 from line 11 • • . . . . . . . . . . . . . . . . . . . . . • 14 Use tax balance. If line 12 is more than line 11, subtract line 11 from line 12 • • • . . • . • • . . . . . . . . . . . . . • 74 00 15 Penalties and interest, See General Infonnallon J. • • • • . • • • . . . . . . . . . . . . . . . . . . . . . . . . . 15 00 16 Balance due. Add line 12 and line 15. Then subtract line 11 from the result • . . . . . . . . . . . . . ■ 10 00 Sign Here lladnr penalltes of poquty, 1.4doclansIFl1f1 I here exanrkwd a Mlurn, lrsmdhg aocempany!ng Wkedulas and atelomenli . and to the boat of my knowlsdi end &AR, 111 true, correct, and cnen(Mo. {10ftation of p(eparer {other than taxpayer) is hlasad on all ida magoll OF MIch preparer has any krww"o. Signature TIFF Date ■Telephone aFofficer ►DAISY TATE WNER 3/18/2022 951-821-8776 Preparers signature P.L3/24/202210rriji ❑ate Check if self- ► ■PTIN P 012 9 4 8 3 8 Paid Pnpsrers Use Only Flrm's name (or yours, ifselF-employed) No. LB TAX SERVICES ■Firm's FEIN and address 514 NORTH COAST HWY STE BB ■Telephone CCEANSIDE CA 92054 760-522-7129 May the FTB discuss this return with the prepefor shown above? See Instructions - . . . . . . . . an Yes No —07-3-1 3651214 F_ Farm 199 2021 Side 1 Part II Organizations with gross receipts of more than $50,000 and private foundations • regardless of amount of gross receipts -complete Part liar furnish substitute information. 4 6 — 2 7 0 5 4 6 9 Receipts from Other Sources Expenses and Disburse. manta 1 Gross sales or receipts from all business activitles. See instructions ... . . . . .... . . . . .. • 2 Interest . . . .. . . . . . . . .. . . . . . . . . . . .. .. . . .. . . . . . . . . . . . . . . . • 3 Dividends . .. . . .. .... . . . . . . . . . . . . . . . . . . . . . . . . . . . , ' ■ 4 Gross rents . ............... ...... , . . . . . . . ... • 5 Gross royalties . . . . ... .... . . . . . . . . . . . .. . . . . . . . . .. . . . . . . • 6 Gross amount received from sale of assets (See instructions) . . .. . . . .. . . . . . . . . . . . • 7 Other income. Attach schedule • .. . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . a 8 Total gross sales or receipts From other sources. Add line 1 through line 7. Enter here and on Side 1, Part I, line 4 . . . • 9 Contributions, gifts, grants, and similar amounts paid. Attach schedule . . . . . . . . . . . . . . . . • 10 Disbursements to or for members . . . .... ... .. . . . . ..... .... ... .. .... • 11 Compensation of officers, directors, and trustees. Attach schedule ....... . .. . .... .. . • 12 Other salaries and wages . . . . • • . . . . .. . . . . . . . . ..... ....... ...... • 13 Interest . ........ ...... . . .. . . . . . . . . . ..... ....... .. .... • 14 Taxes. . . . . . .. ... ... .. . . . . . . . . . . • 15 Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . .. . . . . . . . ■ 16 Depreciation and depletion (See instructions) . . • . . . . . . . . ................. . • 17 Other expenses and disbursements. Attach schedule . . . . . . .................. • 18 Total expenses and disbursements. Add line 9 through line 17. Enter here and on Side 1, Part I, line 9 1 00 2 00 3 00 4 00 5 00 6 00 7 00 8 00 9 00 10 00 11 00 12 00 13 00 14 00 15 00 16 00 77 00 18 00 Schedule L Balance Sheet Raoinnlnn of faYahia vanr e..a ..ffs kle — Assets 1 Cash ........ ............. 2 Net accounts receivable . . . . .... .... 3 Net notes receivable .. • ........... 4 Inventories . . . . . . . . . . . . . . . . ... 5 Federal and state government obligations .. - . 6 Investments in other bonds . . . . . . . . ... 7 Investments in stock . . . . • . • . . . . . . 8 Mortgage loans . . .. • . . . . . . . . . . 9 Other investments. Attach schedule .. . . . . 10 a Depreciable assets . . . . . . . . . . . . b Less accumulated depreciation . . . . • • . 11 Land . . . . . . . . . . . . . . . . . . . . . 12 Other assets. Attach schedule . . • ...... 13 Total assets . . . . . . . . . . . . . . . . . Liabilities and net worth 14 Accounts payable . . . . • . . 15 Contributions, gifts, or grants payable . .. • . 16 Bonds and notes payable . . . . • . . . ... 17 Mortgages payable ........... ... 18 Other liabilities. Attach schedule .. ..... . 19 Capital stock or principal fund . . . . . . . .. ZO Paid -in or capital surplus. Attach reconciliation Z1 Retained earnings or income fund • • .... 22 Total liabilities and net worth . . . . . . . (a) (b) (c) {j • • a ■ • • • • • - • • • • • QUIHMUIV IV1.1 metuorlcmarton or income per 000lcs wren income per return Do not complete this schedule if the amount on Schedule L, line_ 13, column (d), is less than $60.000. 1 Net income per books • . • ... .... . . . • 7 Income recorded on books this year 2 Federal income tax ............... • not included in this return. Attach schedule It 3 Excess of capital losses over capital gains • 8 Deductions in this return not charged 4 Income not recorded on books this year. against book income this year. Attach schedule .. . .. ......... . . ■ Attach schedule ............. a 5 Expenses recorded on books this year not 9 Total. Add line 7 and line 8 . . . • . . . deducted in this return. Attach schedule • 10 Net income per return. 6 Total. Add line 1 through line 5 - - - - - .. Subtract line 9 from line 6 .. • .... . Side 2 Form 199 2021 0 4 3 3652214 �� FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # WESTERN EAGLE FOUNDATION CITY OF TEMEMIA Ill FISCAL YEAR 2022.2023 CA %V COMMUNITY SERVICE FUNDING - REINVESTMENT IN C t! �4� PROGRAM APPLICATION' (Please Print or Type) R DUE ON OR BEFORE: MONDAY, SEPTEMBER 12,2 2022 f MIT IN;X f PROJECT/PROGRAM INFORMATION Amount Requested: $ $50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: Food Boxes for residents in Temecula Start Date: July 1 2122 End Date: June 30,2023 Physical Address of Project/Program: 40940 County Center Drive, Temecula, CA 92591 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Western Eagle Foundation Mailing Address: c/o Todd Sieja, CEO 40940 County Center Drive,Temecula, CA 92591 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Western Eagle Foundation Website: www.westerneaglefoundation.o Number of Paid Staff: 10 Year Founded. 1993 Social Media: FB: westerneaglefoundation Number of Volunteers: 100 Geographic Area(s) the Organization Serves: Temecula Geographic Area(s) the Project/Proctram Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Serena Cooper Title/Position: Program Manager Contact Person's Direct Telephone: 951-541-8571 Contact Person's Email: scooper@western-eagle.org NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: 5/19/1993 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 33-0498064 State Identification Number:'8582i30 _ PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. ® Attach IRS Deductibility Status using this link: http_//api)s.irs.gov/app/eos/ 2. ® Attach State Entity Status Letter using this link: htt s:/Iwww,ftb.ca. oV/online/self serve entitV status fetter/index.as 3. ® Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htto:/Irct.doi.ca.govNerification/Web/Search.asgx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 APPLICATION AUTHORIZATION _ I Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION - This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. I Wester raglQ Foundalion (WE) mission since 1993 is "dedicated to feeding the hungry' with the {owust mat food possible available at the Western Eagle Food aril Hp ng Goads store. A 44, 000 sq,ft warehouse with heavily dtScduntod food and goods purdrased direcliyy from rood brokers andlor donated (from farmers, food distributors and grocers. Open to public. Plrys}cal Address:40940 County Center Drive, Temocu[a, CA. unlike a food pantry, Western Eagle Is open 7 days a weak for easy access to food Program GoaVONactives: tWE FOOD BOX) supports an average of 300 IndividuaWramiiles (no income requifemonts) a week with in store food boxes that includes healthy rood such as staples, breads, fresh fruits, vegetables and dairy, everyone is ellgible and lhere era no INmits to how many boxes may be obra+rsed. {WE BULK Ft7gD Dt17r3Fa4CN] providers bulk food via portents [4ppmx. 1.gM Ibs a year} avaflatla for pickup every 7Fsursdayy to more Ihan twenty churchealnonprofir agentles that delivor to fogd inseclrre cwnmunilies (belrefding t 17,800 families annually) !n urnnmrparated areas of fiiverside County !n tiding Temecula Valley �WE VOLUNTCERSj oifans a work dsvek7pmenl program to volunteer youth, young adults, seniors, individuals with diseblliNos veterans, those recovering (rpm ad [cllans. snorer serving Cdurt•ordared community servrt�, enahtlng than to move forward toward their gsrals and Increase !hair skit! Sat In slacking, packing and shsiving, sorting, p icing, cashiering, cua[omar service, work eth cs• dusJnass pollcins and procedures Fu1i-time vnluntLH3rs are fed breakfast, lunch and food la fake home for d+nrxir. FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 i �5 Timm AM � 8E b -n _ N � E N R,P1 p w . C � N p a Or-, ❑ T r- N p���� vco @-L a N �Iu C: �bp v0Egvv cn2 12 m a I(D C C �A y C:E W z, > -'D=Fa -ffi �°-_ U $� CT m $� �'�s' 0 2d 0�� R N �cc z 11(D a m Ew cu'� EU o� ",7,�� �m�L i� izri q �5 p'C` Q Grp aF z a a 0��31 3N O W oC-f;°'� a� 2 b&?J=-j&Tram m W wao� �°° � m o� pQUwC P 0 'vim u 22-5�— SO a _ m x 4 'U-a�nxc00 a�-w W 0 W W Z Z Ww w Co z J ~ Q p (n ZQO QcoZ Z-ao ,— ZU WWz m W F mgw Q O �-� W Q l- CC J U) Z " 0Wz H g LL U ^�wz a�C) 0 W w o2F- LUF-Z9 LL _CO OZ0C C azo 0WO WSW n Cl) =) W W CY wzW w aQa � m � CM 0 a O Q J a a z cu 0 F- LL N rn c 7 .0 E 0 U cv 0 U FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ® Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP $ $ $ OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? NO ❑ Yes ® IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH + YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ 10,000 ARPA Riverside County Supervisor, District 3 12/2021 $ 30,000 Private Foundations -Awarded 02/2022 $ 10,000 Emergency Food and Shelter Program -HUD 07/2022 $ 40,000 Private Foundations- Pending Pending $ Net proceeds from Western Eagle Store help fund programs, operating and personnel expenses monthly - Donated food from farmers and growers monthly City of Temecula Community Service Funding - Reinvestment In Temecula GRANT APPLICATION Page 7 of 13 FGRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT - RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT. Grant funding will support the Western Eagle (WE) "Food Boxes" program available to the general public, no income restrictions, to help supplement food budgets of all families and individuals in need of food. Todd Sieja, CEO purchases food box staples every week (canned vegetables and fruits, dry pasta and rice, cereals, spaghetti sauce, dried beans, soups, peanutbutter, tostada shells, packaged dinners) from a regional food broker. Donated food such as dairy, breads and fresh fruit and vegetables are added to the €Gad box if available. A transportation service is used to pick up food and home goods several times during the week. Unlike food pantries, food boxes are available seven days a week at the Western Eagle store along with a warehouse of discounted food and home goods to help families stretch their budgets and make a home for less. The food box is posted on social media by Sam every morning to show what is in stock that day.On average, 300 families take advantage of this program a week. The spreadsheet showing data and count of food boxes by month and year shows that more than 1200 families take advantage of the food box program monthly and 14,400 annually. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Awarded funds will be used to purchase "staples" from regional food brokers for the food boxes each week. Data shows that approximately 220 Temecula residents take advantage of the food box a month. At an operational cost of $25 a box times 220 Temecula residents=$5,500 per month, annual cost = $66,000 A grant award of $50,000 will feed 2,200 Temecula residents- individuals and families a year. Staples purchased included cans of Fruits and vegetables, dry pasta, rice and beans, cereals, sauces, crackers/cookies, peanutbutter, and packaged dinners. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS Grant funding will specifically benefit 1'emecula residents by increasing monies used to directly purchase food from regional food brokers and transport stock to the Western Eagle warehouse. Staples are directly purchased and include canned fruits and vegetables, dry paslalricelbeans, peanut butter, cereal, tomatoe sauce and packaged dinners, Additional items donated to the food box Include dairy products (milk, cheese) and fresh fruit and vegetables Food boxes are available 7 days a week for easy access to food and so no one goes hungry. An average of 220 Temecula residents take advantage of the food box program according to the sign -in sheet. Temecula residents are asked numb #poked up, city and aipcode, plus email address for Future newsletters and bulletins, 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 2640 13c ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: 1100 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT —SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. Requesting $50,000 to purchase directly from food brokers "staples" to provide a food box to Temecula residents in need of supplemental food to feed their families. Dairy and fresh fruit and vegetables are donated. 220 residents a month, on average 2,640 a year. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. COVID-19 pandemic affected Western Eagle's ability to get donated food from growers, farmer and suppliers. Inventory and overflow of food was down, there was alot of competition for donated food from other food banks and transportation was costly and not always on schedule. Suppliers began charging for their overstock rather than just giving it away as they did before the pandemic. Western Eagle began buying more "staples" for the food box program and the store. This has caused an increase in operating and program expenses. Inflation is here and caused Western Eagle to let go of their truck and driver, due to the high cost of gasoline and employee retention. Western Eagle now uses a transportation service to pick up food and goods from suppliers. This does cause delay in getting food picked up and brought back to the Western Eagle store. 6 IF APPLYING FOR MORE THAN 15,000, EXPLAIN HOW FUNDS HAVE OR WILL: (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT/PROGRAM, AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. Continue existing program of purchasing directly from food brokers "staples" which are sorted into food boxes that feed a family of four with dryed pasta/rice/beans, tomatoe sauce, canned vegetables and fruits, cereal, peanut butter, crackers or cookies. Other included in food box are donated breads, fresh fruits and vegetables. A picture is posted every morning on social media showing the day's food box options. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM 1- Amount of money requested from this City of Temecula Community Services Grant (Not to exceed $50,000) $ 50,000 Amount contributed to the Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any $ 415,000 $ 30,000 In -Kind match amount or volunteer credit hours estimated amount $ 200,000 TOTAL REVENUE $ 695,000 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $ Facilities/Rent/Insurance $ Supplies Marketing Services $ $ $ Food $ 495,000 Other Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ 200,000 TOTALEXPENSES $ TOTAL BUDGET $695,000 $695,000 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS` FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures.) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organization: not applicable -new applicant Name of Project/Program: FY 2021-2022 Amount of $ CSF Grant Fund Awarded: _ _ Month & Year CSF Grant Received from City: Number of Beneficiaries Living in 92590, 92591, 92592 that Directly Benefitted from this Program/Project (approximate number of beneficiaries if you do not have precise number): E Date on Expenditure U Name of Company Receipt/Invoice Description Purpose P - = on Receipt or Invoice MUST BE ON OR BETWEEN Amount DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE JULY 1, 2021 -JUNE 30. 2022 I' 3 - - I$ I$ 5 6 j 1 EXPENDITURE TOTAL EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. . Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed, The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. . Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. . The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Western Eagle Foundation MAILING ADDRESS: 40940 County Center Drive Temecula, CA 92591 PRESIDENT / AUTHORIZED OFFICER: Todd Sieja CEO SIGNATURE: , ., a::� IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: PHONE: (951 ) 695-7206 EMAIL: cjsieja@gmail.com DATE:'... �i�... MOiNTI I, DAY, YF_.AK SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey.Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 Q HELPQ MENU Home > Charities and Non -Profits > Search f r Charities > Tax Exempt Organization Search Results for Tax Exempt organization Search Select Database 0 Search All V Search By 0 Employer Identification Number (EIN) V Search Term o 330498064 City Temecula State Country All States V United States V Search -1 1 Reset Showing 1-1 results of 1 Sort by: Name A-Z v Western Eagle Foundation Inc. EIN: 33-0498064 1 Temecula, CA, United States Pub 78 Data Copies of Returns Items per page: 25 v Return to Top, Additional information • Frequently sa k-d-ques i s - Exempt Organizations Select Check • Revoc tionsf (c)(3) Determinations SuspensionsP n S i (p). ExempL0--rgmLzpj1ons Bolness Master File Extract '(EO BMF): a list of organizations recognized as exempt by the IRS x Exern anization Search: Bulk Ma—DnWi2d Page Last Reviewed or Updated: 20-November-2020 IMIRS Our Agency About IRS Work at IRS Help Contact Your Local Office Tax Stats, Facts & Figures Know Your Rights Resolve an Issue Taxpayer Bill of Rights Taxpayer Advocate Service Civil Rights Freedom of Information Act No Fear Act Lf4 Share $ Print 910 @'Iona Ira Other Languages Respond to a Notice Espanol Independent Office [P3Z 0 na 0) of Appeals X } Identity Theft Protection iE-q01 Report Phishing Tax Fraud & Abuse PyCCKMA Tieng Viet Kreyol ayisyen English Other Languages Related Sites U.S. Treasury Treasury Inspector General for Tax Administration USA.gov STATE OF CALIFORNIA FRANCHISE TAX BOARD CFTB PO65 SA BOA 9427 !) SACRAME 85 CA 94257 054D Entity Status Letter Date: 7/5/2022 ESL ID: 1823881914 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 1858280 Entity Name: WESTERN EAGLE FOUNDATION ❑— 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. El4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019) Forrp 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) DOPartment of the Treasury ► Do not enter social security numbers on this form as it may be made public. Intemal Rarerwe Service ► Go to tvww.Ir�goylFarrnH9p for instrurtlnne A For the 2020 calendar year, 6 Check if appficable: C Name o ❑ Address Chan B VI LaA I1iLs3 and endfnn �..,.. 9 r4094O business as ❑ Name change ber and street (or P.O. box if mail is not delivered to street address) ❑ Initialvelum Count Center 1?rivt❑ Final reiunt/tem Inaledor town, state or province, coun ❑ Amended return Ter'neCula CA 9259! �' and ZIP or foreign postal code ❑ Appllcailion pending F Name and address of princi 1 ff I Tax•exampt JJ Webelfe; ►► K Form of.ornal u E 0 f, 1 2 3 4 5 6 7a b OMB No. 1545-0047 2020 D Employer identification number Room/suite 1 E Telephone number G Gross r9ceipls $ 15,339,547 H{a) Is this a group mum for subordinales7 ❑Yee 0 No H(b) Are all subordinates included? ❑ Yes ❑ No ff "No." attach a list. See instructions H{o) Group exemption number ► " Association �f Other► L Year of formation: Summary 200f1 M State of Iona} domicile: DF Brieflydescribe the organization's mission or most significant activities. to rovidr_ food far the_hun r _ --------------..................•----••---•----- ..............__... __.�-__.... .__. p-..�. _._..... -... _ _y_ ........_..._.......----.. -- •------•----..------- ---...__........,-_..--..�._�- - ..- - Cfleck this box / ❑ if the organization discontinued its operations or tiispnsed of more than 25% of its net assets. . Number of voting members of the governing body (Part Vf, line 1a) . Number of Independent voting members of the governing body (Part VI, line 1b) q Total number of individuals employed In calendar year 2020 (Part V. line 2a) 5 0 Total number of volunteers (estimate if necessary) - 14 Total unrelated business revenue from Part Vill, column (C), fine 12 6 0 Net unrelated business taxable Income from Form 990-T, Part I, line 11 7e 0 - 7b 0 pa o icer. Todd Sleja 40940 Count Center Drive, Temet:uia CA 92 status: Me 501(c)(a) ❑ 501(c) ( ),4 finsed no.l 4947(a)(1) or n 527 a 8 Contributions and grants (Part VIII, line 1 h) Prior Year current Year . 9 Program service revenue (Part VIII, line 0 0 2g) 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) 336959 410,375 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11 a 77,432 0 12 Tal revenue- add lines 8 throu h 11 (must a ual Part VIII, column (A) line 12 1s,3es 827 13,828592 Grants andsimilar amounts paid (Part IXcolumn (A)lines 13 FE30t 16,801,212 T-L 9{37 enefits paid to or for members (Part IX, column (A), line 4) 0 tzot32,408 alaries, other compensation, employee benefits (Part IX, column (A), lines 5-10 ) 0 0 16a Professional fundraising fees (Part IX, column (A), line 11e) 917,595 797,771 a b Total fundraising expenses (Part IX, column (D), line 25) ■ Ul 0 0 0 r � '- 17 Other expenses (Part IX, column (A), lines 11a-11d, I If-24e) , 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25 () ) 16,4z7,371 967,595 19 - Revenue less ex enses. Subtract line 18 from line 12 - 16,3a4,971 13,828,174 - - -- 456,241 410.793 20 Total assets (Part X, line 16) Beginning of Current Year End of Year 21 Total liabilities (Part X, line 26) a, 3,586,874 3,887,422 22 Net assets or fund balances. Subtract line 21 from line 20 234,762 724,517 S; nature 81flCE< 3352,112 3,7ti2,905 Under penalties of perjury, I declare that I have examined Ihis telum, including accompanying sr:hodufas mw otutam°rrto. and to the }xis[ of m knowledge trva, correc[, and compleIa. Dar;laration of proparer (of her Ilion offced fS based on all Information of which y d9e and belief, it is ixBRorer has any knowledge, Sign ` Signature of officer Here pttn torso, tlookee er Date Type or print name and title Paid Print/Type, preparer's name Preparer's signature Date Check ❑ if PT1fV Preparer soli-sm to p ]red Use Only F'rm. n°me P, —E Firm's address ► Firm's EIN ► May the IRS discuss this return with the Preparer shown above? See instructions Pho'm no. For Pa Paperwork Reduction Act Notice see the separate instructions. (.] Yes (_) No Cat. No. 11282Y Form 990 (2o20) FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 65 WISHERS AND DREAMERS INC. CITY OF TEMECULA FISCAL YEAR 2022.2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MOND", SEPTEMBER 12, 2022 Amnunt Requested: $ PROJECT/PROGRAM INFORMATION 5,000.00 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Volunteer Sewing Events Project/Program Title: Start Date: 7-1-22 End Date: 6-30-23 Physical Address of Project/Program: 32381 Cercle Latour, Temecula, CA 92591 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Wishers and Dreamers, INC. MailingAddress: 31915 Rancho California Rd 200-407 Temecula, CA 92591 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Wishers and Dreamers, INC. Organization: Website: WishersandDreamers.org Number of Paid Staff: 0 r Geographic Area(s) the Organization Serves. USA Year Founded: 2014 -ACC VW 19hcfA- Pk1 WZZ-A#'G�1 �tl — Social Media: t kr0'x Vvr'-1t[a"A,0, p c,u %2 Number of Volunteers: 100 POUTMAX Geographic Area(s) the Proiect/Proaram Serves: Temecula and Temecula Valley Hospitals NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Pamela Babek Title/Position: CEO Contact Person's Direct Telephone: 951-764-1800 Contact Person's Email: WishersandDreamers @gmail.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ■ Date of Incorporation as a Nonprofit: � 1� No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 47-1865187 State Identification Number:- 0252886-- 7tT, U L"� �j j PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: [ji Attach IRS Deductibility Status using this link: http.,I/agps.irs.00y/ar)pteos/ 4 Attach State Entity Status Letter using this link: {httos llwww.fth..ca.gov/online/self serve entity status letter/index.asp 3. ❑i Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: httpalrct.doj ca.govNerificationANeh/Search.aspx?facility=Y City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 Il— APPLICATION AUTHORIZATION Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No G Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No; N Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors # Members -at -Large ❑ y MISSION STATEMENT OF ORGANIZATION I BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION/GOALS AND OBJECTIVES. The specific purpose of Wishers and Dreamers, INC. is to send/donate to children suffering from illness, disease, disabling condition, or fighting medical challenges a hospital gown for their doll, bear, or little buddy to be used as a comfort item, encouragement, and a teaching tool. Also, Wishers and Dreamers, INC. donates gowns to hospitals, medical facilities, and medical staff for their patients to be used as a comfort item, encouragement, and a teaching tool. Many Hospital Child Life Programs and Emergency Rooms use the gowns to teach their patients about their treatments or procedures they will encounter during their hospital visit. FINANCIAL STATEMENTS Ult'ON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 6 of 13 FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No 0 Yes ❑ IF YES, PROVIDE BELOW. NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANTOR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECT/PROGRAM IN THIS APPLICATION? No N Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT RECEIVED I NAME OF ENITY MONTH + YEAR FUNDING RECEIVED ---- City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 GRANT PROJECT/PROGRAM DESCRIPTION IMPORTANT- RECEIPTS/INVOICES IS REQUIRED TO BE SUBMITTED TO THE CITY TO VALIDATE THE ORGANIZATION SPENT GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE 1 DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT_ We are desperately in need of funds to restock our fabric supply. In 2020, during the pandemic, we moved from making our gowns to making cloth facial masks at the request of our community. We made over 28,000 cloth facial masks for our local frontline workers, first responders, Temecula City programs, Local Hospitals and Local Children's Hospitals, Assisted Living, and many more including our local Wineries. This depleted our fabric stock and we have not been able to recoup the supply. The majority of the funds will be used to purchase fabric and supplies to continue our mission of donating our gowns to local hospitals. 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED, ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED OR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Wishers and Dreamers hosts in person sewing events that take place in the City of Temecula several times a year. Our local volunteers make and package hundreds of gowns to be donated to children and hospitals. If awarded the funds we will use the grant to purchase fabric and supplies needed t make and package the gowns. The supplies include, but not limited to, fabric, scissors, thread, packaging materials, postage, shipping, and sewing machines. 3 TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS. Our sewing events are hosted in the City of Temecula and involve volunteers from the Temecula Community. The volunteers consist of students from our local fthools, seniors, families, and individuals in our community that desire to help Comfort children battling medical issues in our local community and hospitals. The gowns from this grant will be earmarked to be donated to our local Medical Community, including but not limited to, Loma Linda University Medical Center, Rady Children's, Temecula Valley Hospital, Southwest Healthcare System, and local pediatric doctors and surgical centers. 3b ESTIMATED NUMBER OF PEOPLE FROM TEMECULA EXPECTED TO BENEFIT FROM THIS PROJECT/PROGRAM: 1000 3 ESTIMATED NUMBER OF VOLUNTEERS INVOLVED IN THIS PROJECT/PROGRAM: ! 100 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 8 of 13 PROJECT/PROGRAM DESCRIPTION CONTINUED 4 SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. If awarded the grant the majority of the funds will use to purchase fabric and :supplies needed to make and package the gowns. The supplies include, but not limited to, fabric, scissors, thread, packaging materials, postage, shipping, and sewing machines. The gowns from this grant will be earmarked to be donated to our local Medical Community, including but not limited to, Loma Linda University Medical Center, Rady Children's, Temecula Valley Hospital, Southwest Healthcare System, and I�)cal pediatric doctors and pediatric surgical centers. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. 'tYe are desperately in need of funds to restock our fabric supply. In 2020, during the pandemic, we moved from making our gowns to making cloth facial masks at the request of our community. We made over 28,000 cloth facial masks for our local frontline workers, first responders, Temecula City programs, Local Hospitals end Local Children's Hospitals, Assisted Living, and many more including our Iecal wineries. This depleted our fabric stock and we have not been able to recoup the supply. The majority of the funds will be used to purchase fabric and supplies to continue our mission of donating our gowns to local hospitals. 6' IF APPLYING FOR MORE THAN $5,000, EXPLAIN HOW FUNDS HAVE OR (1) CREATE NEW PROJECT/PROGRAM, (2) EXPAND EXISTING PROJECT AND/OR (3) CONTINUE EXISTING PROJECT/PROGRAM. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 9 of 13 PROJECT•/PROGRAM BUDGET (do not fill In shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula Community Services Grant (Not to exceed $50,000) $ 5 000 j Amount contributed to the Project/Program by the Applicant Organization $ 5,575 I (:yther grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 300 hrs TOTAL REVENUE $ 1 0,575 LIST OF EXPENSES FOR PROJECT/PROGRAM Sewing Machines and tools Tools/Equipment $2,000.00 Facilities/Rent/Insurance Supplies Fabric,Labels, sewing supplies, event supplies Marketing Services $1775.00 $ 5 000.00 $ 0 $ 800.00 Food Other Packaging and delivery $ 500.00 $ 500.00 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; HOWEVER PLEASE INCLUDE. $ 0 TOTAL EXPENSES TOTAL BUDGET $ 1 0,575.00 $ 1 0,575 $ City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 PREVIOUS' FISCAL YEAR (FY) 2021-2022 COMPLIANCE REPORT IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 21122 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2021-2022 (last year) by the City of Temecula, please submit this information. If your organization was awarded a Community Service Funding Grant in Fiscal Year 2021-2022 by the City of Temecula, all grant funds received must have been expended anytime on or between July 1, 2021, and June 30, 2022. In addition, all grant funds must be substantiated with proper back-up documentation, Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. Ifthe funds were not spent in accordance with the approved/awarded application, the organization will be required to return the amount of funds to the City. To substantiate that Fiscal Year 2021-2022 funds received from the City were spent appropriately, proper back-up documentation including the completed table below with accompanying receipts/invoices, must:,pe submitted to the City on or before due date: September 12, 2022. 1. Fill out table below (make additional copies if needed to explain all expenditures,) 2. Attach copies of receipts/invoices (in the same order as listed in this table.) 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590 Attn: City Manager's Office —CSF EXPENDITURE REPORT due on or before September 12, 2022 Organizati Name of Project/Program: FY 2921-2022 mount of $ CSF'Grant Fun Awarded: Month & Year CSF Grant Received from City: Number of Benefic ries Living In 92590, 92591, 92592 that Directly Benefilted from this Program/P ject (approximate number of beneficiaries if you do not have precise number). Date on Expenditure E aName of Compan\ Receipt/invoice on Receipt or Invoice UST se ON OR BETW-;=p� Amount Description Purpose LY 1, 2oz1 - JUNE ?n. 7a12 DESCRIBE THE EXPENDITURE PURPOSE OF EXPENDITURE az 1 $ 2i $ 3 $ 4 $ 5 $ 6 $ EXPENDITURE TOTAL $ EXPENDITURE TOTAL MUST BE EQUAL TO (OR GREATER) THAN TOTAL AWARD AMOUNT. City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 11 of 13 FISCAL YEAR (FY) 2022-2023 COMPLIANCE REPORT If your organization is awarded a Community Service Funding - REINVESTMENT IN TEMECULA Grant In FY2022-2023 by the City of Temecula, follow these instructions. If your organization is awarded a Community Service Funding Grant - REINVESTMENT IN TEMECULA in FY2022-2023 by the City of Temecula, all grant funds received must be expended anytime on or between March 20, 2020 and June 30, 2024s In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved/awarded application, the organization may not receive and/or will be required to return said amount of funds to the City. To substantiate that grant funds from the City are spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City as outlined on this page. 1. Fill out Expenditure Report table below. Make additional copies if needed to explain all expenditures. A. If awarded $5,000. Submit the following Expenditure Report within 60 days after spending $5,000 no later than June 30, 2024, to demonstrate grant funds were spent in accordance with the Application. [If you were awarded less than $5,000, submit Expenditure Report for that amount.) B. If awarded grant funds exceeding $5,000. A) Follow #1.A above first. B) To receive grant funds exceeding $5,000 (between $5K-$50K), submit the following Expenditure Report to be reimbursed for the remaining balance of award to demonstrate funds were spent in accordance with the Application. This report can be submitted in $10,000 increments (but no less than $10,000 unless the remaining grant award funding amount is less than $10K). This report must be submitted to the City no later than June 30, 2024 to receive remaining grant funds. 2. Attach copies of receiptslinvoices (in the same order listed in table below). 3. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Dept. "CSF-Reinvestment in Temecula" EXPENDITURE REPORT DATED Organization: Name of Project/Program: TOTAL FY 2022-2023 Month & Year FIRST $5,000 check Amount of Grant Fund Awarded: $ was received from City: 1. Is this Expenditure Report Is to provide documentation for first $5,000 awarded and received? Yes_ or No (already submitted). 2. My organization has already received $ of the total FY 2022-23 Grant Fund awarded by the City 3. Is this Expenditure Report Is submitted to request reimbursement of funds? No or Yes If yes, Amount of Request $ Number of beneficiaries living in 92590, 92591, 92592 that directly benefitted from this Program/Project (apptoximate number of beneficiaries if you do not have precise number) C E Name of Company Eon Receipt or Invoice Z Q Z 7i 2 3 Date on Receipt/Invoice MUST BE ON OR BETWEEN March 20, 2020 - JUNE 30, 2024 Expenditure MUST SUPPORT PROJECT/PROGRAM IN APPLICATION & AWARD LETTER Ci 1 Amount Description Purpose EXPENDITURE TOTAL $ EXPENDITURE TOTAL l City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 12 of 13 ACKNOWLEDGEMENT/SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • ' The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • ` If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. I/we hereby certify the information contained in this Application is 1rue to the best of our knowledge and belief. ORGANIZATION NAME: Wishers and Dreamers, INC. MAILING ADDRESS: 31915 Rancho California Rd 200-407 Temecula, CA 92591 PRESIDENT / AUTHORIZED OFFICER: Pamela Babek 0 PHONE: ( 951 ) 764-1800 EMAIL: WlshersandDreamers@gmail.com T E SIGNATURE: DATE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: CEO TITLE 9-9-2022 MONTH, DAY, YEAR PRINT NAME TITLE SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Stacey. Brown@TemeculaCA.gov (951) 694-6413 Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13 INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: DEC 03 2015 WISHERS AND DREAMERS INC C/0 PAMELA BABEK 1285 EL CURTOLA BLVD LAFAYETTE, CA 94549 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 47-1865187 DLN: 17053266322005 Contact Person: MITCHELL P STEELE ID# 31360 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: June 30 Public Charity Status: 170(b) (1) (A) (vi) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: September 9, 2014 Contribution Deductibility: Yes Addendum Applies: No We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 -z- WISHERS AND DREAMERS INC Sincerely, ///-100�— Jeffrey I. Cooper Director, Exempt Organizations Rulings and Agreements Letter 947 STATE OF CALIFORNIA o FRANCHISE TAX BOARD F' �7 PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 09/07/2022 ESL ID: 3455537325 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: 3709871 Entity Name: WISHERS AND DREAMERS INC. ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. X3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. El 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: "' ftb.ca.gov Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States California Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12.2019) 8/31 /22, 5:28 PM 199N e-Postcard I Confirmation I California Franchise Tax Board p _ 199N e-Postcard Confirmation Print this page for your records. The Confirmation Number below is proof that you su your 199N e-Postcard. We received your 199N e-Postcard on 8/31/2022 5:28:30 PM. Confirmation Number: 370987124306 Entity ID: Entity Name: 3709871 WISH ERS AND DREAMERS INC. Account Period Information Account Period Beginning: 7/1/2021 Account Period Ending: 6/30/2022 This is not your entity's first year in business. Your entity has not terminated or gone out of business. Your entity has not changed the account period. Gross Receipts: $7630 This is not an amended return. An IRS Form 1023/1024 is not pending. Entity Information FEIN: 471865187 Doing Business As: Website Address: https://www.wishersanddream ers.org/ Entity's Mailing Address r aV� Confirmation Your Form 990-N(e-Postcard) has been submitted to the IRS • Organization Name: WISHERS AND DREAMERS INC • EIN:471865187 • Tax Year: 2021 • Tax Year Start Date: 07-01-2021 • Tax Year End Date: 06-30-2022 • Submission ID: 10065620222445832521 • Filing Status Date: 09-01-2022 • Filing Status: Accepted MANAGE FORM 990-N SUBMISSIONS Home I a=ffiw-a202 l L.Qg2kd STATE OF CALIFORNIA RRF-1 me- n9nnol% DEPARTMENT OF JUSTICE PAGE 1 of 5W i a_ i. MAIL TO: R110W of Chahlable Trusts ANNUAL REGISTRATION RENEWAL FEE REPORT (For Registry Use Only) Sacramento, Sox 90'CAr94203-4a7D TO ATTORNEY GENERAL OF CALIFORNIA STREET ADDRESS: Sections 12586 and 12587, California Government Code 13001 street 11 Cal. Code Regs, sections $01.306, 309, 311, and 312 Sacramento, CA 95814 (916) 210.6400 Fallura to submit this report annually no later than four months and fifteen days after the end of the erganbartloMs accounting period may rasutt In the loss of talc exampdon and the assessment of a WEBSITE ADDRESS: minlmumux of $800, plus hftms%andrer lines or filing pesaltias. Revenue A To cation Coda section b28M1aag.ra,0otdthadpea 23703; Government Code section 12586.1. IRS extensions will be honomd, Check if: WISHERS AND DREAMERS INC. ❑Change of address ❑Amended Name o ganUgl on report List ail DBAa art names a organixalion uses or has vsed - 31915 RANCHO CALIFORNIA ROAD 4280-407 State Charity Registration Number 0252885 Addross umber a noet) TEI�EC[]LA CA 92591 Corporation or Organization No. 3709871 try or Iowa, Slat$ and1,17 coo (951) 764-1800 Federal Employer ID No. 47-1865187 okphono Num rE-mailAddress ANNUAL REGISTRATION RENEWAL FEE SCHEDULE (11 Cal. Code Regs. sections 301.307, 311, and 312) Make Check Payable to Department of Justice I.otalR venue Ele TSLtW Revenue Eta TQ1a Revanuq Ees Less than $50,000 $25 Between $250,001 and $1 million $100 Between $20,000,001 and $100 million $800 Between'$50,000ond $100,000 $50 Between $1,000,001 and $5 million $200 Between $100,000,001 and $500 million $1,000 Between 3100,001 and $250,000 $75 Between $5,000,001 and $20 million $400 Greater than $500 million $1,200 PART A — ACTIVITIES For your most recent full accounting period (beginning 7 /01/21 ending 6/30/22 ) list: Total Revenue $ (includironcash contributions) 7 630� Noncash Contributions $ 0 , Total Assets $ 8,457. Program Expenses $ 16,531. Total Expenses $ 26,215. PART E — STATEMENTS REGARDING ORGANIZATION DURING THE PERIOD OF THIS REPORT Note: All questions must be answered. If you answer 'yes! to any of the questions below, you must attach a separate page providing an explanation and details for each'yee response. Please review RRF-1 Instructions for information required. Yes Na 1 During this reporting period, were there any contracts, loans, leases or other financial transactions between the organization and any director Iruttoe thereof, ❑ K ❑ officer, of either directly or with an entity in which any such officer, director at trustee had any financial interest? 2 DurinTthis reporting period, was there any theft, embezzlement, diversion or misuse of the organization's charitable properly or funds? ❑ ❑ a 3 During this reporting period, were any organization funds used to pay any penalty, fine or Judgment? 4 Duriru; this reporting period, were the services of a commercial fundraiser, fundralsing counsel for charitable purposes, or commercial ❑ 0 cove&rirer used? 5 During,this reporting period, did the organization receive any governmental funding? ❑ a 6 During this reporting period, did the organization hold a raffle for charitable purposes? ❑ ' 7 Does'!he organization conduct a vehicle donation program? ❑ ❑X 8 Did the organization conduct an independent audit and prepare audited financial statements in accordance with for this ❑ generally accepted accounting principles reporting period? 9 At the end of this reporting period, did the organization hold restricted net assets, while reporting negative unrestricted net assets? ❑ I declare under penalty of perjury that I have examined this report, including accompanying documents, and to the best of my knowledge and belief, the contru correct and complete, and I am authorized to sign. E��7 PAMELA BABEK CEO V 3 2 gnature r Ihorlw pled ime T11!c Date CAEA9801L 01/26/22 TATE OF CALIFORNIA T•TRA ]rig, Q912017) , MAIL TOi Registry of Charitable Trusts ANNUAL TREASURER'S REPORT P.O. Box 903447 Sacramento, GA94203-4470 ATTORNEY GENERAL OF CALIFORNIA Section 12586, California Government Code STR EET ADDRESS: STR 11 Cal. Code Rags., Section 301 f Street Sacramento, CA 96014 (916)210-6400 (FORM CT-TR-1) WEBSITE AQ,DRESS: �a1A�QYdShRItItA9 WISHEI7S AND DREAMERS INC. Name of Organization 31915 RANCHO CALIFORNIA ROAD #200-407 Address (Number and Street) TEMECULA, CA 92591 City or Town, State and ZIP Code r ASSETS DEPARTMEW OF JUSTICE PAGe 1 of r Registry Use Only State Charity Registration Number 0262885 Corporation or Organization No. 3709871 Federal Employer I.D. No. 47-1865187 For annual accounting period ( beginning 07 1 01 1 2021 ending BALANCE SHEET Cash $ 6,307.00 Savings $ Investment $ LandlBuildings $ Other 4";ets $ 2.150.00 TOTAL ASSETS $ 8,457.00 REVENUE 06 1 30 12022 ) LIABILITIES Accounts Payable $ Salary Payable $ Other Liabilities $ I TOTAL LIABILITIES 1 $ 1 FUND BALANCE Total Assets less Total Liabilities $ 8,457.00 �l REVENUE STATEMENT EXPENSES Cash Contributions Noncash Contributions $ 7,629.00 $ T Program Revenue $ Investm+i°Its $ 1.00 Special Events $ Other Revenue $ TOTAL REVENUE $ 7,630.00 NET RE.10ENUE Total Revenue less Total Expenses $-18,585.00 Compensation of Offlcers/Dlrectors $ Compensation of Staff Fundraising Expenses Rent Utilities SupplieslPostage Insurance Other Expenses TOTAL EXPENSES $ $ $ $ $ 4.303.00 $ 1,925.00 $ 19,987.00 $ 26,215.00 hereby declare under penalty of perjury that I have examined this report, including accompanying documents, and, to the best of my knowledge rnd belief, the content Is tr e, correct and complete and I am authorix d to sign. gnature thorized Agent Printed Name Title date FY 2022/2023 COMMUNITY SERVICE FUNDING REINVESTMENT IN TEMECULA GRANT APPLICATION # 66 WOMEN ORGANIZING WOMEN INC. CITY OF TEMEC i J LA FISCAL YEAR 2022 - 2023 COMMUNITY SERVICE FUNDING - REINVESTMENT IN TEMECULA PROGRAM APPLICATION (Please Print or Type)N DUE ON OR BEFORE: MODAY, SEPTEMBER 12, 2022 PROJECT/PROGRAM INFORMATION I Amount Requested: $ $50,000 MAXIMUM ALLOWABLE: $50,000 PER ORGANIZATION Project/Program Title: the Lvd_;� prQjecs,Mp{EQ x;en soclal E��@gyp Start Date: 7/2/2022 End Date: N/A Physical Address of Project/Program: 41765 Rider Way, Temecula CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Women Organizing Women, Inc Mailing Address: PO Box 1382 Temecula CA 92593 I ORGANIZATION AND GEOGRAPHIC AREA SERVED I Name of Applicant Organization: Women Organizing0[ganizing Women Inc Year Founded: 2013 Website: wvvw,womenor anizin womeninc.or Social Media: Facebook: Women Organizing Women, Inc The Lydia Project Facebook Group: The Lydia Marketplace, Insta ram: Women Organizing Women Number of Paid Staff: 0 Number of Volunteers: 78 documented volunteers Geographic Area(s) the Organization Serves: Temecula, CA, Nationally, West Africa, and South India Geographic Area(s) the Project/Program Serves: Temecula, CA NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Contact Name: Robin McCoy Title/Position: President Contact Person's Direct Telephone: 951-676-8010 Contact Person's Email: womenorganizingl@gmail.com NONPROFIT STATUS Is this organization incorporated as a nonprofit? YesJQ Date of Incorporation as a Nonprofit: 10/28/2013 No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: 46-2236828 State Identification Number: C3508295 PRINT OUT AND ATTACH TO THIS APPLICATION VERIFICATION FROM FEDERAL (IRS) AND STATE (FTB) AS FOLLOWS: 1. [ 'Attach IRS Deductibility Status using this link: http //apps-irs., ov/applees/ 2. aAttach State Entity Status Letter using this link: https-://www.ftb,ca.-gov/online/self serve entity status lettedindex.asp 3. D�Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt :1/rct.do".ca. ovlVerificationiWehlsearch.asp facility - City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 5 of 13 FINANCIAL STATEMENTS UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGET/FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAYBE NEEDED UPON REQUEST TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. f FUNDING SOURCES CITY OF TEMECULA—SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM THE CITY FOR ANY PROGRAM? No ❑x Yes ❑ IF YES, PROVIDE BELOW - NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP I FUNDING RECEIVED OR SPONSORSHIP A OTHER OUTSIDE SOURCES —SINCE MARCH OF 2020, HAS THIS ORGANIZATION RECEIVED (OR IS CONCURRENTLY REQUESTING) ANY OTHER SOURCES OF FUNDING FROM ENTITIES (NOT INCLUDING THE CITY) FOR THE SAME PROJECTIPROGRAM IN THIS APPLICATION? No ❑ Yes © IF YES, PROVIDE INFORMATION IN TABLE BELOW. AMOUNT MONTH +YEAR RECEIVED NAME OF ENITY FUNDING RECEIVED $ 500 Indigo life Communications, Inc. July 2022 Women Organizing Women Fundraiser various donors $11775 g g ( ) July 2022 $10, 000 omen Organizing Women (Donor pledges for the next 4 �022 ept, Oct, Nov, Dec, months, $2500 per month) City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 7 of 13 2 DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED. ALSO, INCLUDE A LIST OF GOODS, EQUIPMEMENT, AND/OR SERVICES THIS ORGANIZATION HAS PURCHASED DR PLANS TO PURCHASE WITH AWARDED FUNDS TO SUPPORT THIS PROGRAM/PROJECT. Women Organizing Women will spend the grant funding on: Commercial Refrigerator $1949, Double deck Commercial oven $5699, Commercial fryer$ 1388.05 NSF 3 compartments sink 692.10, 40 gallons freshwater tank $173.99, 60-gallon grey water tank $356 Generator 1499, NSF hand sink $494.10, 6 burner countertop range $949, 4 burner griddle top $259, air conditioner $1350, 3 door prep refrigerator $2799, char broiler with 2 drawer $3019,2- countertop with backsplash $3942 6- pantry shelves $2099, Electric Bosch 7G water heater $1399.64, propane cylinder 401b $229, 2- service window $1546, 8'nsf etls hood with 1 exhaust fan and fire suppression system $5429, 32'inch rear door $1300, engineering and state licenses for build out $6500, storage fees for 1 year $3000, maintenance, supplies(pots and pans), and gas $8000 'Women Organizing Women is actively searching for the truck and plan to purchase this truck by the end of the year. PROJECT/PROGRAM DESCRIPTION CONTINUED SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS. omen Organizing Women, Inc is a faith base nonprofit organization that does not discriminate based on another rrson belief system. Food insecurities are real even in our beautiful city of Temecula where 7.6% of the population at poverty level. If we take the number of people at poverty level in the city of Temecula and divide that number the number of our volunteers, one volunteer would feed an additional 80 people in 1 year. If we partner with nonprofits who has the same objective, the impact will result to a city with no poverty. I had to summarize all the answers of 1 thru 3, the summary will read as follows: Lydia Project Mobile Kitchen Social Enterprise (1) creates jobs, (2) establish business partnerships, (3) inspire epreneurs, (4) works alongside other nonprofit organizations to satisfy mission initiatives and (5) The mobile ien Social Enterprise will help secure food sources to local families who are concerned about their next meal. 5 IF APPLYING FOR MORE THAN $5,000, PLEASE EXPLAIN HOW THE COVID-19 PANDEMIC AFFECTED THIS NONPROFIT ORGANIZATION'S ABILITY TO SERVE THE TEMECULA COMMUNITY. YOU MAY ALSO INCLUDE INFLATIONARY CONCERNS. affected Women Organizing Women, Inc ability to serve the community of Temecula was simply based on A the pandemic to interact with the public. Many volunteers did not feel safe engaging with the public of the consequence of contracting Covid-19. we were not able to have our annual fundraising events, Women Organizing Women stayed diligent in or those grieving and suffering from depression; provided grief counseling, connected virtually through !dia outlets, specifically, the Lydia Project Marketplace in continuing encouragement of women in business esting a variety.of strategies to sustain their businesses which will in turn sustain their households. )rganizing Women was also able to give 2 grants in 2021 both grants of $500 one for a Minority woman owner and the other grant was given to Women in the Military in the month of November for Veteran's Vomen Organizing Women inflationary concerns are for the families, small business owner, and nonprofit rganizations of Temecula. If the families in our community are stress about spending more money to stay above Later, then the small business owner and non-profit organization will not receive the business or donations from a ommunity that is stress and/or short on finances, this eliminates the community walking into businesses and/or ending a $20 donation towards an organization mission initiative. The Lydia Project Mobile Kitchen Social nterprise will be one vehicle in providing a food source to families, income to small businesses, and donations to nonprofit organizations. PROJECT/PROGRAM BUDGET (do not fill in shaded areas) LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES LIST REVENUES/INCOME FOR PROJECT/PROGRAM Amount of money requested from this City of Temecula $ 50,000 Community Services Grant (Not to exceed $50,000) Amount contributed to the Project/Program by the Applicant $10,000 Organization Other grants or funding already awarded for Project/Program if any I $12275 In -Kind match amount or volunteer credit hours estimated amount $18650 TOTAL REVENUE $90925 LIST OF EXPENSES FOR PROJECT/PROGRAM Tools/Equipment $36571.88 Facilities/Rent/Insurance $9999.96 Supplies $12000 Marketing $6000 Services $12000 Food � 14400 Other $9248 Staffing Expense THIS IS INELIGIBLE TO BE FUNDED BY CITY'S GRANT; $ 0 HOWEVER PLEASE INCLUDE. TOTAL EXPENSES $100,219.84 TOTAL BUDGET $90925 $100� ,219.84 City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 10 of 13 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201- Date: WOMEN ORGANIZING WOMEN INC 41911 5TH ST STB 100 TEMECULA, CA 92590 Dear Applicant: DEPARTMIMT OF THE TREASURY Employer Identification Number: 46-2236828 DLN: 17053060304043 Contact Person: DAVID AGUILERA ID# 75867 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170 (b) (1) (A) (i) Form 990 Required: No Effective Date of Exemption: September 18,2012 Contribution Deductibility: Yes Addendum Applies: No 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. Enclosure: Publication 4221-PC Sincerely, Director, Exempt Organizations Letter 947 (DO/CG) Form 990-N Electronic Notice (e-Postcard) OMB No. 1545-2085 Department of the Treasury for Tax -Exempt Organization not Required to File Form 990 or 990-EZ Internal Revenue Service A For the 2021 Calendar year, or tax year beginning 2021:t11.01 and ending 2021-1W B Check if available ❑ Terminated for Business Q Gross receipts are normally $50,000 or less E Website: www.wom uA[ganizingytomilinc.oro 2021 Open to Public Inspection C Name of Organization: iA[QMF.KQKWI2IKQ WQMEN,INC D Employee Identification PO Box 1302, inmacute, Cg, Number 46-ZZ2 68Zq Mfi, 92593 F Name of Principal Officer: Robin McCoy, 31976 Granville Drive, Winchester, CA-U.S, U115 Privacy Act and Paperwork Reduction Act Notice: We ask for the information on this form to carry out the Internal Revenue laws of the United States You are required to give us the information. We need It to ensure that you are complying with these laws_ The organization is not required to provide information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. The rules governing the confidentiality of the Form 990-N is covered in code section 6104. The time needed to complete and file this form and related schedules will vary depending on the individual circumstances. The estimated average times is 15 minutes. Note: This Image Is provided for your records only. Do Not mall this page to the IRS. The IRS will not accept this filing via paper. You must file your Form 990-N (e-Postcard) electronically. Regis tran t De .'airs EWIJLy type. C-orpoiclLe w; li':gis(.orco vAin o! fslai-- orhi)'icd or founfling P: r.,-(;[,J,xJ0T, Organization Name: WOMEN ORGANIZING WOMEN, INC. IRS FEIN: 462236828 Entity Type: Religious SOS/FTB Corporate/Organization Number: 350829:5) Registry Status: Exempt - Religious Renewal Due/Exp. Date: RCT Registration Number: Issue Date: 10/11/2012 Record Type: Charity Registration Effective Date: 10/11/2012 ,Date of Last Renewal: DBA: Mailing Address No address Information Correspondence No Related Documents ARmUai gene.' Dato No Annual Renewal Data Related Reg istr-c4t-Wns grant t Repo f hf,, ;;o RCT -J. No Related Records Item No. 14 CITY OF TEMECULA AGENDA REPORT TO: City Council FROM: Aaron Adams, City Manager DATE: November 15, 2022 SUBJECT: Receive and File the Recommended Updated Allocations from Community Reinvestment Program Funding (At the Request of Subcommittee Members Mayor Rahn and Council Member Edwards) ______________________________________________________________________________ PREPARED BY: Kevin Hawkins, Assistant City Manager RECOMMENDATION: That the City Council receive and file the recommended updated allocations from Community Reinvestment Program (CRP) Funding and provide general direction regarding the same. BACKGROUND: At the Strategic Fiscal Planning Ad Hoc Council Subcommittee (Mayor Rahn and Council Member Edwards) meeting on October 5, 2022, Staff provided the Subcommittee with the latest status update on allocated CRP funds. The City Council approved CRP funding allocations on March 8, 2022, in the following six categorical appropriations over the next two fiscal years (from the Community Reinvestment Fund): 1.Business Support $3,580,000 -Outdoor dining in Old Town ($2,000,000) Funds originally designed to assist restaurants within Old Town to develop dining parklets that meet the City’s aesthetic criteria, as well as ADA standards and pedestrian safety. Funding was subject to the approval of the City Council this Spring, to determine whether the Outdoor Dining program would be extended beyond June 30, 2022. The program was not extended, leaving a balance of $2,000,000 within the Community Reinvestment Program Fund for business support as part of the COVID-19 Pandemic Community Reinvestment Program. $1,500,000 was allocated for the Outdoor Dining Program in Old Town with the remaining $500,000 appropriated to launch comprehensive "way-finding" decorative signage throughout Old Town. This includes the development of a sign program and construction of decorative signs. Currently in design, these decorative way-finding signs are intended to help direct visitors to parking, restaurants, businesses, and civic facilities throughout Old Town. -Marketing campaign to increase local economy ($500,000). The City’s Office of Economic Development has partnered with the Small Business Development Center (SBDC) on bringing brick-and-mortar businesses into the digital world, through a program called “Main Street Digital”. This program will assist Temecula businesses in creating a digital presence learning to drive traffic through paid and non -paid advertising. Each business owner will be assigned an SBDC business consultant to assist them. Every quarter the SBDC will track and measure the success of each business owner as they deploy their marketing campaigns. The SBDC will track changes in sales, jobs created and increase in customer traffic. The funds will be used as grants for each business owner to pay for eligible expenses relating to the marketing digitalization of their business. The City will designate SBDC for implementation of the program and issuance of the $500,000 grant funds. The SBDC will work with each business to complete a W-9 and grant agreement. - General Business Grants ($1,000,000) The overall use of this grant is concentrated on providing Temecula local businesses with support for workforce and staffing needs. Multiple strategies will be deployed for this, which includes: $300,000 Externship Funding ($100k annually for three years): Business Grants will place and fund qualified workers into paid extemships with Temecula in the automotive, manufacturing, hospitality, construction, and non-profit sectors. This is an expansion of the Temecula Summer Youth Employment Program, which has successfully placed youth ages 16-24 with local businesses. This effort assists local businesses in also addressing the workforce gap and provide valuable training, mentorship, skills, and paid experience to local youth. - $180,000 Internship Funding ($60k annually for three years): This will expand the highly successful Internship program to support internal City operations and to provide local Temecula area youth with opportunities for learning and advancement. The funding will assist the City in placing paid interns in nearly all departments, including at the TVE2, the City's business resource center. Proposed $520,000 Business Support Grants (working on TVE2 Expansion to 2nd floor to create an Entrepreneurial Resource Center with ED regional partners; this grant program will be vetted thereafter with expanded partnerships at TVE2 for best program outcomes. - Rent waiver for businesses at the Temecula Valley Entrepreneur's Exchange ($80,000): To support the entrepreneurs of the Temecula Valley, the Office of Economic Development proposes to waive rent at the City's business incubator, the TVE2, for a timeframe of three years or until the $80,000 is expended. The rental waiver will apply to all existing and incoming incubator tenants that occupy the TVE2. The rent waiver expands the City's support of local entrepreneurs in the Temecula Valley and will be used to recruit prospective tenants. 2. Non -Profit Support $2,000,000 - Non-profit support grant funding will invest in the community and assist in recovery from the economic impacts of the global pandemic. The grant will aid local tax exempt 501(c)(3) nonprofit organizations with eligible programs/projects that serve Temecula residents in some of the following categories: families, youth, special needs, seniors, veterans, social service providers, the arts, and minorities (which includes cultural, ethnic, racial, or other distinct groups that experience a narrowing of opportunities in proportion to their total population). - A total of $2,000,000 appropriated for nonprofit support is proposed to be divided into two application rounds at $1,000,000 each. Round 1 will be in 2022 (with Community Services Funding Subcommittee — Schwank/Stewart) recommendations from the meeting of 10/25/22 and Round 2 will be in 2023. The application periods for both will be open from July through September. Applicants may request up to $50,000 for goods/services expended no earlier than March 20, 2020 (when the pandemic started) and no later than June 30, 2024. This grant will follow a similar policy currently used for the City's annual Community Service Funding (CSF) Grant, https://temeculaca.gov/440/Communiiy- Service-Funding-Grants in terms of general policy, funding philosophy, eligibility, guidelines, procedure, criteria, and compliance. Expenditures may be made prior to grant submission at the start of the pandemic when fundraising opportunities for nonprofits were bleak. In such cases, receipts shall be included with the application. Additionally, because of the large nature of possible grant awards, quotes/estimates will be requested to be included with the application for future purchases. In all cases, compliance requires the award applicant to substantiate all grant funds were spent with the approved purpose stated on the application. As noted, these applications will be vetted through the Community Service Subcommittee and brought to City Council for full approval. 3. Homeless Services $1,000,000 - This additional funding will assist staff in continuing to combat homelessness, mitigate encampment activity (including cleanups and fencing), provide outreach services and ongoing support to the Responsible Compassion partners. Staff recommended dividing this allocation roughly in half and funding approximately $500,000 in expanded outreach, prevention and diversion programs and other services, and $500,000 in infrastructure, primarily fencing. Fencing has been a key element in developing City infrastructure which discourages unwanted behavior such as trespassing and vandalism, so an additional investment in fencing will allow staff to install fencing in identified high -value areas along Temecula and Murrieta Creeks. 4. Housing Assistance $5,500,000 - Vine Creek Affordable Housing Project ($4,000,000) Funding to assist project in becoming competitive for tax -credit financing. This project will provide for 60-units of affordable housing with 12 units designated for families with special needs. Note: This funding was approved at the February 22, 2022, City Council Meeting. - Uptown Temecula Future Affordable Housing Project ($1,000,000) Funding designed to attract future affordable housing project in Uptown Temecula. - Residential Rehabilitation Grant Program ($500,000) Funding to be provided through Habitat for Humanity to low/moderate-income households to expedite the completion of critical home improvements, including those related to health and safety, the Americans with Disabilities Act, and specific needs of seniors. 5. Behavioral Health Services Support $1,000,000 - Funding to support Veterans, First Responders (police, fire, medical services) and other at - risk individuals as identified by the City's Homeless Outreach Team (comprised of Community Services and law enforcement personnel), typically associated with the City's at -risk youth and homeless population needing behavioral health services in the form of a Temecula Safe grant. The City will provide a grant to the Temecula Valley Hospital to assist veterans, first responders and the other at -risk homeless individuals that reside/work in Temecula needing behavioral health services, which would seek to cover the gap between insurance coverage and the cost of behavioral health care. The proposed grant amount would be from $5,000 - $25,000 per individual/family within the identified groups. The City's Quality of Life Master Plan prioritizes a core value of a healthy and livable city that will allow for adequate community benefit findings to support the aforementioned and not a for profit entity. 6. Hh!her Education/Workforce Development $1,000,000 CSUSM/MSJC community & business certificate programs $1,000,000: The City's Office of Economic Development proposes to continue to work alongside California State University San Marcos Temecula Campus and Mt. San Jacinto College Temecula Campus in fostering and creating a comprehensive higher education facility to benefit the residents and businesses of the Temecula Valley. The City is particularly interested in seeing CSUSM Temecula and MSJC Temecula continue to work together on the creation of accelerated degrees and certificate programs that are relevant and needed to help support the business and economic ecosystem in Riverside County, and to equip residents with the tools needed to secure quality employment. The recent completion of MSJC's Temecula Campus, which includes thousands of square feet of growth opportunity, makes it the perfect location for both campuses to grow and flourish in creating the next level of higher education. The City proposes that CSUSM Temecula and MSJC Temecula each receive $500,000 to be spent on completing the buildout of a collaborative higher education environment located at the newly opened Mt. San Jacinto College Temecula Campus. Additionally, at the recent Strategic Fiscal Planning Subcommittee meeting, representatives from Temecula Valley Hospital (TVH), CAL FIRE, and Riverside Sheriff's Office attended to provide background on possible options for allocating the Category S. Behavioral Health Services Support - $IM, which at the recommendation of this subcommittee, had previously been set aside by the City Council to address mental and behavioral health needs in the community. At the conclusion of the meeting, it was recommended that staff explore the reallocation of the discontinued Old Town Outdoor Dining program funding, which was budgeted at $1,500,000. Following powerful testimonials from Fire Chief Crater and RSO Capt. Hall on the need for additional focus, support, and resources for behavioral and mental health services in public safety, the Subcommittee concluded that CRP funding would make an immediate and significant impact for those public safety/first responders personnel assigned to Temecula. As such, with the concurrence of the Subcommittee, it is recommended that the Old Town Outdoor Dining allocation be reduced by $500,000 (from $1.5M to $1M), and reallocate the monies to CAL FIRE and RSO ($250,000 each) to support their direct -to -members mental health resources. Additionally, TVH requested to receive $575,000 annually for two years to provide mental health resources to veterans, first responders, and other at -risk populations upon the completion of their expansion in 2024. Prior to any additional consideration of funding reallocation, the Behavioral Health component prescribed to TVH was allocated at $1,000,000. The current TVH proposal exceeds that amount by $150,000. Staff recommends maintaining the $lM allocation to TVH at $500,000 annually for two years. The revised categories still total $14,080,000 (see attached). Previously, the Subcommittee entertained the following Old Town Outdoor Dining funding reallocation options: 1) Old Town Parklets (small gathering areas), 2) Vacant lot beautification, and 3) Enhancing Old Town Holiday lights/decorations. The recommended funding allocation still maintains an available balance of $1,000,000 to pursue those recommendations and/or other City Council considerations for overall community benefit, impact, and fiscal transparency. FISCAL IMPACT: It is anticipated that a total of $14,080,000 in community support grants will be appropriated from the Community Reinvestment Program Fund over the next two fiscal years, to assist in mitigating the economic impacts of the global pandemic. ATTACHMENT(S): COVID-19 Pandemic Community Reinvestment Program (CRP) Summary City of Temecula COVID-19 Pandemic Community Support Program Total Appropriation Recommendation 14,080,000 Appropriation Categories 1 Business Support 3,080,000 Previous Outdoor Dining Allocation 1,000,000 - Wayfinding Signs in Old Town 500,000 - Campaign to boost local economy ("Main Street Digital") 500,000 - General Business Grants 520,000 - Intership/Externship 480,000 -Waive Incubator Businesses' Rent 80,000 - Families/Youth - Veterans - Special needs - Minorities 2,000,000 - Social Service providers - The Arts - Seniors 3 Homeless Services 1,000,000 - Homeless Prevention/Diversion 500,000 - Fencing 500,000 4 Housing Assistance F - Affordable Housing (Vine Creek Project) - Affordable Housing Project (Uptown Temecula) - Residential Rehabilitation Grants > through Habitat for Humanity 5,500,000 4,000,000 1,000,000 500,000 5 Behavioral Health Services Support 1,500,000 TVH Behavioral Health Service Expansion - Veterans - First Responders (Public Safety, Medical) 1,000,000 Homeless Individuals/families - At -risk Youth Direct Support to First Responders - CAL FIRE Benevolent Fund 250,000 - RSO Direct Support 250,000 6 Higher Education/Workforce Development 1,000,000 - MSJC/CSUSM program expansion and campus 1,000,000 buildout ($500k to each institution) Item No. 15 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Luke Watson, Deputy City Manager DATE: November 15, 2022 SUBJECT: Approve Quality of Life Master Plan (At the Request of Subcommittee Members Mayor Rahn and Council Member Edwards) PREPARED BY: Matt Peters, Principal Planner RECOMMENDATION: That the City Council approve, in substantial form, the Quality of Life Master Plan 2040. BACKGROUND: The City's Quality of Life Master Plan (QLMP) was adopted during the Fall of 2011 and identified six Core Values including: 1. Healthy and Livable City; 2. Economic Prosperity; 3. A Safe and Prepared Community; 4. A Sustainable City; 5. Transportation Mobility and Connectivity; and 6. Accountable and Responsive City Government The initial version of the plan, referred to as QLMP 2030, reflected a 20-year planning period from 2010-2030. That document included specific goals; key accomplishments; key findings; metrics of progress; and strategic priorities. Since adoption of the plan, projects or programs proposed in the City's Capital Improvements Program (CIP) and Annual Operating Budget (AOB) were required to describe how they help achieve the goals and objectives of the Core Values. Performance indicators were reviewed annually by all departments for conformance with the City's Core Values and achievement of goals. Given the substantial progress made to implement the plan during the last several years, the General Plan Update Subcommittee at that time, consisted of Mayor Maryann Edwards and Mayor Pro -Tern Matt Rahn, decided it was time to update the QLMP to set the direction for the City over the next twenty years. It was also intended that the QLMP would provide the foundation for a comprehensive update to the City's General Plan using the Core Values as the organizing principles. Furthermore, the update includes the addition of a seventh Core Value, referred to as "Equity." Inclusion of the Equity Core Value is based on direction from the City Council through a Resolution passed on August 25, 2020 to implement three specific phases of the Race, Equity, Diversity, and Inclusion (REDI) initiative, which includes: 1) establishing a REDI Commission, 2) diversity training for City Staff, and 3) Equity Core Value in the QLMP. Citizens' Community Opinion Survey The first step in the process of updating the plan was to conduct a Citizen's Community Opinion Survey. The City regularly engages a third party to conduct community surveys of citizen satisfaction, priorities, and concerns on a variety of services that the City provides. The survey methodology combined mail and telephone recruiting strategies with online data collection to ensure accessibility and statistically reliable data sampling. The results of the survey were summarized for the Blue Ribbon Committee (BRC) at each meeting to inform the plan update and decision -making process. Blue Ribbon Committee (BRC) On April 19, 2021, the City Council appointed a Blue Ribbon Committee (BRC) to assist with the update to the QLMP. Like the first QLMP adopted in 2021, the BRC appointees represent diverse geographic, demographic, and economic interest of the City. The BRC included the following members: • General Plan Update Subcommittee; o Mayor Matt Rahn and o Councilmember Maryann Edwards; • A representative from each of the City's Commissions and Boards, including; o Public/Traffic Safety Commissioner David Matics; o Community Services Commissioner Kathy Sizemore; o Planning Commissioner Lanae Turley-Trejo; o Race/Equity/Diversity/Inclusion Commissioner Eric Faulkner; and o Old Town Local Review Board Member, Ross Jackson; and • Community Representatives; o Aaron Petroff, Social Work Action Group (SWAG) o Amy Minniear, representing the Special Needs Community o Brooke Nunn, Temecula Valley Chamber of Commerce o Carl Love, Local Historian o Darlene Wetton, Temecula Valley Hospital o Gary Oddi, Bike Temecula Valley Coalition (BTV) o Jacob Mejia, Pechanga Band of Luiseno Indians o Jeremy Brown, Mount San Jacinto College (MSJC) o Juan Carlos Duron, Optiforms o Karen Valdes, Temecula Valley Unified School District (TVUSD) o Kimberly Adams, Visit Temecula Valley (VTV) o Sandy Rosenstein, Interfaith Council o Chad Pelekai, Camp Pendleton o Scott Treadway, Rancho Christian Schools o Tammy Marine, Habitat for Humanity o Teri Biancardi, Sierra Club The BRC members played a vital role in the plan update. They held several meetings to review the Citizens' Community Opinion Survey results on topics related to each Core Value, consider new data on population and economic trends, and to discuss evolving issues and conditions in the City and surrounding region. Most importantly, they helped update the goals and objectives, and the Citizen's Priorities Timeline for the next twenty years. Public Outreach The QLMP 2040 update was developed through an extensive community outreach process, including three separate surveys. In addition to the Citizen's Community Opinion Survey, the City conducted another survey with questions focused on the goals and objectives in the QLMP. The QLMP survey was promoted on three major social media platforms, which resulted in over 800 responses. Results from the QLMP survey indicated a low number of responses from the youth and young adult demographic (ages 16-24) so a third survey was conducted, as well as a roundtable discussion with the City's Youth Advisory Committee (YAC). In addition to the three surveys, the City held four Saturday morning pop-up events at community events and nineteen publicly noticed meetings on the QLMP update, including two City Council workshops, and two online virtual workshops. The City also had a dedicated webpage Temeculaca.gov/QLMP where residents could learn more about the update, sign up for e-mail notifications, and watch video recordings of each BRC meeting. Equity Core Value As mentioned previously, the City Council adopted Resolution No.20-59, on August 25, 2020. This resolution is often referred to as the City's Race/Equity/Diversity/Inclusion Initiative. The Agenda Report associated with the Resolution presented on July 14, 2020, recommended incorporation of the core principles of the Race, Equity, and Leadership (REAL) program, developed by the National League of Cities, of which the City is a member (Exhibit A). City Staff and the QLMP Consultant held three meetings with the REDI Commission to develop the Equity Core Value. A Draft of the Equity Core Value was then presented to the BRC with background on the REDI Initiative provided by Director of Legislative Affairs/City Clerk Randi Johl, additional background about the process of developing the Equity Core Value was provided by REDI Commissioner, Eric Faulkner, and a pre-recorded video by Mayor Matt Rahn describing the City Council's perspective on including the Equity Core Value in the QLMP. Vision Statement The vision statement included in the QLMP 2040 update was based on input from BRC members, which focused on the themes of innovation, family, home, and small town character. The vision statement also utilized familiar references around City Hall. The statement "Old Traditions. New Opportunities." is on the City seal. The Council Chambers, named after former Councilmember Jeff Comerchero, pays homage to his often -referenced statement, "You never regret doing it right." And finally, City Staff often refer to our culture of doing things the "Temecula Way" in reference to collaborating with other departments and taking into consideration as much input as possible from local residents. All of these factors were combined, resulting in the following Vision Statement: With a deep understanding of our history, the City of Temecula is a community and culture on the move. We are dedicated to family, neighborhoods, economic prosperity, education, health, and safety. Focused on doing it right the first time, we continue to pursue the highest quality of life for all — something we call... "The Temecula Way. " Maior Themes Incorporated into the QLMP 2040 Update As a result of the community surveys, BRC meetings, and extensive public outreach, several themes became apparent for inclusion in the QLMP update. The major themes incorporated into include: A Focus on Safety; Creating Local Jobs and Providing Career Technical Education; Additional Youth Opportunities and Services; Increased Resiliency (as relates to infrastructure, the economy, natural resources, disaster planning and hazard mitigation); Preserving the Environment; Taking a Regional Approach to Address Traffic; Implementing Technology to Improve Service Delivery to Residents; working with Developers to Provide Attainable Housing; and Equity - including extensive community outreach and the removing barriers so all residents can participate in local government programs and activities. Meetings with Commissions and the General Plan Update Subcommittee City Staff and the consultant presented the Draft QLMP to the Public/Traffic Safety Commission on August 25, 2022, the Community Service Commission on October 10, 2022, the Race, Equity, Diversity, and Inclusion (REDI) Commission on October 13, 2022, and the Planning Commission on October 19, 2022. Staff recognized each commission representative on the BRC, answered questions, and recorded feedback. A summary of the meetings is included as Exhibit B. Staff Recommendation It is recommended that the City Council consider adopting the Quality of Life Master Plan 2040, in substantial form. The QLMP will be available on the City's website at Temeculaca.gov/QLMP once it has been approved and adopted. FISCAL IMPACT: There is no fiscal impact with this action. However, the QLMP and its implementation with all have an effect upon the City's Operating and Capital Improvement budgets in the coming years. ATTACHMENTS: 1. Quality of Life Master Plan 2040 2. Citizens' 20-year Priorities Timeline 3. Exhibit A - July 14, 2020 Agenda Report to City Council with subject: Receive Report on Race and Equity Efforts and Provide General Direction Regarding the Same 4. Exhibit B - Commissions Meetings summary D RAFT 10/21 DRAFT 10/21 Heart d Southern California wme cou-, © 2022 City of Temecula • TemeculaCA.gov QUALITY OF LIFE MASTER PLAN Lighting the Path to 2040 DRAFT 10/21 DRAFT 10/21 he QLM P Team THE BLUE RIBBON COMMITTEE TEMECULA CITY COUNCIL THE PROJECT TEAM uENaRrF� p ■coliEo /AB Ec O OEVEIOPMENi Ho MIcs M Gi DEFINITIONS Vision A statement describing Temecula's approach to sustaining a high quality of life enjoyed by its residents. Core Value A statement of the values that comprise Temecula's vision of its desired quality of life. Goals Outcomes the community desires to achieve in order to attain its desired quality of life. The City has overall goals, or aspirations, and also specific goals and objectives within each Core Value area. Performance Indicators Data points used to measure progress towards achieving Core Value goals. Strategic Priorities Projects to help implement the goals within each Core Value. The Quality of Life Master Plan A framework of goals and performance measures that the City uses in its planning and budgeting process. Each City Department sets annual service goals in the budgeting process and is measured against those goals during the following year's budget process. In addition, each project included in the Capital Improvement Program is aligned with the QLMP Core Values and must bejustified in terms of how it helps to achieve the Core Value objectives. CITY OF TEMECULA QLM TABLE OF CONTENTS OUR VISION 3 EXECUTIVE SUMMARY 5 CITIZENS' 20 YEAR PRIORITY TIMELINE 8 SETTING THE STAGE 9 1 A Safe and Prepared Community 15 • Transportation Mobility and Connectivity 21 3 Healthy and Livable City 27 4 Economic Prosperity 33 • A Sustainable and Resilient City 39 • Accountable and Responsive City Government 45 • Equity 51 i ❑z D RAFT 10/21 DRAFT 10/21 .14, . « ,. rid.+ . -•s With a deep understanding of our history, the City of Temecula is a community and culture on the move. We are dedicated to family, neighbor- GIs, economic prosperity, education, health, safety. Focused on doing it right the first we continue to pursue the highest quality e for all - something we call... E COLLECTING THE DATA FOR QLMP 2040 The Temecula Quality of Life Master Plan (QLMP) 2040 is a visionary and li document created to express the aspirations, ideals, and strategic priorities of the and community. This second edition continues the successful path established b} predecessors in 2009, when the City marked its 20-year incorporation anniversary A LOOK AT THE PAST During Temecula's first twenty years, City leaders and residents engaged in proactive community building that resulted in many significant accomplishments and a cherished, high quality of life. With vision, focus, planning, and follow-through, Temecula forged itself into a dynamic City and regional economic center for Southwest Riverside County. Throughout this transition Temecula retained its small town feel and character even in the midst of strong population and economic growth. Throughout the past ten years, the QLMP has been a very successful tool for City goal setting and project implementation. All City Departments maintain performance indicators based on the QLMP Core Values and all Capital Improvement Projects are evaluated in terms of their adherence to the QLMP values. The original QLMP was intended as a 20 year plan, but many of the goalsand project priorities havealreadybeen accomplished. City leaders, anticipating the larger general plan update, determined that this was an important opportunity to update the QLMP to help set the stage for that comprehensive planning process. The first and second editions of the QLMP are framed between a series of major economic and social disruptions. In 2009, the Great Recession resulted in one of the worst economic declines in United States history. In 2020, as the City embarke the QLMP update, the COVID-19 pandemic, in conjunction with a national social justice movement, culminated in historical socio- economic impacts that challenged basic health, cultural, and societal norms. Never one to shy away from a leadership role, the City and community engaged in difficult conversations and strategic actions to ensure a high quality of life for those who choose to live, work, visit, and play in Temecula. The City's commitment to strong fiscal stewardship and inclusiveness regardless of race, ethnicity, or ability, has helped the community navigate through the pandemic and emerge even stronger. With a renewed strength and resolve to maintain our local control and high quality of life, Temecula is dedicated to building a resilient capital and social infrastructure and community support network. COMMUNITY INPUT COMMUNITY SURVEY The City of Temecula regularly engages a third party to conduct community surveys of citizen satisfaction, priorities, and concerns on a variety of services that the City provides. Survey methodology combines mail and telephone recruiting strategies with online data collection to ensure accessibility and statistically reliable samples. The most recent survey was conducted in Spring 2021. The results of the survey for topics relevant to the QLMP are provided throughout this document. PUBLIC OUTREACH This update to the QLMP was developed through an extensive public outreach process and shaped by a Blue Ribbon Committee (BRC) appointed by the City Council. Similar to the first QLMP adopted in 2010, the Blue Ribbon Committee appoilntees represent diverse geographic, demographic, and economic interests of the City. The BRC held several meetings to review each Core Value, consider new data on population and economic trends, and to discuss evolving issues and conditions in Temecula that should be addressed in the updated QLMP. The QLMP process was supported by the consulting team of Applied Development Economics and Moore lacofano Goltsman, both California firms with extensive experience in long term strategic planning processes and community engagement. The project team conducted an online survey of residents which supplemented the True North Survey and provided com- munity input specifically on the QLMP Core Values and related issues. Other community outreach during the process included: • POP-UP EVENTS in which the team set up booths at community events and solicited input from event participants. • A DEDICATED PROJECT WEB PAGE where members of the public could learn more about the QLMP 2040, watch video recordings of each BRC meeting and stay engaged in the process. • PUBLIC WORKSHOPS to engage the community, conducted both in person and online. ❑5 ❑6 DRAFT 10/21 OUR 7 CORE VALUES Each Core Value contributes to our overall Quality of Life. The diagram below is the compass by which we measure the strength of our goals as we develop the Citizens' 20 Year Priorities Timeline to the right. EQUITY SAFE & PREPARED Equityvalues help remove COMMUNITY barriers to ensure opportunities Public safety is the foundation for all to prosper through data- of Temecula and the most driven decisions personalized to basic service for which the residents of the City. City is responsible. ACCOUNTABLE & RESPONSIVE CITY GOVERNMENT Meeting requisite health and public safety needs while )roactively seeking to enhance service delivery to the community and maintaining fiscal transparency and prudent stewardship of local resources. SUSTAINABLE ol RESILIENT CITI Sustainable City values plan for the future by me _ present needs without compromising the resources needed for future generations. ECONOMIC PROSPERITY A business -friendly local economy providing diverse opportunities to live, work and play in Temecula. TRANSPORTATION MOBILITY & CONNECTIVITY Transportation mobility, street maintenance and sanitation are basic but essential functions deemed highly important by residents. HEALTHY & LIVABLE CITY inities for parks, recreation, __.._ural arts, programs and events for civic engagement help to define the great quality of life in Temecula. See Attached Timeline Where We Are Going LOOKING TO THE FUTURE As the City grows, Temecula can expect to experience continued demographic change, as well as continued innovations in communications, transportation tech- nologies,and in the ways work, life, and even shopping are conducted. The next section highlights some of the "Drivers of Change" the City has identified in its planning. The City anticipates private development will add more than 4,000 housing units by2028, which will increase the population by more than 12,000 residents. Many of these units will be pedestrian oriented multi -family housing in locations close to amenities such as the Jefferson Avenue Corridor, Old Town, and the Promenade Mall. Well -planned developments help to meet a variety of resident needs while ensuring safety, providing smooth circulation, and offering access to the services, shopping and other amenities that are the foundation ofTemecula's high quality of life. DRIVERS OF CHANGE OVER THE NEXT 20 YEARS • Shifting demographics, with people over 65 the fastest growing population segment • Greater emphasis on health care delivery and mental health services • Increasingly diverse population in Temecula, with a wide range of needs for housing, employment, and services • Evolving family structure, with more multi - generational households as well as single parent and single senior households • Greater emphasis on active transportation (biking and walking) and a wider variety of transportation options, particularly electric and micro -mobility technologies • Variable work patterns • Evolving technology and increased internet access changing transportation systems and service delivery • Additional communication platforms and greater reliance on broadband infrastructure • Housing price pressure continuing to make it difficult for younger families and many local workersto stay in Temecula, increasing the need for smaller, less expensive (attainable) housing near amenities and services • Increasing effects of climate change, including extreme heat, wildfire risk and drought PARKS, RECREATION & OPEN SPACE ■ 41 fully -equipped parks - 320 acres of developed parkland ■ 99% of residents within 3 miles of open space, 54% within walking distance ■ 7,000+ acres of open space, 29% in the City ■ Eagle Soar Playground and Splash Pad. Safe and welcoming for children of all abilities ■ Annexed 4,200 acres of Santa Margarita Ecological Reserve (SMER) ■ Updated Community Services Master Plan ■ Created an Urban Forest Master Plan ■ 4 Pump Tracks creating an action sports destination 700 W1, a' , DIVERSE ECONOMY ■ 5,600 businesses and 62,000 jobs ■ Regional retail sector with over 4.5 million sq. ft. ■ Top 13%in California retail sales generation ■ Wine tourism drawing 3.1 million visitors annually and an economic engine in excess of $1.1 billion ■ Over 2,900 hotel rooms in the Temecula area ■ Pechanga Resort Casino ■ Vibrant and Historic Old Town destination r STATE OF THE ART CIVIC CENTER ■ LEED Certified ■ Convention space for community functions and meetings ■ Renewably - powered facility utilizing electricity from a solar project located in the Santa Margarita Ecological Reserve ■ Emergency Operations Center Our EDUCATION ■ School District test scores rank in Top 20%in CA ■ 23 elementary schools recognized as "Gold Ribbon Schools" since 1995 ■ Mt. San Jacinto College campus ■ CSU San Marcos Temecula campus ■ University of Redlands campus ■ Accredited vocational, technical, and trade schools Accomplishments ARTS & TRANSPORTATION CULTURE ■ $619.8 million ■ Old Town Theater in circulation with 354 seats improvements and The Merc planned between with 48 seats 2022-2026 ■ Award -winning ■ Future 17-mile Professor loop trail Pennypickle's ■ Old Town rated Children's "Very Walkable" ' Museum by Walk Score ■ Two public ■ 48 miles of trails libraries with and 74 miles of state of the art bike lanes, with a technology Bikeways and Trail ■ Temecula Valley Master Plan to add History Museum another 60 miles iz HEALTH & SAFETY ■ Temecula Valley Hospital opened in 2013 ■ Rated 16th in Public Safety nationwide ■ Response times at 5 minutes or less ■ Police Officer ratio more than 1 per 1,000 residents W GOVERNMENT SERVICES ■ Excellence in Capital Improvement Program and Annual Operating Budget Awards annually since incorporation in 1989 ■ 20% budget reserve and 5% secondary reserve ■ FY22-27 Capital Improvement Budget: $793.7M ■ FY22-23 Annual Operating Budget/ General Fund: $103.4M ■ 178 Full-time employees ■ Recreation and Community Service programs serving more than 18,000 annual participants ■ 1 Senior Center and 3 Community Centers with intergenerational programs Our Aspirations for 2040 ■ Continue to be one of the Safest Cities in the USA ■ Facilitating a comprehensive human services delivery system that meets diverse needs across all age groups ■ Recognized as a major "Destination" by the tourist and travel industry ■ Supporting the fair and equitable treatment of all human beings in ajust society ■ Renowned for its entrepreneurial and creative economy, providing more quality jobs close to home for residents ■ A City surrounded by unscarred natural terrain and bounded by the Escarpment and Wine Country, with pristine air quality ■ Home to an expanding hospital offering state of the art medical and mental health care services ■ Supportive of higher education, integrated with the Ca reer Tech n ica I Education (CTE) programs offered at the high school level ■ Afamily-oriented community with both a small town feel and urban amenities ■ A City that continues to maintain pristine landscaping at parks, along roadways and at public facilities ■ Protection of Wine Country from urban encroachment ■ A City where local history is cherished, celebrated, and protected ■ A City offering a healthy and active lifestyle for all, including seniors, vetera and those with special needs ■ A center of art, culture, heritage, and lif ong learning opportunities ■ Building a resilient community by mini izing impact to life, property, and the environ ent from natural or man-made hazards an emergency situations by maintaining a high level of emergency management planning, facilities and technology, inCIL ding coordination with regional partners ■ Creating a safer community to include Murrieta Creek flood control improvem nts that also include trails on both banks a a major sports complex within the detention basin ■ Aging commercial corridors revitalized into vibrant mixed use centers with a variety of housing types, access to transit, and urban amenities ■ An outdoor recreational environmental haven, with Temecula's trails fully integrated with trails in Wine Country, the City of Murrieta, and surrounding region ■ A model for fiscal stewardship of the Cit s assets, with opportunities for civic engag ment and volunteerism ■ A region I retail center offering higher -end shopping opportunities at the 2Lgmenade Mall and Old Town ■ A gre ation for housing choices for all ages, incomes and needs, including housing for families, singles, seniors, and those with special needs ■ A goldJel bicycle -friendly community as recogd by the League of American Bicyclists ■ Reco d as a major recreation center, offering competi ve and training sites in Southern Californi for aquatics, tennis, pickleball, and other sp its facilities in sustainability and resilience, including renewable energy, innovative storm water management, urban forest and green waste management, and fire safe hardening of the built environment ■ ACity with upgraded infrastructure, including enhanced connections from housing in the east to jobs in the west of Temecula, as well as improvements to 1-15 and additional interchanges ■ Avibrant, safe Old Town Temecula that preserves its charming historic appeal IF C " 161 131 rAchaw".1 S_ CORE VALUE--- _ _ �7 �11MjM1 WAM 9L TB IT IS IMPORTANT TO ADDRESS AND PREVENT BOTH THE REALITY AND PERCEPTION OF DISORDER WITHIN THE COMMUNITY. A safe community is one that has low crime rates; responsive police, fire and emergency services; safe routes of travel for pedestrians, and those on bikes; well -publicized emergency evacuation routes; well -maintained proper- ties and spaces; and a strong sense of community that enhances the perception and experience of safety and well-being. The City's approach to police protection continues to evolve to meet the ever - changing needs of its residents and businesses. The City has implemented Community Policing which provides for continuity in police personnel so they can build relationships with the neighborhoods they patrol. The City has established the Old Town Metro Team, which is comprised of dedicated deputies who provide added engagement with business owners, employees, visitors, and residents of the Old Town area. The deployment of the team helps improve enforcement efforts and enhance relationships with the community and visitors on a daily basis. I Resident importance to maintain low crime rate 939% . Resident satisfaction with Temecula's crime rate 79.6% Resident importance to provide r neighborhood police patrols Resident satisfaction with _ neighborhood police patrols 747% p + Resident satisfaction with enforcement of traffic laws Resident importance to provide fire 92.0% protection and prevention services Resident satisfaction with fire 96'S% protection and prevention services Resident importance to provide 95.6% emergency paramedic services Resident satisfaction with emergency 94.6% paramedic services 69.5% 15 D RAFT 10/21 D RAFT 10/21 Safe &Prepared Community The Old Town Metro Team is supported by Code Enforcement, Building and Safety, and Fire Inspection personnel, so health and safety issues can be addressed proactively. The City also participates in the Community Behavioral Health Assessment Team (CBAT) that includes social workers and mental health professiona Is. Avery effective Homeless Outreach Team (HOT) was created with the mission to connect homeless individuals with services as well as to enforce the law. Communities and residents also need to be well prepared for natural and other disasters, as wildfires in the region have shown, with effective emergency communications and response systems. The City has hired an Emergency Manager and plans to undertake the creation of a comprehensive Emergency Management Master Plan. Important elements of this planning process include upgrading the Emergency Operations center (EOC), establishing secondary/alternate EOCs, upgrading the technology used by the public safety communications system and establishing citywide Shelter in Place and Mass Evacuation Plans. In addition, training citizens to increase resiliency in case of emergency is an extremely effective strategy, and remains an ongoing priority for the Fire Department and the Office of Emergency Management. MEASURING DDQGPESS MEETS/EXCEEDS NEEDS INDICATOR ING ..IMPROVEMENT Police Protection (Source: City Data) Number of Police Officers: Goal is 1 officer per 1,000 residents "Progressing" is 0.90-0.99 per More than 1 officer 1,000 residents, and "Needs Improvement" is per 1,000 residents less than .90 officers per 1,000 residents Average response time for police for Priority I Crimes: Goal: 5 minutes or less "Progressing" 4.96 minutes average is 5-6 minutes response, and "Needs response time (2021) Improvement" is more than 6 minutes* PropertyViolent and FBI rating for Safest Cities in America: Goal: Be Data) Ranked 16th in the top ten; "Progressing" is 11-25 safest cities; safest city in "Needs Improvement" is 25+ safest cities America Number of violent crimes per100,000 residents: Goal: decreasing crimes more than 166 crimes per 2.5%; "Progressing" is no increase in crimes from population, from (0-2.5%); "Needs Improvement" is increase in 15% in 01 crimes more than 2.S% rea (3.5/o increase) Number of property crimes per100,000 2,,00 crimes per residents: Goal: decreasing crimes more than 100 down from 2.5%; "Progressing" is no increase in crimes 2,83834 in 2010 0-2.5%); "Needs Improvement" is increase in (7.3%decrealease) crimes morethan 5% *Priority Icalls are those which require immediate response, and there is no reason to believe that an immediate threat to life exists. MEASUPIPROGRESS. ..NEEDS INDICATOR ..IMPROVEMENT Fire Protection and Emergency Services (Source: City .- Effective response time for fire protection: Goals: 5 minutes or less, 90%+ of the time; 90% of response "Progressing " is 80-89% of the time; "Needs times (2021) Improvement" is less than 80% of the time Effective response time for ambulance, emergency services: Goals: 10 minutes or Less than 10 minutes less; "Progressing " is 10-12 minutes; "Needs Improvement" is > 12 minutes ISO Fire Insurance Rating: Goal: <3 ISO rating; "Progressing" is 3-3.5 ISO rating; "Needs 3.5 Rating Improvement" is 4+ ISO rating Emergency Preparedness (Source: City Data) Number of citizens trained in CPR, First Aid and healthcare provider CPR and Stop the Bleed program: Goal 850 per year; "Progressing" is 633 500-850 per year; "Needs Improvement" is <500 per year Number of citizens trained in Community Emergency Response Team Training (CERT): 139 Goal 175 per year; "Progressing " is 100-175 per year; "Needs Improvement" is <100 per year Number of new enrollees per year in the mass notification system: Goal: 7,000 (20%) households per year; "Progressing" is 3,500- 3,000 registrants 7,000 (10-20%); "Needs Improvement" is <3,500 (10%) Number of partnerships developed with key community stakeholders- public and private partners, non -profits, tribal government, community groups, faith -based organizations, and schools - to enhance emergency 7 preparedness, response and recovery within the City of Temecula. Goal=7-10, "Progressing" is 4-6; "Needs Improvement" is <4 Traff ic Safety Overall traffic safety for driving, cycling, (source: CA Off ice of Traff ic Safety) walking: CA Office of Traffic Safety rating for cities with 100,000-250,000 populations: Goal: Ranks #21 to rank in the top 10 cities; "Progressing" is in the top 11-20 cities; "Needs Improvement" is 20+ cities ranking Abatement (City Data) Graff iti Remove graffiti within 24 hours: Goal: 90% of the time; "Progressing" is 80-89% of the time; 95% "Needs Improvement" is 79% or less of the time 17 D RAFT 10/21 Safe &Prepared Community ■ Implemented community policing which provides for continuity in police personnel so they can build relationships with the neighborhoods they patrol ■ Established the Metro Team, which includes Sheriff's Deputies supported by Code Enforcement, Building and Safety, and Fire Inspection personnel so that crime prevention can be addressed in a proactive and holistic approach ■ Participation in the Community Behavioral Health Assessment Team (CBAT) that includes social workers and mental health professionals ■ Very effective Homeless Outreach Team (HOT) with the mission to connect homeless individuals with services as well as to gain compliance with the law ■ Purchased a new ladder truck in 2021 ■ Installed personal thermal imaging cameras for every seat on each of Temecula's fire engines and truck companies ■ Filled the Emergency Manager position to run the Office of Emergency Management ■ Expansion of Old Town Police Station ■ Renovations to Fire Station 84 located on Pauba Road. This renovation will include a new state of the art training facility to ensure our community is prepared ■ Over the next two years, complete an addition to Fire Station 73 to add two additional bays to store the Urban Search and Rescue (USAR) and medical squad/swift water rescue vehicle. This addition will also include adding a gym to the facility ■ Introduce new pre -planning programs and training tools for the Fire Department. The City of Temecula strives to be on the cutting edge on ways to respond to emergency incidents ■ Acquire Fire Station 12 from the State and update itto be a state ofthe art fire station that will continue to serve the Old Town area ■ A new fire training facility ■ Monitor need for a second ladder truck as highrise development intensifies ■ Continuous updates to Emergency Preparedness and Response Plans, and upgrades to technologies at the City's existing Emergency Operation Centers (EOCs) located at City Hall and the Library ■ Implement Emergency Preparedness Programs to train citizens to be prepared in case of an emergency ■ Wildfire Mitigation Fuel Management Program ■ Neighborhood and City Facility Fire Hardening Program DRAFT ICORE VALUE J L TRANSPORTATION MOBILITY & CONNECTIVITY means providing all residents with access to good jobs, housing choices and neighborhoods, quality schools and medical facilities, shopping, restaurants, recreation and the goods and services that make a city desirable and livable. Western Riverside County and the City of Temecula have grown rapidly over the past twenty years with high levels of population growth projected to continue. While local and regional policies emphasize development of more quality jobs within the Cityand region forTemecula'sresidents, many must commute to jobs elsewhere, including San Diego County. These factors lead to long commutes, traffic congestion, air pollution, and strains on work/life balance. Congestion and travel delay add up to significant costs in lost productivity for businesses and increased costs for both households and employers. Temecula is located at a major regional crossroads in Southern California, and much of the traffic through the City is not locally generated. The City must collaborate with regional partners, including both Riverside County and San Diego County to address regional traffic patterns and mitigations. Resident importance to maintain ° local streets and roads 94.1/o all Resident satisfaction with maintenance of local streets and 70.7% roads Resident satisfaction with efforts s <i to improve traffic circulation by improving roads, intersections, signal timing and other measures Resident importance of 80.7% coordinating traffic signals Resident satisfaction with 71.4% coordinating traffic signals Resident satisfaction with 94.6% emergency paramedic services 60.1 % 21 D RAFT 10/21 DRAFT Transportation M obi I ity&Connectivity IN THE TRUE NORTH SURVEY, residents expressed a strong desire to reduce traffic. In the upcoming General Plan Update, the City will adopt a new Circulation Element, whichwill providean opportunityto identify ways to better manage traffic throughout the City. In 2022, the City engaged in the development of a Local Road Safety Plan (LRSP) which is identifying high accident locations for both auto travel and bicycles/ pedestrians. The City is studying further ways to integrate technology into the local transportation system to improve traffic flow and provide a foundation for the potential transition to autonomous vehicles and other new forms of mobility. Resident importance to maintain Bike Trails, Pathways, Walkability ° 94.1/° local streets and roads Resident satisfaction with maintenance of local streets and 70.7% roads Resident importance of providing Transit local public transportation and 45.8% shuttle services Resident satisfaction with local public transportation and shuttle 73.2% services Rating of Make infrastructure Resident Spending Priorities (medium and high priorities) improvements to improve traffic 93.2% circulation Advocate to State, Federal Depts of Transportation to improve 91.7% traffic circulation on 1-15 Expand and improve the network of bicycling, pedestrian, 62.9% recreational trails Build additional park-n-ride lots for carpoolers 34.3% Encouragement of micro mobility options, e-bikes, and scooters, in addition to further implementation of the Bikeways and Trails Master Plan, will help reduce vehicle trips in some areas of town. As stated by members of the Blue Ribbon Committee, "Let's move people, not cars." Optionsto improvetransit connections as well ascreating newoptions such as light rail travel may be explored. PROGRESSMEASURING OUR INDICATOR MEETWEXCEEDS NEEDS .-IMPROVEMENT Local Streets and Roads Maintenance (Source: City Data) Goal: Ensure that 75% of City's lane miles meet or exceed PCI (Pavement 70% meet standards Condition Index) of70 Data)Transportation Congestion/Circulation (Source: City Goal: Ensure 85% of intersections along the roadway network defined by the V Circulation Element of the General Plan operate at Level of Service "D" or better Goal: Ensure 90%of the road segments along the roadway network defined by the Circulation Element of the General Plan operate at Level of Service "D" or better Bike Trails, Pathways & Walkability Goal: Complete 80 miles of Bike Lanes (Source: Temecula Bikeways and Trails Master Plan; 74 miles or 92.5% City Public Works) completed Goal: Complete 60 miles of 48 miles or 80% Multipurpose trails completed Goal: Maintain a "Very Walkable" rating for Old Town; 70-89 is a rating of "Very Rating: 78 Walkable" based on Walk Score Goal: Maintain a "Walkable" rating for Citywide average; 50-69 is a rating of "Walkable" based on Walk Score; less Rating: 29 than 50 is very car dependent Goal: A Gold Level Bicycle -Friendly Community; "Needs Improvement" is bronze; "Progressing" is silver; "Meets/ Bronze Exceed Goals" is gold Goal: Higher People for Bikes City Rating; "Needs Improvement" is 0-30; "Progressing" is 31-60; "Meets/Exceeds 28 Goals" is 61-80 Transit (Source: Riverside Transit Goal: Increase transit ridership by 5% 11.4% increase Agency) Goal: Increase inter -regional transit ridership by 5% 3.6%increase 23 ell DRAFT 10/21 Our Accomplishments _44 Our Strategic Objectives THE CITY AND REGIONAL AGENCIES ARE MAKING CONTINUAL INVESTMENT IN TRANSPORTATION INFRASTRUCTURE. MANY OF THE PROJECTS TAKE MULTIPLE YEARS TO COME TO FRUITION, AND COMPETITION FOR SCARCE FINANCIAL RESOURCES WILL BE A CHALLENGE 6 25 lopp"p—THE CITY'S TRANSPORTATION MOBILITY CONNECTIVITY GOALS FOR 2040 ADDRESS INFRASTRUCTURE, TRANSPORTATION SYSTEM BUILDING, SERVICE LEVELS AND JOB CREATION IN TEMECULA AND THE SURROUNDING AREA ,Q6i,Goals for 2040 ■ Maintain and improve our roadway network so that the flow of traffic is efficient ■ Promote job growth in Temecula and nearby areas to reduce commuting ■ Market the opportunities to work and shop locally to residents ■ Expand and enhance the transportation network by completing missing links with appropriately sized streets ■ Establish a connected pedestrian, bicycle and equestrian transportation system consistent with the Multi -use Trails and Bikeways Master Plan ■ Coordinate land use and transportation to create a balanced, modern and integrated transportation system ■ Increase transportation and mobility options ■ Develop a Complete Streets Policy document ■ Additional public Electric Vehicle (EV) charging stations CITY OF TEM ECVL QLMlli* HEALTHY & LIVABLE CITIES are characterized by high levels of civic pride, community engagement and a strong sense of place. Increasingly, livability and community health also are synonymous with sustainability. Maintaining health means not only having access to high quality health care, but also the facilities and services needed to maintain an active and healthy lifestyle, such as parks and trails. The completion of the Temecula Valley Hospital was a major goal of the QLMP 2010, and was accomplished early in the decade. A network of health services has Resident satisfaction with Overall Quality of Life Resident importance of providing senior services Resident satisfaction with senior services Resident importance of providing teen services Resident satisfaction with growth management and planning: commercial/ residential 87.6% DRAFT I developed and the hospital now has plans to expand, including a new Behavioral Health facility. The hospital is working to attract new doctors to serve the growing population and to provide an expanding range of services. A barrier that many employers experience is high housing costs in Temecula. Through its 6th cycle Housing Element and other programs, the City is striving to create more "Attainable Housing" in the community. This is housing that is affordable to working people so that workers can live close to their jobs in Temecula. 71.2% 81.7% 62.8% 79.7% 51.7% (Commercial) (Residential) DRAFT 10/21 DRAFT 10/21 e lithy & i b e City THE BLUE RIBBON COMMITTEE is especially cognizant of the importance of addressing mental health, and this QLMP includes a measure of mental health in Temecula from the Strategic Health Alliance Pursuing Equity or "SHAPE" Riverside County health surveys. The experience of the COVID pandemic certainly reinforced the critical importance of avenues for social interaction and entertainment, but it is evident in normal everyday life that the ability of a place to nurture its residents spirits as well as their material needs is an essential aspect of livability. The City's open spaces, libraries, museums, cultural and performance venues, places of worship, and entertainment spots provide a rich contribution to community lifethat is highly valued by its residents. COMMUNITY• PROGRESSING EXPECTATIONSTOPIC EXCEEDS OR OR IS A HIGH PRIORITYPRIORITY• Parks and Recreation Resident satisfaction with the variety of parks and recreation 90.8% facilities Education, Civic and Cultural Amenities Resident importance of providing cultural arts, public art, theater and museum ° 62.1/0 services Resident satisfaction with library services 90.5% Resident satisfaction with the quality of education of Temecula Valley Unified School 85.4% District For improved appearance Rating of Resident Spending Priorities of public infrastructure and 68.2% landscapes Expand Teen services and ° 68.4/0 programs Develop high quality arts, culture, history, and sporting 67.9% events and facilities Increase recreational programs 67.4% MEASU UR... . INDICATOR MEETSJEX EEDS PROGRESSING NEEDS Health indicators (Source: Strategic Health Alliance Pursuing Equity (SHAPE) Riverside County) Asthma (Goal: <8.4%; "Progressing" 8.4- 9.5%; "Needs Improvement" >9.5%) 8.5% Adults with Diabetes (Goal:10%; "Progressing" 10-13%; "Needs 7.5% Improvement" 13%+) Adults Who are Sedentary (Goal: 21.2%; "Progressing" 21.2-29.6%; "Needs 19.3% Improvement" >29.6) Poor Mental Health (Goa l:<13.2%;"Progressing" 13.2-16.1%; 13.3% "Needs Improvement">16.1%) Parks & Recreation (Source: Developed parklands: Goal: 5 acres per Community Services Master Plan; City Bike-Ped Counts) 1,000 residents; "Progressing" is 3.0- 4.9 acres per 1,000 residents; "Need 2.8 acres Improvement" is <3.0 acres per 1,000 residents) Accessible Parks: Percent of population within 15 minute walk of a neighborhood park: Goal: 85%; "Progressing" is 70-84%; ° 54/0 "Needs Improvement" is <70% Pedestrian Use of Trails: Goal: Increase; "Progressing" is steady level; "Needs Increasing Improvement" is a decrease Bicyclist Use of Trails Increase: Goal: Increase; "Progressing" is steady level; Increasing "Needs Improvement" is a decrease Arts, Culture & Lifelong Library Use: Goal: Circulation greater Learning (Source: TCSD facility participation counts) than 700,000; "Progressing" is Circulation between 500,000 and 699,000; "Needs 559,230 Circulation Improvement" is Circulation of499,000 or less Visit to City Museums: Goal: Increase; "Progressing" is steady level; "Needs Increasing Improvement" is a decrease Old Town Community Theater Ticket Sales: Goal: Increase; "Progressing" is steady level; "Needs Improvement" is a Increasing decrease L9 30 DRAFT 10/21 Our Accomplishments r rr _. all Our Strategic Objectives AT ITS CORE, RESIDENTS DESIRE THAT TEMECULA BE A PLACE WHERE THEY CAN LIVE THROUGH THE ARC OF THEIR ENTIRE LIVES, WITH HOUSING AND SERVICES FOR ALL AGES, INCOMES AND ABILITIES - A CITY THAT ALLOWS EACH RESIDENT TO LIVE LIFE TO THEIR FULLEST AND MOST SATISFYING POTENTIAL yy s � • 4 8 Sf'YRwr' 4 ' 1 ■ Support healthy and active lifestyles by promoting recreation programs, parks, trails and competitive facilities for swimming, tennis, soccer, baseball, basketball, and other sports, including action sports ■ Be a sustainable community that embraces residents' quality of life through protect-ing the natural environment, maintaining the City's fiscal stability, and supporting the community's health and equity ■ Be a diverse community that values and supports people of all ages, backgrounds, cultures, disabilities and religious beliefs ■ Provide accessible sports, recreational, cultural, health/therapeutic and community engagement facilities, programs and resources for all Temecula residents, including seniors, youth, families and those with special needs ■ Enhance Temecula's position as a regional medical center of excellence, offering advanced medical specialties and research facilities, and a sufficient ratio of physicians to residents ■ Value the growth of non-profit organizations, churches, temples, mosques, and other places of worship ■ Continue to be a community where local history is remembered and respected, and local culture and artistic creativity is supported ® 32 CITY OF TEMECULA QLM�w Economic Prosperity I -- - t` i r 1-4 Ix . tw .±c -. .r -� 1p, - •`� ti �`� y�.am.�, _ � - � - F. :; ' ..`J�- - .ti•� ti ate' rr�' lk r � FA W a LL a 2 Z O W D RAFT 10/21 D RA FT 10/21 Economic Prosperity TEMECULA'S RESIDENTS HAVE EXPRESSED A STRONG DESIRE TO BE ABLE TO LIVE AND WORK IN TEMECULA, and to have more diverse and well -paying jobs available. They also want their children to be able to find meaningful work and affordable housing so they too can live and work in Temecula as they become young adults. Echoing residents' concern for their children's future job opportunities, the Blue Ribbon Committee highlighted the need to foster the Career Technical Education (CTE) system in the community. Temecula was fortunate that Mt. San Jacinto College (MSJC) acquired the former Abbott office campus. The new MSJC Temecula campus has further expansion potential and opportunities to merge CTE curriculums at the high schools with MSJC programs to provide local students the opportunities to train for vocational jobs in Temecula. Further coordination with CSU San Marcos will also help to extend these workforce training and education opportunities to the four year degree level. The City is especially interested in fostering entrepreneurial opportunities. The Temecula Valley Entrepreneur's Exchange (TVE2) is a business incubator and regional resource center managed by the City's Economic Development Division that fosters business growth and economic vitality for entrepreneurs and early stage companies by providing access to low cost commercial space, technology, high quality resources, and leveraging a strong network of community partners located at the TVE2, including the Small Business Development Center (SBDC), the Economic Development Coalition (EDC), and Riverside County Workforce Development. Residents closely associate the presence of independent, locally -owned businesses with the City's cherished small town atmosphere and the TVE2 is actively supporting new start-up small businesses to succeed in Temecula. Temecula features a number of strong business sectors that offer a wide range of job opportunities, as well as help to support City revenues and high quality services. The biomedical cluster employs thousands in healthcare and manufacturing of medical devices. The tourism industry attracts sales exceeding $1.1 billion annually, anchored by the Pechanga Resort Casino, Old Town Temecula, and Temecula Valley Wine Country with more than 45 wineries, marketed through Visit Temecula Valley. The retail sector is especially strong, ranking Temecula in the top 13% sales tax generators in the State. The City has committed to growing these and other economic opportunities to benefit its residents, workforce, and sales tax revenue funds that support enhanced infrastructure and public safety in Temecula. Annual Employment Rate: Goal: 95%+; "progressing" is 93-95%; "Needs Improvement" is <93% Household Income: Goal: Annual Increase; "Progressing" is stable; "Needs Improvement" is annual decrease Housing Affordability Index: Goal: More than 65%for Riverside County Housing Options: Goal: 65% single family; "Progressing" is 66-75%; "Needs Improvement" is>75% Residential Building Permits: Goal: Increase Commercial Building Permits: Goal: Increase Vacancy Rates: Commercial Buildings (SW Riverside Region): Goal: <10%; "Progressing" is 10-15%; "Needs Improvement" is >15% Vacancy Rates: Industrial Buildings (SW Riverside Region): Goal: 5-7%; "Progressing" is 8-10%; "Needs Improvement" is >10%) Per Capita Sales Tax Goal: Be in the top 15% among State agencies; "Progressing" is in top 16-25%; "Needs Improvement" is > 25% of agencies 96% 1.5% increase 332% increase Ranking is 13% Hotel Occupancy Rates: Goal: 70%; "Progressing" is 50-69%; "Needs 67.5% Improvement" is <50%) Transient Occupancy Tax Revenues: Goal: >5% annual increase; "Progressing" is 1-5% 24% increase increase; "Needs Improvement" is annual Ldecrease 7Br,adb,rndcess for business: Goal: sing" is 70 99%; "Needs 80.0% pis <70% 33.0% 78.5% 21.5% decrease 1 15.7% (Office) 19.2% (Retail) 18.4% DRAFT 1( ■ Uptown Temecula Specific Plan ■ Opening of Mt. San Jacinto College Temecula Campus (MSJC), Cal State University San Marcos at Temecula, and the University of Redlands satellite campus ■ Selected as the US Small Business Administration's Community of Excellence recipient ■ Created and implemented workforce programs, including the City's intern program and an extern program that matches students with Temecula businesses ■ Launched and expanded TVE2 as the City's business resource center and business incubator for entrepreneurs and businesses to include the presence of the SBDC, EDC, and Riverside County Workforce providing tools and resources for a successful business ■ Launched and continue to grow annual college and vocational fair hosted at Promenade Temecula, which also supports retail sales ■ Produce new marketing materials and outreach campaigns each year to educate the community, promote existing Temecula businesses, and attract new companies to Temecula ■ Pursue long-term economic diversification for job creation ■ Support the retail sector's adaptation to a changing marketplace ■ Nurture small businesses and regionally unique commercial uses ■ Encourage development and activities that attract visitors and conventioneers ■ Cultivate an entrepreneurial and academic environment ■ Promote and protect the City's brand as "Southern California's Wine Country" ■ Continue implementation of Uptown Temecula for Jefferson Avenue area revitalization ■ Attract luxury hotels and a convention center ■ Support Old Town's revitalization as it evolves to protect its charm and historic appeal ■ Continue support of the Pechanga Tribe and their ongoing development of upscale luxury resort(s) and entertainment ■ Foster Career Technical Education in support of high school and MSJC curricula OR E V A L U E E 38 DRAFT CORE V A L U E • �' � 'S.$. is �� �� ..]F�� ,.s�SS� �A 9 Sustainability can be defined in ma ny ways. The fol lowi ng clef i n ition captures Temecula I s most commonly held concepts: A SUSTAINABLE COMMUNITY USES ITS RESOURCES TO MEET CURRENT NEEDS WHILE ENSURING THAT ADEQUATE RESOURCES ARE AVAILABLE FOR FUTURE GENERATIONS. IT SEEKS IMPROVED PUBLIC HEALTH AND BETTER QUALITY OF LIFE FOR ALL ITS RESIDENTS BY LIMITING WASTE, PREVENTING POLLUTION, MAXIMIZING CONSERVATION AND PROMOTING EFFICIENCY, AND DEVELOPING • ry K2 RESOURCES TO REVITALIZE THE LOCAL ECONOMY A SUSTAINABLE CITY is one that conducts its daily business and plans for the future dedicated to these principles and en- courages and promotes residents and businesses to adopt sustainable practices. A sustainable city also focuses on the inter- connectedness of three vital systems - a prosperous economy, a healthy environment, and an equitable community -"the three E's" Facing the increasing effects of climate change, communities are also becoming focused on the concept of resiliency, which is to harden the built environment, and creating more redundant and efficient backup systems for energy, communi- cations, banking, etc. when disasters occur. This concept is inherent in the City's efforts to prepare for emergencies as discussed in the Safe and Prepared Community Core Value, but it is also intrinsically connected to long term effortsto managethe incremental environmental effects of climate change. 39 D RAFT 10/21 DRAFT 1 Sustainable & Resilient City THE CITY WILL CREATE a Climate Action Plan (CAP), as required by state law, when it updates its General Plan in 2023-2025. The CAP will create a scientific baseline for Temecula of Greenhouse Gas (GHG) emissions and climate change risks. It will create metrics and adaptation strategies the community can use to reduce its impact on the environment. It is important to recognize the need for a commitment to adaptive management and a science -based approach to developing future strategies for both sustainability and resiliency. WHEN WE MEASURE OUR PROGRESS, we can see that the City has engaged in a number of actions to improve the efficiency of resource use and to protect environmental quality in the community. In addition, the City's municipal utility and service partners, including Southern California Edison, Rancho California Water District, Eastern Municipal Water District (EMWD), and CR&R Environmental Services (solid waste) have also imple- mented a number of sustainability and resiliency measures. The City can also coordinate with the many regional, state and federal agencies and organizations working on resiliency and environmental quality. Resident importance to provide reliable garbage and recycling 88.7% services Resident satisfaction with City's efforts to provide reliable garbage 91.5% and recycling services Open Space Resident importance to acquire 78 0% and protect open space Resident satisfaction with City efforts to acquire and protect 70.4% open space MEASURING. PROGRESS MEETS/EXCEEDS PROGRESSING NEEDS GOALSINDICATOR •. Air Quality (Source: South Coast . . Ozone: Maximum 8 hr. concentration in 0.091 (2020) ppm: Goal:.07 ppm; Progressing: <.085 Energy Use and Clean Energy Generation (Source: So. Cal. Edison and City .- City facilities energy usage baseline: Goal: V Decreasing Trend Community -wide energy usage baseline: Goal: Reduction per capita Kilowatts/megawatts of renewable energy generated: Goal: Increasing trend Open Space, Natural Habitat and Parks (Source: Community Services Master Plan) Preserved open space: Goal: 30% of City in parks and open space 29.0% Reduction (Source: 2010 State baseline of7.5 Ibs dailywaste City Data)Waste per person: Goal: Exceed State baseline 4.8 Ibs per person Consistent with SIB 1383, provide organics collection service to all residents and businesses Reduction/QualityWater Usage . Data) Community usage of potable water (non agricultural): Goal: Decrease in usage Down 27% City facilities baseline usage of water: A/ Goal: Decrease in usage Goal: Reduction of urban runoff - decrease Goal: Improved water quality in creeks A/ 41 DRAFT 1�/21 �R ;�a,;?�7�.,,�. � : � � . s r� . •.�` :Z y�y`'�e;�'� N , Vi .- �. �.: . ..4,;����r�;,"- ., ��„ s�t«�: _ "'°°�;�°° - Y 'ram . � • _ - � •-��' � mar � -Max- 7 Our Accomplishments Our Strategic Objectives MANY OF THE THINGS THAT RESIDENTS VALUE MOST ABOUT LIVING IN TEMECULA ARE DIRECTLY CONNECTED TO THE PRISTINE ENVIRONMENT; THE CITY'S PICTURESQUE VISTAS, OPEN SPACE, SURROUNDING MOUNTAINS, FRESH WATER, AND CLEAN AIR Our Goals for 2040 ■ Be the most sustainable city in Southern California - one that uses local resources effectively and efficiently; protects the City's residents and environment; develops a more diverse, green and competitive economy, and improves the livability and quality of life for all its residents ■ Ensure safe and sufficient water supplies for the 21st century, through continued conservation (reduced per capita use and recycling), infrastructure improvements, and protection of 100 year floodplains in their natural state ■ Work to maintain the City's high level of air quality possible in Temecula ■ Develop community resiliency in infrastructure, the economy, natural resources, and hazard mitigation ■ Adopt a Climate Action Plan (CAP) as part of the General Plan update and Environmental Impact Report (EIR) CITY OF TEM ECVL Qll-mlli* 5 H Z w_ J U1 LU a 06 LU J m Q Z H V) 44 FT 1 �\ccc r�-m L,� MEMNI 9k ,:,, ui:llul 16 BUILDING GREATNESS, MAINTAINING EXCELLENCE" TEMECULA RESIDENTS ARE DEEPLY ship. An accountable and responsive City COMMITTED TO THEIR COMMUNITY and government isonethatsetsastandardfor a reliable two-way communication effort excellence in the governance of the City. from their City government that provides It embodies leadership that is accessible information on issues vital to this relation- to residents, businesses and employees; PROGRESSING .• IS A NOT SATISFIED •OR .- IS A HIGH PRIORITY PRIORITY • - 1 ' 1 , Resident satisfaction with Quality Quality of Life 88% Resident satisfaction with municipal services 83% satisfaction with FlIes.ident munity facilities and 85% rams Resident satisfaction with the Waste Reduction services the City is providing 84.7% Resident importance of providing online access to City services, 75.0% information, and resources Resident satisfaction with providing online access to City services, information, and ° 85.6/° resources Resident satisfaction with the Community Involvement City's efforts to communicate with residents through 69.4% newsletters, the Internet, social media, and other means Resident importance of providing special events, Fourth of July 58.4% Parade, summer concerts 45 D RAFT 10/21 DRAFT 1 Accountable &Responsive City Government r transparent in its decision making; com- mitted to the effective and efficient delivery of services that the community most values; and is a steward of the City's human and fiscal resources. An accountable and responsive City govern- ment demonstrates a culture of servant leadership that helps the community navigate through change. It also provides an opportunity for residents to be engaged and involved in their community. In its 30+ years as a City, Temecula's City government, in partnership with residents, has set high standards for excellence and clear priorities that have made Temecula a great place to live, work and play. The City strives to balance these aspirations with the realities of resource constraints and competing demands, guided by deliberative processes that involve listening to the community, setting clear and achievable goals, making prudent investments, being adaptive to changing conditions, and assessing outcomes to improve future performance. CITY DEPARTMENTS REPORT ON MORE THAN 160 PERFORMANCE MEASURES tied to the QLMP Core Values in the annual City Operating Budget. The QLMP is integral to how the City organizes its work and views its mission. The indicators dashboard on the following page highlights some key performance measures related to fiscal policy, funding for desired service levels and citizen communications and involvement, which is also a key element of the Equity Core Value in the next section. THE CITY OPERATES UNDER A THEME OF "BUILDING GREATNESS, MAINTAINING EXCELLENCE." As the City builds out, the focus is increasingly on maintenance of facilities and service levels that meet the expectations of current residents. As shown in the 20 year project goals at the beginning of the QLMP, investments in technology and operating systems are critical to maintaining exceptional service standards while achieving high levels of governmental efficiency. Cost per capita of City operating budget: Goal: Maintain or reduce annual net per capita cost General Fund Reserve 25% I Sales tax per capita: Goal: Increase annually; "Needs Improvement" decrease annually 3.9% charge Transient Occupancy Tax: Goal: Increase 3.0% annually Registered voter turnout: Goal: 80%+ registered voters Participation in Boards, Commissions, Leadership activities: Goal: Increasing Number of public outreach messages, advisories, press releases or posts (in print or electronically) shared with the community daily on various platforms or delivery methods containing City education/ information: Goal:1,600; "Progressing" 1,200- �600; "Needs Improvement" <1,200 Increase in followers on City social media accounts: Goal: Facebook: 10%; Instagram: 20%; Twitter: 5% Number of Citywide social media posts: Goal: 2,300+ "Progressing" is 2,200-2,999; "Needs Improvement" is <2,000 86.7% V Instagram: 24% $938.46 1,460 Facebook:5% Twitter: 3% 2,200 Number of digital media communications, including Around and About Temecula, Park Adventure Scenes, Alumni Project, 23 etc. Goal: 25; "Progressing" is 20-25; "needs Improvement" is <20 Number of updates to Temecula Outreach Channel 3 and YouTube: Goal:100; "Progressing" is 75-99; "Needs 147 (2019 2020) Improvement" is <75 Ac Untable &Responsive City Government ■ Created a formal Asset Management Plan and dedicated accounts to maintain high quality amenities ■ Created irrevocable trusts for pension obligations ■ Implemented QLESS calendaring software which allows citizens to make appointments with City staff online ■ Achieved and maintained a CIS Top 20 rating for excellent cybersecurity protection of City systems ■ Created technology centers and extensive WIFI capability for the public at libraries, Old Town, parks and other City facilities, as well as locations in coordination with local schools ■ Numerous state -recognized awards for programs, planning, and special events ■ Developed a free City app to facilitate communication and input from residents ■ Significant social media presence on Facebook, Instagram, and Twitter to inform the community of City business ■ Significant long-term investments in digital capabilities, including permitting, remote work, and other related infrastructure that allows the City to be more flexible to workforce/ business needs Received yearly professional association awards for Annual Operating Budget, Capital Improvement Program Budget and Annual Comprehensive Financial Reports for past 30 years ■ Prioritize funding and support for maintaining a safe community as top priority ■ Sustain the asset management accounts to ensure the City has resources to replace capital assets as they reach the end of their useful I ives ■ Expand City use of paperless technology. Among other benefits, this will help facilitate electronic workflow management, greatly increasing efficiency ■ Maintain an exceptional work environment for City employees to help attract and retain high quality staff ■ Maintain staffing levels necessary to deliver desired service levels to residents ■ Build out the City's fiber optic network, not only to provide public broadband access but to help manage City facilities and equipment ■ Install Smart City technology to increase efficiency of service delivery ■ Continue to evolve social media outreach as technology changes CORE VALUE L9 so DRAFT P CORE VALUE ■ 0 AN EQUITABLE COMMUNITY IS ONE THAT LISTENS WITH EMPATHY, AND UNDERSTANDS WITH COMPASSION, that different barriers impact the lives of its residents in a variety of ways. To minimize these impacts and remove barriers, Temecula continues to build on our diverse and inclusive legacy with specifically tailored tools and resources that are provided to residents and businesses, thus ensuring that equitable opportunities (from housing and recreation to education and employment) are achievable for ALL members of the community. Social opportunity includes the ability to acknowledge and heal the struggles of O Residents importance of providing programs and services 73.2% to those with special needs Residents satisfaction with programs and services to those 86.0% with s pecial needs Community Involvement Provide for diversity, inclusion in events, services, programs, 59.3% policies Residents satisfaction with City efforts to provide for diversity, 70.6% inclusion in events, services, programs, policies Pating of Residents Expand programs and services to Spending Priorities (medium and high priorities) ° 70.7/° those with special needs D RAFT 10/21 DRAFT Equity individuals and families that have been historically or presently underrepresented in the community. Regardless of ethnicity, gender, ability or socio-economic status, Temecula continues to have heart. SUPPORT IS PROVIDED THROUGH ACC- ESSIBLE EDUCATIONAL PATHWAYS AND NEED -BASED ASSESSMENTS created with the full and inclusive participation of the diverse community. Once identified, inequity gaps are closed through appropriate resource allocation, enhanced programs, and service delivery. Policies are regularly reviewed and updated to ensure community satisfaction and a high quality of life remain at the forefront. An equitable environment fosters a sense of belonging through various cultural experiences and diversityofthought, where all individuals feel welcome, engaged, and part of the community. OUR PPOGPESSmAW GOALSMEASURING INDICATOR MEETS/EXCEEDS PROGRESSING NEEDS •• Fair and Equitable Treatment (source: CA EPA; HUD; City Data) CalEnvironScreen Composite Score: Goal: 25 or lower; "Progressing" is 26-35; 30.05 "Needs Improvement" is>35 Number of HUD identified racially or ethnically concentrated areas of 0 poverty (R/ECAPs) in the City: Goal: 0 Racial/Ethnic Dissimilarity Index: Goal: 39 or less; "Progressing" is 40-54; 19-26 (2010) "Needs Improvement" >54. Number of Certificates/ Proclamations/ Presentations recognizing community 168 contributions and Prosperous Number of Students in Youth in Environment (Source: City Data;Healthy Government: Goal: 21; "Progressing" is 21 15-20; "Need Improvement" is <15 Collaborate with Riverside County Law Library to offer law related classes to the public: Goal: 6; "Progressing" is 4-6; 4 "Needs Improvement" is <4 Equity is measured through and by the people. Inclusion isthe measurable goal. An equitable community reflects a high level of community engagement and participation. The key to accountability and the equitable delivery of programs and services lies in the specific and direct qualitative and quantitative data. An equitable community consistently collects and shares data with the residents it serves in a manner that is accessible and understandable. Number of nonprofit organizations funded through the Community Service funding and the City Council Grant Program: 25 Goal: 25+; "Progressing":15-24; "Needs Improvement" <15 Number of affordable (Extremely Low - Low Income) housing units constructed :Goal: 192* 64 per year; "Progressing" is 32-63; "Needs Improvement" is <32 PesourceData; Point in Time Homeless Survey) No. of community -wide special needs specific programs presented through TCSD 5 (12+; 8-11; <7) Number of special needs participants provided with swim lessons and water 66 safety programs: Goal: 90; "Progressing" is 50-90; "Needs Improvement" is <50 Human Service programs for at-riskyouth: Goal:32; "Progressing" is 25-32; "Needs 29 Improvement" is <28 Computer classes provided in the technology homework center at the Temecula Public Library: Goal:12; 12 (2021-2022) "Progressing" is 9-12; "Needs Improvement" is <8 Continue to fund and track homeless outreach services and participate in the annual Point -in -Time Survey. 59 in 2019; Targets in Goal: Reduce homeless numbers (PIT 2020: 40; 2021: 35 count); "Progressing" is Stable; "Needs Improvement" is increasing * The City has 192 units approved through Las Haciendas, Vine Creek and Rancho Las Bolsas. These projects are in various stages of financing and construction. ** The City is creating a web -based dashboard to measure and track progress of the indicators over time. New indicators will be incorporated into the web -based dashboard as better data sources become available. 53 54 E ■ Extensive community outreach from City Departments through multiple media channels ■ Formation of the Race, Equity, Diversity and Inclusion (REDI) Commission ■ Youth in Government and other Youth Intern/Extern, and vocational programs ■ Homeless Outreach Team (HOT) with focus on intervention and street -level outreach ■ Annual Pu'eska Mountain Day celebrating Pechanga )`j 0'J j j I'AT r ijA l 1 ■ Cultural Heritage Month and Culture Fest ■ Established Wi-Fi Gardens for all ■ Senior Center and shuttle services ■ Created a Human Services Division ■ Eagle Soar Park and Splash Pad with inclusion and special needs playground ■ Reduction of chronically homeless based on county -wide point -in -time surveys ■ Invested $1 million through COVID funds for behavioral health support ■ Friendship Park with inclusion and accessible play equipment for children of all abilities IN ALL THAT IT DOES, TEMECULA CONTINUOUSLY STRIVES TO BE AN EQUITABLE COMMUNITY FOR ALL ■ Implement all three phases of the Race, Equity, Diversity and Inclusion (REDI) Initiative: 1) REDI Commission 2) Diversity training 3) Equity Core Value in QLMP ■ Develop a web -based dashboard to help communicate with Temecula residents and track progress over time ■ Consider incorporating transportation insecurity questions into City survey efforts ■ Continued advocacy for under -represented groups ■ Work with private sector to develop attainable housing Lightlen �tn t�040 - AAF r� �` E..ria. - ti � .. .a .. _ >_ t . .•ram ��~ _. «� -� iL �r �,n L'f. Alt Y- r • • , �� '���� _ �y' � � a.Z ,', :��. '�r" �Y, `�•-�.I ..�' � � .� },: • i�• r ..- � r. _"-Y� r ..:.. _ i l�r r"k. ,.. �,� � • , � �� � >:� fib,. �ai{�; .x. ._ e�' � � _ , � � p.s.. ` .�, 3� _S•S, � � r s ` �,. •uy-' ►�,��• f 1'�If A i,� �` • ' - '.r :�. Y�� Akik IL Mv ULZ N -" 7 x e. A Y' D RAFT 10/21 0 aW Mz 0W _N 2 c N .-1--) U Setting the Stage .. 07. r - a, fit• •;v:j:��r';':i�cY••s,,i. S� ,. 'r':•'�..� ., ..� r . .... . = �4•.•ativt'':C�: •t+k��ri Fi`�?"?S`. ,,. .>,:.:t: � � . ...'�,_ ����, � ., . Where We Have Been Temecula grew from a small bedroom community to a regional center in its first 20 years, all the while maintaining a highly valued quality of life for its nearly 110,000 residents. Over the twelve years since the first QLMP was adopted, a number of systems have been put in place to protect and enhance the investments that were made during the City's early years. The QLMP has been incorporated into the City's Capital Improvement Program (CIP) budget and its Annual Operating Budget (AOB). Increasingly, the focus is to ensure that the City is able to maintain the highest quality of services for its residents and that it is building its resiliency against all types of potential future disruptions, including economic, health, and natural disasters. r91 L_J Renovate Skate Park at Ronald Reagan Sports Park * 41 Implement Comprehensive Community Policing Strategy (Metro, Core, etc.) 04 Expand Asset Management FOLD -OUT TIMELINE SIDE 2 k - "-. Old Town Creek Walk Landscape Enhancements New Pickleball Crtc * Ynez Road Widening north of Santiago Road * French Valley Parkway Interchange, Phase 2 *** System * aj Renovate In -line Hockey Rink at Ronald Reagan Sports Park* 4 Old Town Police Substation* Ifs � Build new Margarita Recreation Center Overland Bridge with Intergenerational Widening and Recreation extension over Programming * Murrieta Creek* Am Broadband Master Plan MS)C� Support Career Technical Education (CTE) Matching TVUSD Students to MSJC Programs and Local Business Needs *** IR Complete Renovations to Fire Stations 73 and 84 * 40 Stormwater Master Plan Ism General Plan Update * Develop a Digital Dashboard to Track Data and Measure Accomplishment of City Goals * Coordinate Acquisition of Fire Station 12 in Old Town* Implement Smart City Technology to Increase Efficiency and City Service Delivery * Establish a Transportation Task Force to address Regional Circulation Needs*** Temecula Valley Hospital Expansion ** ■ Partner to Promote and Build Attainable Housing *** Complete Fiber Optic Connections to City Facilities * Auxiliary Lanes Both Directions Nicolas Road On 1-15 * Extension * Mobile Library D-,-..—N/ *** Wineries/Hotel/Old Town Transit Line and ans A Emergency Management Master Plan * Park & Ride ** Jedediah Smith Road Roundabout* * City Development ** Private Development ***Public -Private Development or Multi -Public Agency Development NOTE: Timeline will change due to budget considerations and community priorities. Project placement on the timeline indicates approximate initiation/completion within a 5 to 10 year period, not the exact year it will take place. Climate Action Plan with Diaz Road Greenwayslnfrastructure Element Including Master Drainage Study, Trails and Bikeways, and Urban Forest Management Plan * - -_ 1-15 Gateway Monument* Murrieta Creek Bridge at Cherry, Connecting to French Valley Parkway *** Freeway Landscape Widening * Beautification *** Pen ovate/Upgrade Community Recreation Center (CRC), including Integrated * Watershed Old Town Parking Build Fire Training Western expanded Teen Room * Structures * *** *** Management Plan O Facility with Tower Bypass Corridor q A Expand City WIFI to Complete Temecula All Public Spaces* Loop Trail * General Plan Performing Arts Update * Center *** Organic Community New Tennis Complex*** Garden *** Aquatics Facility with Olympic -size Swimming Pool *** NOF South Side Senior Wildlife Crossing Center for Active Over 1-15 *** Adults * Complete Implementation of Old Town Specific Plan Building Greatness Maintaining Excellence C r Continued Implementation of Uptown Temecula Specific Plan * IV French Valley Parkway Interchange Phase 3 *** CITY OF TEMECULA AGENDA REPORT TO: City Council FROM: Aaron Adams, City Manager DATE: July 14, 2020 SUBJECT: Receive Report on Race and Equity Efforts and Provide General Direction Regarding the Same PREPARED BY: Randi Johl, Director of Legislative Affairs/City Clerk RECOMMENDATION: That the City Council receive the report on race and equity efforts and provide general direction regarding the same. BACKGROUND: On May 25, 2020, George Floyd, a 46-year old unarmed black man, was killed after being arrested by police in Minneapolis, Minnesota for possessing a counterfeit $20 bill. The nation watched in horror as video footage showed the police officer kneeling on Mr. Floyd's neck for approximately 8 minutes, while Mr. Floyd was repeatedly heard saying "I can't breathe". The deaths of George Floyd, Breonna Taylor, Ahmaud Arbery, Stephon Clark, Philando Castile, Tamir Rice, Michael Brown, Eric Garner, Trayvon Martin and many more, have led to nationwide protests and demands for police reform. Social justice organizations and legislators across the spectrum are renewing efforts to examine the issues of systemic racism in this country. Corporations and institutions are examining their own unconscious bias to understand where they fit in this narrative. Various chapters of Black Lives Matter are organizing community protests and meetings in their own cities. Friends and family are discussing race and equity at backyard barbeques and dinner tables. These important conversations are happening everywhere, including in the City of Temecula. Temecula, like other cities, is not immune from the challenges associated with racism. The local protests over the last several weeks, along with community meetings with local Black Lives Matter and faith leaders, have shined a light on that which was always present, even if it was not overt. Members of the community have shared their personal stories, their discriminatory experiences, and their powerful voices, in an effort to be heard and seen. Many of these voices are being shared for the first time by our residents. The City Council also shared their voices, individually with staff, each expressing a strong desire to address the needs of the community in this space and effectuate change. This agenda item, which includes numerous ideas and opportunities to bring about change, is being brought forward as a result of this collective dialogue. In an effort to succinctly group and describe the various ideas and opportunities presented, the core principles of the Race, Equity and Leadership (REAL) program developed by the National League of Cities, of which the City of Temecula is a member, have been applied. The program, created in 2014 in response to the Ferguson, Missouri unrest, is designed to strengthen the knowledge of local leaders to eliminate racial disparities, heal racial divisions and build more equitable communities. REAL subscribes to three core principles in order to have respectful and meaningful dialogue, as well as measurable long-standing results. While an in-depth review of REAL includes several details associated with each principle, generally the three principles are described as follows: 1. Normalize Conversations — This step has already started to some degree both internally at City Hall and externally in the community as described above. The broader concept associated with this step is to not only speak about race and equity openly in different settings, but to develop a shared understanding amongst stakeholders of common definitions and basic analysis. There is an urgency in this step to prioritize some conversation and action immediately. 2. Operationalize Actions — The broader concept associated with this step is to develop tools that will drive results to close the equity gap. Data is crucial in this step to help identify strategies that will yield the desired outcomes. 3. Organize Sustainable Effort — The broader concept associated with this step is to develop capacity to work intentionally on equity within in the organization through structure, policies and processes in an ongoing and routine manner. The ideas and opportunities that have been shared by the City Council and the community are categorized below based on these principles. A general description for each idea is also referenced for broader understanding and discussion only and does not represent a final determination of the idea or concept. The final determination is subject to City Council review, revision and approval. The ideas and opportunities presented are as follows: Phase 1 (Normalize the Conversation • City Council Engagement and Involvement — Each member of the City Council has indicated a desire to be fully engaged equally in the race and equity conversation internally and externally. As such, staff will continue to collaborate with each member individually or in pairs in a manner that is consistent with the Brown Act. • Resolution Supporting Unity and Racial Equity — This is a public declaration and formal stance of the City Council supporting unity amongst all races, ethnicities and cultures and denouncing all forms of hate and racism. Similar resolutions have been adopted by local governments across the nation. • Professional Assistance for Internal Training on Diversit/EquitX — This includes contracting with the National League of Cities REAL administrators (or other professional outlet) to provide diversity, inclusion, implicit bias, and race equity training to City employees, board and commission members and City Council. • Professional Assistance for Internal Training on Media Relations — This includes contracting with a professional outlet (i.e., professional firms identified and/or utilized by the League of California Cities) to provide public communication and media training to the executive staff and City Council. • Communication with Law Enforcement (Initial) — This includes initial conversations with law enforcement to develop an understanding of what the existing policies and procedures are for the Riverside Sheriff's Office in regards to the hiring and training of police officers, as well as community policing principles. A review of opportunities for improved communications between the City and the Sheriff's Department on incident awareness and community integration is also included. • Communication with CommunityInitial) — Understanding that internal training is a prerequisite to full engagement with the community, this includes opportunities for one- way listening and learning from the community. The primary example is the attendance of Council and/or staff at educational events and/or meetings organized by community groups that the City is invited to for the purposes of listening and learning. Phase 2 (Operationalize the Action): • Board or Commission — This includes an opportunity to create a citizen board or commission, similar to the existing board and commissions within the City, to advise the City Council on matters of diversity, inclusion, race, equity, etc. This group could be utilized for redistricting purposes as well. Given the important nature of this subject and Council's desire to equally participate, makeup could include an appointee by each Council Member from their respective district. • Professional Assistance for Community Dialog — This includes contracting with the National League of Cities REAL administrators (or other professional outlet) to facilitate conversations on diversity, inclusion, race and equity within the community. • Communication with Community On-oin — Understanding that internal training is a prerequisite to full engagement with the community, this includes opportunities for two- way dialogue between the City and the community on the topic of race, equity, and diversity. Opportunities to conduct this dialogue could include small group gatherings with interested persons, meetings with homeowner associations, coffee with council members in districts, etc. Law enforcement could also be incorporated into these gatherings. • Communication with Law Enforcement (Ongoing) — This includes ongoing conversations with law enforcement to build a stronger community policing model based on the overall needs of the City, the business community and individual residents. These conversations would also include opportunities to partner with the school district. • City Council Protocol Manual — This includes the creation of a City Council Protocol Manual, similar to those that are in place in other cities but specialized for Temecula. Contents could include rules of decorum, code of ethics, standards for communication, etc. The manual would serve as an orientation, education and accountability tool. • Citywide Policies and Programs — This includes a review of various citywide policies and programs (i.e., holiday recognitions, board and commission recruitments, internships, lighting city facilities, community service and block grant funding, etc.) to determine opportunities for additional diversity and inclusion of the underrepresented and minority population of the community. Phase 3 Organize the Sustainable Effort • Budget — This includes a refreshed budget process which includes the ability for additional public engagement utilizing new outreach methods, as well as internal Council and department considerations for spending priorities on public transportation, housing, and community services based on the needs of the underrepresented and minority population of the community. • Quality of Life Master Plan — This includes the addition of an equity value to the existing six values in the Quality of Life Master Plan (QLMP). The equity value would outwardly demonstrate the City's commitment to overall equity for residents of all racial, ethnic, and cultural backgrounds. An additional value of diversity and inclusion could also be considered during the QLMP process. As the values of the QLMP are tied to annual departmental goals in the budget, General Plan and Housing Element updates, Parks Master Plan, etc., the addition of these values and related effort will be sustainable. As previously stated, the above -referenced ideas and opportunities represent the collective dialogue of the City Council and community members to date. It is not meant to be an exhaustive list of solutions to the challenge before us, but rather a starting point for discussion and consensus. As additional ideas and opportunities are brought forward, they too will be brought to Council for consideration and consensus. Temecula has a solid foundation upon which it was built as a City and community, and these efforts will only further strengthen its collective resolve to represent all of its residents. It is therefore recommended that the City Council provide general direction to staff on whether it wishes to proceed with each idea or opportunity and share any general concept amendments. FISCAL IMPACT: There is no fiscal impact associated with the consideration of this item. Funding will be needed for professional assistance in the various areas of training and community dialogue as referenced above if and when those measures are implemented. ATTACHMENTS: None MEMO TO: Matt Peters FROM: Doug Svensson DATE: October 24, 2022 SUBJECT: Commission Comments on QLMP The following are questions and comments received from the Temecula Commissions on the QLMP. Public/Traffic Safety — August 25, 2022 ■ The Career Technical Education Center is a great recommendation. ■ Glad to see the Equity Core Value in the QLMP. ■ The QLMP mentions improving green waste recycling. Can it also include improved use of reclaimed and recycled water? Community Services — October 10, 2022 ■ Glad to see the goal of preserving open space. Can the City be more proactive in terms of acquiring open space to ensure its preservation? ■ Questions for clarification included size of survey sample (893 for QLMP survey; 923 for True North, whether core values are prioritized (no); approach to bike lane planning. ■ Glad to see Climate Action Plan included as well as a strong level of bike friendliness. Access to commercial services needs to go along with active transportation options and glad to see that included as a strategic initiative. REDI — October 13, 2022 ■ Strongly support inclusion of Equity core value. ■ Vision statement could reflect a stronger connection to equity by replacing all with every individual. Also, the traditional way of doing things is great, but don't lose sight of the fact that changes may be needed to meet future conditions. 3527 Mt. Diablo Blvd. #248, Lafayette, CA 94549 ■ Tel 925.934.8712 www.adeusa.com ■ "Equity gaps" may be better term than "inequity gaps." ■ Should resiliency include mention of distributed power grid? ■ Would like to see the City promote the core values among residents and provide annual updates to the commissions of the City's progress. ■ Digital access through a indicators dashboard would be a good way to connect residents to QLMP and REDI progress. Planning Commission — October 19, 2022 ■ "Attainable" housing is a great term. ■ It is important to post the QLMP on the website for the public to see ■ Kudos on the level of community engagement in the QLMP update process, particularly among youth. Youth mobility options and youth in government/internships are important topics to emphasize in the document. ■ In future update processes, should there be more direct representation of senior citizens? ■ The QLMP should perhaps emphasize the City's accomplishments more as well as the levels of citizen satisfaction documented in the survey results. ■ One commissioner questioned whether the Equity core value should be named "Advocacy" instead, which is maybe less divisive. However, another commissioner suggested that sounds too narrowly focused on legislative matters. Applied Development Economics I Page 2 REQUESTS TO SPEAK REQUEST TO SPEAK CITY OF TEMECULA Date: 2 Public Comment: Non -Agenda Item 1�f Agenda Item: ❑ Future Agenda Item ❑ Item Description or Item No. Request to Speak forms for Public Comments or items listed on the Consent Calendar may be submitted to the City Clerk 2EiqE to the City Council commencing the Public Comment period. 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