Agenda — Temecula City Council, November 15, 2022 (part 4 of 6)

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 [email protected]
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: [email protected]
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. [email protected] (951) 694-6413
Betsy. [email protected] (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.

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: [email protected]

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:/I www.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

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

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

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: [email protected]
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:

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.

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.

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:

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/[email protected]=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

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: [email protected] (951) 694-6413
[email protected] (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

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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.

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).

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
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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.,It www.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

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 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

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.

ORGANIZATION NAME: Oak Grove Center 0
MAILING ADDRESS: 24275 Jefferson Avenue PHONE: ( 951 ) 677-5599 Murrieta, CA 92562 EMAIL: [email protected]
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: [email protected] (951) 694-6413
Betsy. [email protected] (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).

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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: [email protected]

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

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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.

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: [email protected]
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:

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.

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).

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

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

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.

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

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

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

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: [email protected]
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:

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.

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
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 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: [email protected] 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:lf 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: 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.

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: [email protected]
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:

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Rotary Club Of Temecula Fa ndation

EIN: 33-0856109 1 Temecula, CA, United Stites
Pub 78 Data Copies of Returns
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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.

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

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

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 ends

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

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
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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 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

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: [email protected]
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:

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.

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).

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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:
[email protected]

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:ll 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 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

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

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

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.

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.

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

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.

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: [email protected] 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:

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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.

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:ll www.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

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

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

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:

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.

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

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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: [email protected]

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

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

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.

ORGANIZATION NAME: Smiles by Angels Foundation
MAILING ADDRESS: lrr-' Via NOrtada PHONE: (714 ) 32H2HH3 Temecula, CA 92590 EMAIL: [email protected]
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:

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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.

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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
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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: [email protected]

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

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 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: [email protected]
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: [email protected] (961) 694-6413
[email protected] (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.

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
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a
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(916)853-3516
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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: [email protected]

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

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

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

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 [email protected]
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:

��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.

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).

** 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: [email protected]

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

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

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: [email protected]
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:

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).

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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

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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
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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: [email protected]
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. [email protected] (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.

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:[email protected]

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

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

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.

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

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.

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.

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: [email protected]
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:

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

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—[email protected] 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:/1 www.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

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.

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:

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: [email protected]
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. [email protected] (951) 694-6413
[email protected] (951) 693-3959
City of Temecula Community Service Funding - Reinvestment in Temecula GRANT APPLICATION Page 13 of 13

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EIN: 33-04744301 Temecula, CA, United States
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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.

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).

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: [email protected]

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

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.

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:
[email protected]
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:

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.

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).

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

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

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.

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

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

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: [email protected] 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 [email protected] (951) 694-6413
Betsy. [email protected] (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.

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).

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

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.

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: [email protected]
Treasurer
DATE: September 11,2022
-v UN1 [4, 0AY, r-AR
SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 12, 2022, TO:

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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.

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).

32218IS
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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.
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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
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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
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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
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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.
----------------------
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----------------------
----------------------
----------------------
----------------------
----------------------
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$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

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

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.

Temecula City CouncilNovember 15, 2022

Temecula City Council
November 15, 2022