Agenda — Temecula City Council, October 28, 2025 (part 3 of 5)

FY 25/26 Community Service Funding (CSF)
Grant Application
10 DOMESTIC VIOLENCE

AND ABUSE PROTECTION

Aft
s Community Service Funding Application
(rke H—t of S—thc— CuIifo https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Applicant Organization Year Organization
Name: Founded:

Domestic Violence and Abuse 2021
Protection
Mailing Address:*
PO Bcx: 51
Contact Name:*
Jeffrey Lee
Contact Email:*
[email protected]
Number of Paid Staff:*
Website:
www.dvapriverside.org
Contact Title:*
Executive Director
Contact Phone:
951.275.8301
Number of Volunteers:*
10 Alternate Contact Name: Alternate Contact Email: Alternate Contact Phone:

Melissa Montoya [email protected]
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? South Riverside County
ko
A current City of Temecula Business
License may be required to submit prior to
fund disbursement.

Understand
Geographic Area(s) the Project/Program Serves:*
Temecula

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$S,000.00
MAX: $5,000 PER ORG
Start Date:*
2025-09-30
ProjectlProgram Title:*
Protection when restraining orders aren't enough
End Date:*
2026-06-01
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
3900 Orange St Riverside CA 92501
Make Check Payable to:*
Domestic Violence and Abuse Protection

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
State of California Entity ID:*
4784S96
To find CA Entity Status Letter,
click the link below:
https://www.ftb.ca.gov/help/business/entity-
status-letter.asp7VVT.mc_id=akBEStatus
IRS Employer Identification plumber (EIN):
87-2740988
To find IRS Deductibility Status,
click the link below.
https://a pps.irs.gov/a pp/eos/
Date of Incorporation:*
08/31 /2021
Attach State of California Entity Status Letter:*
Entity Status Ietter.pdf
Attach IRS Deductibility Status:*
IRS 501(C)(3) Approval Letter (1).pdf
Provide further verification as follows:*
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) Attach First Page of Most Recent Form 990*
You aright find IRS Form 990 DVAP 990.pdf
on the link below: (990, 990-EZ, 990-PF, 990-T)
https-//rc.t.doj.ca.gov/Verification/Web/Search.asp2L?
fac RMYY
"AWIM 4.1
386.37KB
282.93KB

Application Authorization
Has the organization or any members of the Board of ❑irectors 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?
ye' , N"
Is a Temecula City Council Member a member of the Board of ❑irectors ❑r an Officer of the ❑rganization?
Ye'4 R_-
This Application has been authorized by the organization's: * Executive Committee Board of Directors Members -at -Large

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* We provide "Protection when restraining orders aren't enough". We provide professional physical security at no cost to victims of violence, abuse and stalking from violated restraining orders. We also provide the same access to protection during court appearance with families and children, for example, Child Protective Services Court. In addition , we over watch the exchange during court mandated child visitation, to ensure a violent encounter or abduction does not occur. Process service is also part of our project for family law restraining orders, including cases (but not limited to ) involving children.

UPON REQUEST, COPIES OF THE ORGANIZATIOWS CURRENT BUDGETIFINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT MAY BE NEEDED TO Understand DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
ye,q k

NAME OF PROGRAM/PROJECT

FUNDED BY THE CITY GRANT

OR SPONSORSHIP
DVAP Protection
AMOUNT:*
$5,000.00
MONTH +YEAR FUNDING

RECEIVED
20 March 2S

NAME OF CITY GRANTOR

SPONSORSHIP
24/25 CSF

Project/Program Description

RECEIPTSIINVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE Understand PROJECTIPROGRAM AS DESCRIBED HERE.

Project/Program Title: Protection when restraining orders aren't enough

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* DVAP Protection Temecula Grant will fund Court accompaniment cases. The service of process of restraining orders, and protection operations within the City of Temecula. Child exchange over watch Operations =that occur within the City of Temecula.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

The funding will provide for Protection Operators to be onsite with victims of domestic violence when restraining orders are violated. It will also provide Operators to accompany individuals to court jurisdiction of Temecula residence requiring protection from threat and/or intimidation. Temecula Grant Funding will also allow Operators to Process restraining orders originating from the City of Temecula. We will connect with survivors/victims through our partnership with SAFE Family Justice Center also located in Temecula which we occupy office space.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

IN addition nto our partnership with SAFE FamilyJustice Center, Temecula residence can access our services for protection of violence, stalking and intimidation. We proudly serve the community we are now a part of.
3h. ESTIMATED NUMBER OF PEOPLE FROM 3C. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJECT/PROGRAM:

PROJECT/PROGRAM:

ER
"2

4. SUMMARY STATEMENT— SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* Domestic Violence and Abuse Protection is a unique and first of its kind solution to violated restraining orders. We provide protection during the critical gap of time between when the court orders protection and when police arrive. This and other services are at no cost to the victim/survivor.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $ 5, 000.0 0
*
Amount contributed to the Project/Program by the Applicant Organization $0.00
*
Other grants or funding already awarded for Project/Program, if any $100,000.00
Doyle Foundtion
*
In -Kind match amount or volunteer credit hours estimated amount $0.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment* EXPENSES*
NIA $0.00
Facilities/Re ntll nsuira nce *
NIA $0.00
*
Supplies*
$0.00
NIA
*
Services*
DVAP Contracted Operators $5,000.00
*
Food*
NIA $0.00
*
Other (i.e. Marketing, etc)*
$0.00
NIA
*
Staffing Expense
$0.00
TOTAL REVENUE: TOTAL EXPENSES
$105,000.00 $5,000.00

Compliance
If your organization is awarded a Community Service Funding Grant in Fiscal Year 2025-2026 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2025, and June 30, 2026.

In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds.

To substantiate that Fiscal Year 2025-2026 funds received from the City were spent appropriately, proper back-up documentation including the report (in the link below) with accompanying receipts/paid invoices, must be submitted to the City on or before due date: Monday, September 14, 2026.

Compliance Expenditure Report Form
have read and understand the above policy that if this organization is awarded a Community Service Funding Grant in FY 2025-2026 by the City of Temecula, a compliance expenditure report is due by Monday, September 14, 2026.

CHECK THE BOX TO CONFIRM
Confirm

Acknowledgement/Signature
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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
Domestic Violence and Abuse Protection
President/Authorized Officer Name:*
Melissa Montoya
E-mail:*
Mel [email protected]
President/Authorized Officer Signature*
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
President
Phone:*
951.27S.8301
Submission Date:
2025-09-12 11:56:47 AM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

IF DIFFERENT THAN ABOVE, APPLICATION PREPARED BY:

Melissa Montoya President Domestic Violence and Abuse Protection Name, Title, & Organization
If you have any questions, please contact: [email protected] (951 ) 693-3959 or [email protected] (951) 694-6413

raDepartment of the Treasury
Internal Revenue Servicee
Tax Exempt and Government Entities
I P.Q. Box 2508
Cincinnati, OH 45201

DOMESTIC VIOLENCE AND ABUSE

PROTECTION INC
3681 SUNNYSIDE DRIVE 2704
RIVERSIDE, CA 92516
Dear Applicant:

Date:
12/01 /2021
Employer ID number:
87-2740988
Person to contact:

Name: Peter Orlett
ID number: 31436
Telephone: (877) 829-5500
Accounting period ending:

June 30
Public charity status:
170(b)(1)(A)(vi)
Form 9901990-1-Z! 990-N required:

Yes
Effective date of exemption:

August 31; 2021 -
Contribution deductibility:

Yes
Addendum applies:

No
DLN:
26053666004171
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 addenda n applies, the enclosed addendum is an integral part of this letter.

For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities .

Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements.

Sincerely,
Stephen A. Martin
Director, Exempt Organizations
Rulings and Agreements
Letter 947 (Rev. 2-2020)
Catalog Number 35152P

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 9/9/2025
ESL ID: 1703986117
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: 4784596
Entity Name: DOMESTIC VIOLENCE AND ABUSE PROTECTION, INC. 1 1

1. The entity is in good standing with the Franchise Tax Board. 0 2.

The entity is not in good standing with the Franchise Tax Board. ❑

3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . ©

4. We do not have current information about the entity. ❑

5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

Important Information
This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body.

If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1).

The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

Connect With Us
Web: ftb.ca.gov
Phone: 800-852-5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-845-6500 from outside the United States
California
Relay Service: 711 or 800-735-2929 (For persons with hearing or speech impairments) FTB 4263A WEB (REV 12-2019)

SEp:oF--T STATE OF CALIFORNIA
Office of the Secretary of State
w
m` STATEMENT OF INFORMATION
o;

Entity No. 4784596
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
3900 ORANGE STREET
RIVERSIDE, CA 92501
PO BOX 51
RIVERSIDE, CA 92502-0510

JEFFREY LEE
Officer Name
Officer Address
Position(s)
WAYNE S. MCPHERSON
3900 ORANGE STREET
Chief Financial Officer
RIVERSIDE, CA 92501

TRISHA WOOD
3900 ORANGE STREET
Secretary
RIVERSIDE, CA 92501

MELISSA MONTOYA
3900 ORANGE STREET
Chief Executive Officer
RIVERSIDE, CA 92501
Additional Officers
Officer Name Officer Address Position Stated Position
None Entered
Agent for Service of Process
Agent Name WAYNE MCPHERSON
Agent Address 710 BROOKSIDE AVENUE SUITE 7
REDLANDS, CA 92373
Email Notifications
Opt -in Email Notifications No, I do NOT want to receive entity notifications via email. I prefer notifications by USPS mail.

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

WAYNE S. MCPHERSON
Signature
0811112025
Date

Page 1 of 1 ends

FY 25/26 Community Service Funding (CSF)
Grant Application
11 EMPTY CRADLE

as Community Service Funding Application
R
�rke Hc.ar t aF So u t her n Cut. Foma
Wines Country
Organization
https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Applicant Organization
Name:

Empty Cradle
Mailing Address:*
31938 Temecula Pkwy Ste A
#385, Temecula, CA 92592
Contact Name:*
Rachel Redhouse
Contact Email:*
rache I @em ptycrad le.o rg
Year Organization
* Founded:
1982
Number of Paid Staff:*
0 Website:
* EmptyCradle.org
Contact Title:*
Director
Contact Phone:
6194025741
Number of Volunteers:*
65 Alternate Contact Name: Alternate Contact Email: Alternate Contact Phone:

Ysabella Carson [email protected]
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? Riverside County & San Diego County Business License No.*
058507
Copy of Business License*
Empty Cradle Temecula Business License 2025.p
df
https://css.temeculaca.gov

94.69iCB
*
Geographic Area(s) the Project/Program Serves:*
Temecula

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$5,000.00
MAX: $5,000 PER L RG
Start Date:*
2025-01-01
ProjectlProgram Title:*
Empty Cradle
End Date:*
2025-12-31
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
various- Temecula
Make Check Payable to:*
Empty Cradle

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
IRS Employer Identification Number (ElN):
330421466
To find IRS Deductibility Status,
click the link below:
https://apps.irs.gov/app/eos/
Provide further verification as follows:*
Date of Incorporation:*
07/09/2012
Attach IRS Deductibility Status:*
EC_N oti ce_of_Tax_Exe m pt_Status.pdf
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) State Registry search Tool: Attach State Registry Documentllnfo*

63.85KB
https://rct.doj.ca.govNerification/Web/Search.aspx ? State Registry Info Details- Empty Cradle.pdf 86.93KB facility=Y

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* Empty Cradle is a nonprofit organization dedicated to supporting families in Southern California who have experienced the heartbreaking loss of a baby through miscarriage, TFMR, stillbirth, infant death, SIDS, or SUIT. Our mission is to provide compassionate care and connection through a resource parent network, monthly support meetings, written materials, remembrance events, memory boxes and care packages, financial assistance for burial and cremation, and collaboration with the health care community.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
Yes k

Project/Program Description
RECEIPTSIINVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE _ ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE Understand PROJECTIPROGRAM AS DESCRIBED HERE.

Project/Program Title: Empty Cradle

1. ❑ESCRIBE THE PROJECTIPROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* Year-round programs that support local bereaved families, including our Memorial Garden Project, Care Package and Memory Box Program, and our newest initiative —the Memory Cart Project

2. ❑ESCRIBE HOW THE ORGANIZATION WILL SPEN❑ THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

Funds will help replenish supplies for our Care Package Program, including 200 memory boxes, 50 miscarriage care bags, and 100 sibling backpacks, all provided to newly bereaved families. Support will also go toward our newest initiative —the Memory Cart Project —which equips hospitals with rolling carts and supplies so families can create precious keepsakes after the loss of their baby. In addition, funds will be used to enhance our local Memorial and Rock Garden with new plants, remembrance rocks, and art supplies, offering families a meaningful place of reflection and remembrance

3. EXPLAIN HOW 'THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAMIPROJECT IF AWARDED CITY FUNDING.

One in four families will experience pregnancy or infant loss —impacting more than 13,000 women in Temecula alone, many of whom face multiple losses. As private donations and funding decline, our commitment remains strong: to provide free support services, remembrance opportunities and events, and vital education for the healthcare community. At the same time, the cost of supplying bereaved families and hospitals with remembrance items and care packages has risen by nearly 30%. 3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJECTIPROGRAM:

PROJECTIPROGRAM:
750

4. SUMMARY STATEMENT— SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* Empty Cradle supports bereaved families through care packages, remembrance opportunities, a memorial garden, and our new Memory Cart Project in hospitals. With rising costs and declining donations, funds are needed to sustain free services, remembrance opportunities, and healthcare education for the 1 in 4 families impacted by pregnancy or infant loss.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to page2) $5 000.00
*
Amount contributed to the Project/Program by the Applicant Organization $5,975.00
*
Other grants or funding already awarded for Project/Program, if any $0.00
*
In -Kind match amount or volunteer credit hours estimated amount $0.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equiipment* EXPENSES*
Gardening Equipment $475.00
*
Faciliities/Rentflnsurance *
nla $0.00
*
Supplies*
Care package supplies, cart supplies, plants, rocks, ground cover $10,500.00 *
Services*
nla $0.00
*
Food*
nla $0.00
Other (i.e. Marketing, etc)*
*
$0.00
nla
*
Staffing Expense
$0.00
TOTAL REVENUE: TOTAL EXPENSES
$10,975.00 $10,975.00

CHECK THE BOX TO CONFIRM
Confirm

Acknowledgement/Signature
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 50 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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
Empty Cradle
President/Authorized Officer Name:*
Rachel Redhouse
E-mail:*
[email protected]
President/Authorized Officer Signature*
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
Director
Phone:*
5194025741
Submission Date:
2025-09-13 04:40:35 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

INTERNAL REVENUE SERVICE
P. 0. BOX 2508
CINCINNAT'I, OH 45201
Date: JUL 0 S 2012

EMPTY CRADLE
30520 RANCHO CALIFORNIA ROAD 107-63
TEMECULA, CA 92591
Dear Applicant:

DEPARTMENT OLD' THE TREASURY
Employer Identification Number:
33-0421466
DLN:
17053072309042
Contact Person:

JASON T SAMMONS ID# 31616
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status:
170(b) (1) (A) (vi)
Form 990 Required:

Yes
Effective Date of Exemption:

May 15, 2010
Contribution Deductibility:

Yes
Addendum Applies:

Yes
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)

-2-

EMPTY CRADLE
Enclosure: Publication 4221-PC
Sincerely,
�i
HO O. Paz 40
Director, Exempt Organizations
Rulings and Agreements
Letter 947 (DO/CG)

-3-

EMPTY CRADLE
Based on the information submitted with your application, you meet the requirements for retroactive reinstatement under Notice 2011 -43.

Letter 947 (DO/CG)

BUSINESS LICENSE CERTIFICATE
The person, firm or corporation named below is hereby granted this certificate (pursuant to the provisions of the City Business License Ordinances of the City of Temecula: Cal ifornia)to engage in, carry on or conduct, in the City of Temecula, California, the business, trade, calling, profession, exhibition or occupation described below for the period indicated. This license is permission only, and is issued without verification that the license is subject to or exempt from licensing by the State of California; nor shall such issuance be deemed a waiver of the City of Temecula of past or future violations of such laws or ordinances.

BUSINESS NAME: Empty Cradle
BUSINESS LOCATION: 32321 Alpine Ct, Temecula, CA 92592
BUSINESS OWNER: Rachel Redhouse

EMPTY CRADLE
31938 TEMECULA PKY. A385
TEMECULA, CA 92592

TO BE POSTED IN A CONSPICUOUS PLACE

CITY OF TEMECULA
Finance Department
41000 Main Street
Temecula, CA 92590
DESCRIPTION: Non -Profit Organization
Business License Number: 058507
License Fee: $4.00
Effective Date: January 08, 2025
Expiration Date: January 31, 2026
Fees paid in accordance with City Ordinance
NOT TRANSFERABLE and NON-REFUNDABLE

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n' State of California
Secretary of State
Cae rr.oax+�

REGISTRATION OF UNINCORPORATED NONPROFIT ASSOCIATION
PURSUANT TO CALIFORNIA CORPORATIONS CODE SECTION 21300
Instructions:

1. Include filing fee of $10.00 per box checked below.

2. Certification Fee (Optional) - $5.00
REG. NO. 14035 (A)
1 Secretary of State
State of California
11 /06/2024
Filing Dais
This space For Filing Use
Association includes any lodge, order, beneficial association, fraternal or beneficial society, historical, military, or veterans organization, labor union, foundation, or federation, or any other society, organization, or association, or degree, branch, subordinate lodge, or auxiliary thereof.

Registration For:
❑ Name
Association Name

EMPTY CRADLE
❑ Insignia
Street or Mailing Address
31938 TEMECULA PKWY STE A #385
Nature of Alteration (If Any):

ADDRESS AND CONTACT INFORMATION
❑� Alteration
❑ Cancellation
City and State Zip Code
TEMECULA, CA 92592
Description of Insignia, which may include badge, motto, button, decoration, charm, emblem, or rosette:

Attach Facsimile:

I declare under penalty of perjury under the laws of the State of California that I am a chief officer of the association; that I am authorized to act on behalf of the association with respect to completing and submitting this application; that the information contained in this application is true and correct. x
m Signature of Officer Date

RACHEL REDHOUSE, PRESIDENT
SL
Typed Name and Title
0 Sec/State Form LP/UNA 128 (Rev 03/2022)
Signature of Additional Officer (Optional)
Typed Name and Title
Date
2022 California Secretary of State

FY 25/26 Community Service Funding (CSF)
Grant Application
12 FINE ARTS NETWORK

53 Community Service Funding Application
, 4e
rhe+scartaFSo. thernC.hF., l
Wines Country
Organization
https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Applicant Organization
Name:

Fine Arts Network
Mailing Address:*
25185 Madison Ave Suite A,
Murrieta, CA 92562
Contact Name:*
Lena Sinclair
Contact Email: *
Year Organization
* Founded:
1994
Number of Paid Staff:*
i
Website:
* www.fantheater.com
Number of Volunteers:*
100
Contact Title:*
Board of Directors, President
Contact Phone:
9095038216
Alternate Contact Name: Alternate Contact Email: Alternate Contact Phone:

Justin Beals [email protected]
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? Temecula
ko
A current City of Temecula Business
License may be required to submit prior to
fund disbursement.

Understand
*
Geographic Area(s) the Project/Program Serves:*
Temecula

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$5,000,00
MAX: $5,000 PER L RG
Start Date:*
2025-07-01
ProjectlProgram Title:*
'25 f '25 Season of Fine Arts Network
End Date:*
2026-06-30
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
420S1 Main St, Temecula, CA 92590
Make Check Payable to:*
Fine Arts Network

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
IRS Employer Identification Number (ElN):
33-06Z4570
To find IRS Deductibility Status,
click the link below:
https://apps.irs.gov/app/eos/
Date of Incorporation:*
10/07/1994
Attach IRS Deductibility Status:*
FAN - IRS Tax Exempt Letter - Copy of Original Letter.png Provide further verification as follows:*
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) You might find IRS Form 990
on the link below:
http.s.//rct.doj.ca.govNerification/Web/Search.asp ?
facilityY
Attach First Page of Most Recent Form 990*
990 -Exempt Organization Tax Return - Fine Arts Network (1). pdf
(990, 990-EZ, 990-PF, 990-T)
206.44KI3

3.53MB

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* Since being established in 1994, Fine Arts Network Theater Company has been committed to creating community opportunities for high quality theatrical productions. Fine Arts Network Theater Company strives to give every performer a chance to better their craft. We work within the community to help with other local productions and offer support to theatrical events throughout the Inland Empire. Our FANmily's goal is to provide excellent productions that leave the community better for having produced them.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
Yes k

ProjectlPrograrn Title: '251'26 Season of Fine Arts Network

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* We have a full season of performances planned including: Fiddler on the Roof, White Christmas, Prince of Egypt and other shows at the Merc including: The last five years, Ride the Cyclone and others. We are performing high quality musical productions for the community.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

We will use funding to help produce our next productions, including purchasing the rights for music for the shows, advertising 1 marketing, programs, and costumes and sets. Without these items, we would not be able to put on quality productions of these musicals.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

We perform high caliber musical productions for an affordable cost for Temecula residents, presented at the local Old Town Temecula Community Theater and The Merc. Without funds, it is a challenge to produce art in the current season, but we aim to put on the best caliber presentations so individuals who cannot afford to go to LA or other major cities, can still have the opportunity to be exposed to the arts and culture of Musical Theater.
3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJ ECTIPROG RAM:

PROJECT/PROGRAM:
10,000

4. SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* We perform high quality presentations of popular and classical musical theater productions, at an affordable cost for the community of Temecula

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $ 5, D00.0 0
*
Amount contributed to the Project/Program by the Applicant Organization $100,000.00
*
Other grants or funding already awarded for Project/Program, if any $0.00
NIA
*
In -Kind match amount or volunteer credit hours estimated amount $5,000.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment* EXPENSES*
Sets $2,000.00
Facilities/Rentflnsurance *
Theater Rental expenses $1,000.00
*
Supplies*
$2,000.00
Costumes, Props, Music, Rights to music I shows
*
Services*
NIA $0.00
*
Food*
NIA $0.00
*
Other (i.e. Marketing, etc)*
$0.00
Postcards, Faceboo k and Instag ram Posts
*
Staffing Expense
$12,000.00
TOTAL REVENUE: TOTAL EXPENSES
$110,000.00 $5,000.00

CHECK THE BOX TO CONFIRM
Confirm

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
Fine Arts Network
President/Authorized Officer Name:*
Lena Sinclair
E-mail:*
President/Authorized Officer Signature*
064Mk5wel v t
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
President
Phone:*
909-503-8216
Submission Date:
2025-09-15 07:11:35 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

MfER.AI, RRVSKIN SERVICE
➢ISTRIM DIRECINOR
I CUPAHIA CRCL6
I0NT6RSt PARS. CA 91755-7406
Date! V 07 1994
FM ARTS NBIROR%
C/O VIRa VNI➢ R. COSILON
18410 PRAII 9TREST, SUITE 104
TH4C0N, CA 92590
near applicant
➢EPARIVEN'S o9 TRa iReRSnRY
wployer Ident£ficatiw number:
33-0634510
Huber:
base954230016
contact IIDRY ILNtI
Content Telephone Number:
(714) 829-1448
Rcccuntlnp Period andigg:

December 3
Foundation status C11"ificatiw:
0sia)(2)
Advance Ruling Period empire:

Duly 10, 1994
advance Ruling Period fade:

Addendum Applies
No
Based on information you supplied, and assuring y epetatimes will be a stated in your application for recognition of exeny[irn, we has determined you exempt £ran e federal incomtax Order section Sole) of the Severe, Revee
Cadeam an organisation described 11 Section 501(cl b1.

Strauss you mom a newly created organization, we are not now nuking e final determineticn of gout foundation status under section so9(a) of the Cade. we he" determined that you c reasonably expect to be a publicly supported orguiz a ti on Described in Section 309(a)(2).

Acecrdiogly, dniing me advance ruling period you will be treated as a publicly wppotted orNwiretirn, add note a private foundation. This advance ruling period beginsd evde on the daeee shown above.
within 90 days after the fad of your advww ruling period, you fart lead us the £nfornation unclad to determine ucltber you have mat the rmgnirm counts
-
of the applicable Support test dwdog the advents ruling period. If yru establish that you have been a publicly SOppotted orgwiveoiw, we will ilaeai- fy you an a secti,m 5091a) Ill 0r09(a) UI organization am laws as you continue to meet the requirements of the applicable support [ if you do act met the public euppnit requirements during the advance ruling period, wa will classify you an a private foundation for future periods. also, if we classify you as a private -foundation, we M11 treat you as a private foundation firm your bepuv iog date for puryoSes of ,action 507(d) seed 4940.

Stanford asul contributors may rely On, yo our determinatirn that u are n a private foun0at£an=ill 90 days after the Sod of your advance ruling period.

If you vend us the required information within the 90 dare, grantor..M

SEp:oF--T STATE OF CALIFORNIA
Office of the Secretary of State
w
m` STATEMENT OF INFORMATION
o;

CA NONPROFIT CORPORATION
California Secretary of State
�q iFoaN`.P' 1500 11th Street
Sacramento, California 95814
(916) 657-5448
Entity Details
Corporation Name FINE ARTS NETWORK
Entity No. 1872912
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
25185 MADISON AVE
STE A
MURRIETA, CA 92562-8977
25185 MADISON AVE
STE A
MURRIETA, CA 92562-8977
Justin Beals
For Office Use Only
-FILED -
File No.: BA20241100926
Date Filed: 6/7/2024
Officer Name
Officer Address
Position(s)
Justin Beals
25185 MADISON AVE
Chief Financial Officer
STE A
MURRIETA, CA 92562-8977
0 Lena Sinclair
25185 MADISON AVE
Chief Executive Officer
STE A
MURRIETA, CA 92562-8977
0 Janine Klaisle
25185 MADISON AVE
Secretary
STE A
MURRIETA, CA 92562-8977
Additional Officers
Officer Name
Officer Address
Position
Stated Position
0 Brittany Campbell
25185 MADISON AVE
Vice President
STE A
MURRIETA, CA 92562-8977
0 Joseph Arreola
25185 MADISON AVE
Other
Artistic Director
STE A
MURRIETA, CA 92562-8977
Agent for Service of Process
Agent Name
Agent Address
Justin Beals
25185 MADISON AVE
STE A
MURRIETA, CA 92562-8977
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Page 1 of 2 ends

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

Justin Beals 0610712024
Signature Date
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Page 2 of 2 ends

FY 25/26 Community Service Funding (CSF)
Grant Application
13 G FWC - TE M ECU LA VALLEY

WOMAN'S CLUB

53 Community Service Funding Application
, 4e
rhe+scartaFSo. thernC.hF., l
Wines Country
Organization
https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Applicant Organization
Name:

GFWC- Temecula Valley
Womans Club
Mailing Address:*
PO Box 1056
Temecula, CA 92S93
Contact Name:*
Patti Castillo
Contact Email: *
Year Organization
* Founded:
1980
Number of Paid Staff:*
0 Website:
* www.tvwc.com
Contact Title:

Treasurer
Contact Phone: *
Number of Volunteers:*
0 Alternate Contact Name: Alternate Contact Email: Alternate Contact Phone:

Pat Nelson
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? Temecula Valley
Yes No
Business License No.*
060394
Copy of Business License*
TVWC Business License.pdf
https://css.temeculaca.gov
rMM1.61
Geographic Area(s) the Project/Program Serves:*
Temecula Valley

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$S,000,00
MAX: $5,000 PER L RG
Start Date:*
2025-07-01
ProjectlProgram Title:*
Stong Start- Backpacks for Temecula Youth
End Date:*
2026-07-01
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
P 0 Box 1056, Temecula 92593
Make Check Payable to:*
GFWC- Temecula Valley Woman's Club

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
State of California Entity ID:*
1119999
To find CA Entity Status Letter,
click the link below:
https://www.ftb.ca.gov/help/business/entity-
status-letter.asp?WT.mc_i d=a kB ESaatus
Provide further verification as follows:*
Date of Incorporation:*
07/08/1982
Attach State of California Entity Status Letter:*
document.pdf
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Too] (link below) Attach First Page of Most Recent Form 990*
You might find IRS Form 990 2022 990 EZ.pdf
on the link below: (990, 990-EZ, 990-PF, 990-T)
h tt ps. //rct. d o j.ca.govNe rifi c at io n/web/Sea rc h. a s px? facility YY
370.54KB
778.86KB

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* The Temecula Valley Woman's Club is part of an International organization dedicated to the improvement of the educational, ethical and cultural life of he community through volunteer service.

UPON REQUEST, COPIES OF THE ORGANIZATIONS CURRENT BUDGETIFINANCIAL STATEMENTS _ (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA's AUDIT MAY BE NEEDED TO Understand DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
Yes k

Project/Program Description

RECEIPTSIINVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE Understand PROJECTIPROGRAM AS DESCRIBED HERE.

Project/Program Title: Stong Start- Backpacks for Temecula Youth

1. DESCRIBE THE PROJECTIPROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* STRONG START- Backpacks for Temecula Youth is a community -driven initiative designed to support underprivileged and at -risk youth by providing them with the essential tools they need to succeed in school. This program distributes brand-new backpacks filled with age -appropriate school supplies to children from low-income households, foster care, shelters, and other vulnerable situations at the start of each academic year.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

Funds for this program will be used to purchase 400 backpacks filled with supplies tailored to the student's grade level — such as notebooks, books, pencils, pens, folders, crayons, glue sticks, calculators, and hygiene items as well as basic school supplies.

3. EXPLAIN HOW 'THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAMIPROJECT IF AWARDED CITY FUNDING.

Strong Start's target audience are Youth from low-income families, Children experiencing homelessness, Foster youth and students in crisis -affected households. By ensuring that every child starts the school year equipped and empowered, this program helps build self-esteem, improves academic performance, and reduces dropout risks among vulnerable youth populations. It also sends a powerful message: that every child deserves the opportunity to learn, grow, and thrive — no matter their background. 3b. ESTIMATED NUMBER OF PEOPLE FROM 3C. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJECTIPROGRAM:

PROJECTIPROGRAM:
911
35 4. SUMMARY STATEMENT— SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* Strong Start will provide underprivileged, at -risk youth with essential school supplies, and backpacks, helping them start the academic year prepared and confident. Partnering with various non -profits, the program will support educational success, ease financial strain on families, and promote self-esteem and school engagement for vulnerable children in the Temecula Valley.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $ 5, DOD. D 0
*
Amount contributed to the Project/Program by the Applicant Organization $0.00
*
Other grants or funding already awarded for Project/Program, if any $0.00
*
In -Kind match amount or volunteer credit hours estimated amount $2,087.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equiipment* EXPENSES*
Backpacks $2,500.00
*
Faciliities/Rentflnsurance *
Facility rental
1 00.00
*
Supplies*
various school supplies for backpacks $2,100.00
*
Services*
nla $0.00
*
Food*
$300.00
snacks for backpacks
Other (i.e. Marketing, etc)*
*
*
Staffing Expense
$0.00
TOTAL REVENUE: TOTAL EXPENSES
$7,087.00 $5,000.00

CHECK THE BOX TO CONFIRM
Confirm

Acknowledgement/Signature
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 50 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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
GFWUC- Temecula Valley Womans Club
President/Authorized Officer Name:*
Patti Castilla
E-mail:*
President/Authorized Officer Signature*
CPhlo OW61/Zo
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
TVWC - Treasurer
Phone:*
Submission Date:
2025-09-11 06:33:38 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 9/2/2025
ESL ID: 5638255924
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 1119999
Entity Name: GFWC - TEMECULA VALLEY W©MAN'S CLUB
0 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 f. ©

4. We do not have current information about the entity. ❑

5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

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).

BUSINESS LICENSE CERTIFICATE
ThN P==dti *M*r .w++.f IWOW 1/ J psrleq U1s cd+r"M Pu um b Hie pw scns �Y M to 92S{173r:

LAMM OP10AWK46 6i In Coy Cf Te"65AL C.41aw. No ape In * f m or a3r?W n M CAT at T*M-14i%, l.ait+na, it" ea,reuM. �i+p n rfrCyryn pr rrl3►[dllrr d97M4e0 belorr'1d 1rrt rlYFsc1 v>'9c�d TM Icon" s -,masw +rMf. iM b Mard rrhiU r�1+r.ar:,r Iek Ire -1ur+M a n rr cari>M h^an e++��v try e•r �iAr d CMY.amam+r mr dvri 0 L •-4 robs be derrrd ■ .r •v d M- Cry d +—a— m pee= r t w+ etdlit— N i At" an a rl dnt+rdloff BUSINESS NAME: GFWC - Temecula Valley Woman'& C1u0
BUSINESS LOCATION: 31492 Pennant Ct. Tarnecuta. CA 92591 BUSINESS OWNER: Patricia Naito
POWs Castilla

TEMECULA VALLEY WOMANS CLUB
GFWC • TEMECULA VALLEY WOMAN'S CLUB
Pip BOX 1056
TEMECULA, CA 92593
TO BE POUTED IN A CONSF+ICUOUS PLACE

CITY OF TEMECULA
Finance Department
41001) V.urt Strr.rt
Tv-nnVL&1. CA 97690
DESCPJ1113T"0 ► w-Profn Organization
6usmess License Number; 060394
License Fee: S4.00
Effective Date- Scoexmber 03, 2025
Expiration Lkate. January 31, 2026
Fees paid in acoordance ► O City Ordinance
NOT TRANSFERABLE ana NON-REEUNDARIL

SEp:oF--T STATE OF CALIFORNIA
Office of the Secretary of State
w
m` STATEMENT OF INFORMATION
o;

CA NONPROFIT CORPORATION
California Secretary of State
�q iFoaN`.P' 1500 11th Street
Sacramento, California 95814
(916) 657-5448
For Office Use Only
-FILED -
File No.: BA20250197455
Date Filed: 1/28/2025
Entity Details
Corporation Name GFWC - TEMECULA VALLEY WOMAN'S CLUB
Entity No. 1119999
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
27784 BOTTLE BRUSH WAY
MURRIETA, CA 92562
PO BOX 1056
TEMECULA, CA 92593
Officer Name
Officer Address
Position(s)
Patricia Nelson
PO BOX 1056
Chief Executive Officer
TEMECULA, CA 92593
Susan Barrett
PO BOX 1056
Secretary
Temecula, CA 92593
© Patti Castillo
27784 BOTTLE BRUSH WAY
Chief Financial Officer
MURRIETA, CA 92562
Additional Officers
Officer Name
Officer Address
Position
Stated Position
Marva Murray
PO BOX 1056
Vice President
TEMECULA, CA 92593
Haydee Schaffer
PO BOX 1056
Vice President
TEMECULA, CA 92593
Jayne Schneider
PO BOX 1056
Assistant Treasurer
TEMECULA, CA 92593
Agent for Service of Process
Agent Name
Agent Address

PATTI CASTILLO
27784 BOTTLE BRUSH WAY
MURRIETA, CA 92562
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

L. CERWIN
Signature
0112812025
Date

Page 1 of 1 ends

FY 25/26 Community Service Funding (CSF)
Grant Application

HABITAT FOR HUMANITY

INLAND VALLEY

� Community Service Funding Application
a
(rke +ica. t of S— t hc— Cup i fo https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
_:0 - fi',TI
Applicant Organization
Name:

Habitat for Humanity Inland
Valley, Inc.

Mailing Address:*
2747S Ynez Road, #390
Temecula, CA 92591
Contact Name:*
Mary Stein
Contact Email:*
mart'@habitativ.org
Year Organization
* Founded:
1991
Number of Paid Staff:*
41 *
Website:

Number of Volunteers:*
1,35
Contact Title:*
CFO, Director of Programs
Contact Phone:*
9512963362
Alternate Contact Name: Alternate Contact Email: Alternate Contact Phone:

Tammy Marine [email protected] 9512963362
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? Southwest Riverside County
Business License No.*
031945
Copy of Business License*
City of Temecula License_TEM_031945_exp 1.31

26.pdf
https://css.temeculaca.gov

95.1 KB
*
Geographic Area(s) the Project/Program Serves:*
Temecula

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$5,000,00
MAX: $5,000 PER L RG
Start Date:*
2025-07-01
ProjectlProgram Title:*
A Brush With Kindness
End Date:*
2026-06-30
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
41615 Winchester Road, #214, Temecula CA 92590
Make Check Payable to:*
Habitat for Humanity Inland Valley, Inc.

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
State of California Entity ID:*
3618039427
To find CA Entity Status Letter,
click the link below:
https://www.ftb.ca.gov/help/business/entity-
status-letter.asp?VVT.mc_i d=a kB ESaatus
Provide further verification as follows:*
Date of Incorporation:*
02/11 /1991
Attach State of California Entity Status Letter:*
HFHIV Entity Status Letter.pdf
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Too] (link below) Attach First Page of Most Recent Form 990*
You might find IRS Form 990 HFHIV 990 Page 1.pdf
on the link below: (990, 990-EZ, 990-PF, 990-T)
h tt ps. //rct. d o j.ca.govNe rifi c at io n/web/Sea rc h. a s px? facility YY
370.55KI3
203.73KB

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* The mission of Habitat for Humanity, in partnership with God, is to facilitate the dream of homeownership as well as improve the living conditions for those in the community.

UPON REQUEST, COPIES OF THE ORGANIZATIONS CURRENT BUDGETIFINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA's AUDIT MAY BE NEEDED TO Understand DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
ye,q k

NAME OF PROGRAM/PROJECT
FUNDED BY THE CITY GRANT AMOUNT:*

OR SPONSORSHIP
Critical Home Repair $75,000.00
A Brush With Kindness $5,000.00
Senior Minor $7,474.00
Maintenance &
Cleanup Program
A Brush With Kindness $5,000.00
Pathway to $7,236.00
Homeownership
MONTH +YEAR FUNDING NAME OF CITY GRANTOR

RECEIVED SPONSORSHIP
July 2025 CDBG 25126
December 2024 CSF 24125
July 2024 CDBG 24f25
November 2023 CSF 23/24
July 2023 CDBG 23/24

Project/Program Title: A Brush With Kindness

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* The A Brush with Kindness (ABWK) program is our minor home repair program providing qualified, low- income Temecula residents with no to very low cost minor exterior home repairs and maintenance services with the goal of protecting and preserving home affordability. We serve any low-income resident in need, the majority of those seeking services are seniors. Typical repairs include weed abatement, exterior painting, fence work, accessibility and minor repairs that are often outside of the scope of eligible repairs through our Critical Home Repair Program, which is currently funded by the City of Temecula.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

Habitat for Humanity Inland Valley will spend the grant funding on the ABWK program, serving any qualified, low-income resident within the City of Temecula, who is in need of minor exterior home repairs and maintenance services. Funds will provide the basic materials and supplies needed for repairs such as nails, lumber, paint, paint supplies, tools, siding and other supplies. In addition, funds may also be used towards the purchase of a small trailer for programmatic activities

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

The project is only available to qualified, low-income Temecula residents and will help keep neighborhoods beautified while protecting affordable housing and stabilizing residents. Many times simple repairs can cause struggling residents to quickly become financially unstable, but with A Brush with Kindness, residents can gain some financial stability. Over 90% of those served by this project are fixed -income seniors and 100% live at or below the poverty line. 3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJECT/PROGRAM:

PROJECTIPROGRAM:
15 4. SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* Funds would be used to provide no to very low cost, exterior minor home repair or maintenance projects to low-income residents within the City of Temecula with the goal of preserving home affordability.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $5,000.00
*
Amount contributed to the Project/Program by the Applicant Organization $11,000.00
*
Other grants or funding already awarded for Project/Program, if any $0.00
*
In -Kind match amount or volunteer credit hours estimated amount $S,aaa.aQ

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equiipment* EXPENSES*
Small tools and trailer $4,500.00
Facilities/Re ntf l nsura nce *
Facility Rent and insurance $9,000.00
Supplies*
ABWK Program Supplies $6,000.00
Services*
MIA $0.00
Food*
$SQa,aa
Volunteer Supplies
Other (i.e. Marketing, etc)*
$1,000.00
Marketing/Advertising
Staffing Expense
$S,aaQ.QQ
TOTAL REVENUE: TOTAL EXPENSES
$21,000.00 $21,000.00

CHECK THE BOX TO CONFIRM
Confirm

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization: *
Habitat for Humanity Inland Valley, Inc.

President/Authorized Officer Name:*
Tammy Marine
E-mail:*
[email protected]
President/Authorized Officer Signature*
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
CEO
Phone:*
9512963362
Submission Date:
2025-09-15 04:18:24 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

IF DIFFERENT THAN ABOVE, APPLICATION PREPARED BY:

Mary Stein, CFO/Director of Programs, Habitat for Humanity Inland Valley, Inc.

Name, Title, & Organization
If you have any questions, please contact: [email protected] (951 ) 693-3959 or [email protected] (951) 694-6413

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 811812025
ESL ID: 3618039427
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 1681922
Entity Name: HABITAT FOR HUMANITY INLAND VALLEY, INC.
1 1

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 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).

BUSINESS NAME: Habitat For Humanity Inland Valley Inc
BUSINESS LOCATION: 27999 Jefferson Ave, C&D, Temecula, CA 92590 BUSINESS OWNER: Habitat For Humanity Inland Valley

HABITAT FOR HUMANITY INLAND VALLEY INC
27475 YNEZ RD, 390
TEMECULA, CA 92591

TO BE POSTED IN A CONSPICUOUS PLACE

CITY OF TEMECULA
Finance Department
41000 Main Street
Temecula, CA 92590
DESCRIPTION: Retail
Business License Number: 031945
License Fee: $35.00
Effective Date: November 18, 2024
Expiration Date: January 31, 2026
Fees paid in accordance with City Ordinance
NOT TRANSFERABLE and NON-REFUNDABLE

SEp:oF--T STATE OF CALIFORNIA
Office of the Secretary of State
w
m` STATEMENT OF INFORMATION
o;

Entity No. 1681922
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
41615 WINCHESTER ROAD
214
TEMECULA, CA 92590
27475 YNEZ ROAD #390
TEMECULA, CA 92591
Dawn Madera
Officer Name
Officer Address
Position(s)
0 David Blake
41615 WINCHESTER ROAD #214
Chief Financial Officer
TEMECULA, CA 92590
Luanne Jobgen
41615 WINCHESTER ROAD #214
Secretary
TEMECULA, CA 92590
Tamara (Tammy) Marine
41615 WINCHESTER ROAD #214
Chief Executive Officer
TEMECULA, CA 92590
Additional Officers
Officer Name
Officer Address
Position
Stated Position
Jacqueline M Steed
41615 WINCHESTER ROAD
Chairperson of Board
STE 214
TEMECULA, CA 92590
Connie French
41615 WINCHESTER ROAD #214
Other
Past President
TEMECULA, CA 92590
0 Anna Sacco -Miller
41615 WINCHESTER ROAD
Other
Vice Chair
214
TEMECULA, CA 92590
Agent for Service of Process
Agent Name
Agent Address
Dawn Madera
42014 VIA RENATE
TEMECULA, CA 92591
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Page 1 of 2 ends

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

Dawn Madera 0511312025
Signature Date
J
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Page 2 of 2 ends

FY 25/26 Community Service Funding (CSF)
Grant Application
15 HIS LITTLE FEET

Community Service Funding Application
The Heart of Southern California
Wine Country
Organization
https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Confirm
Applicant Organization
Name:

His Little Feet Nonprofit
Mailing Address:*
Contact Name:*
Hali Wolf
* Year Organization Website:

Founded: hislitfeet.org
2014
Number of Paid Staff:*
3 Contact Email:*
[email protected]
Number of Volunteers:*
90 Contact Phone:*
5623970370
Alternate Contact Name: Alternate Contact Email: Alternate Phone:

Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:* Temecula Business License? Temecula
Yes No
A current City of Temecula Business
License may be required to submit prior to
fund disbursement.

Understand
Geographic Area(s) the Project/Program
Serves:

Temecula

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Amount Requested:* Project/Program Title:*
$5,000.00 Back to School Fair
MAX: $5,000 PER ORG
Start Date:* End Date:* Physical Address of Project/Program * 2026-07-01 2026-07-31 41000 Main St, Temecula, CA 92590 Preferred Payment Method:
(If grant is awarded.)
Make Check Payable to:*
His Little Feet

Check Mailed Check Picked Up
Electronic File Transfer
Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
State of California Entity ID:
3776899
To find CA Entity Status Letter,
click the link below:
https://www.ftb.ca.gov/help/business/entity-
status-letter.asp?WT.mc_id=a kBEStatus
IRS Employer Identification Number (EIN):
4737369966
To find IRS Deductibility Status,
click the link below:
https://apps.irs.gov/app/eos/
Date of Incorporation:
04/13/2015
Attach State of California Entity Status Letter:*
State of California Entity Status Letter.pdf
Attach IRS Deductibility Status:*
HLF IRS Deduductibility Status.pdf
Provide further verification as follows:
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) You might find IRS Form 990
Attach First Page of Most Recent Form 990*
2024_HLF_990.pdf
401.33KB
541.86KB
104.43 KB
on the link below: (990, 990-EZ, 990-PF, 990-T)

https.//rct.doj.ca.gov/Verification/Web/Search.aspx?
facility=Y
State Registry Search Tool:
https://rct.doj.ca.gov/Verification/Web/Search.aspx ?
facility=Y
Application Authorization
Attach State Registry Document/Info*
CT0230552 2023 RRF.pdf

83.1 KB
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?
Yes No
Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization?
Yes No
This Application has been authorized by the organization's: * Executive Committee Board of Directors Members -at -Large Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* Our mission is to share God's love and uplift underprivileged youth with new socks, shoes, and other basic necessities.

Our vision is to build confidence in children facing homelessness with new foot ware.

Every year our goal is to serve over 2000 children with new foot ware. Additionally, we hold an annual community -wide Back to School Fair. At this event, local businesses gather as we pour resources into the most vulnerable individuals in our community. The Back to School fair includes new haircuts, backpacks, school supplies, socks, shoes, crafts, food, and games to the underprivileged children. As a result, these children can start the new school year prepared and on level footing.

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 TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. Understand Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other

sources of funding from the City of Temecula?
Yes No
Project/Program Description

RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE

ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. Understand
Project/Program Title: Back to School Fair

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* The Back to School Fair is a unique local event that provides proper resources for underprivileged and impoverished children to be able to enter the new school year. Additionally, fostered and homeless children receive these same resources. All of the children served are given brand new backpacks, school supplies, shoes, socks, and haircuts. Temecula is in desperate need of the continuation of this program as it is unique to our area. And there are always children who need help getting on the right foot.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

A large portion of the sum will be distributed to buying new shoes and socks for the children. New, quality shoes and socks are not cheap, especially when being distributed to hundreds of children.

Similarly, the cost of new backpacks and school supplies is not cheap. We will be using the a portion of the sum to purchase these items for the children.

Finally, any additional funding will go towards food items, decorations, crafts, or activities for the day of the event.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

When we benefit the next generation, we always improve our future. By giving children without common needs and privileges proper foot ware and school supplies, we ensure a more confident and prepared child. Absenteeism within our schools is an increasingly growing problem. Children should be able to attend school, play in sports, participate in playgrounds, and walk to -and -from school comfortably and without holes in their foot ware. For families without vehicles, foot ware becomes a more integral form of transportation. And they should be able to do that with foot ware that is not falling apart or unsafe.

3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM INVOLVED IN THIS PROJECT/PROGRAM:

THIS PROJECT/PROGRAM: 35
100

4. SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* ChatGPT said:

The Back to School Fair equips underprivileged, fostered, and homeless children in Temecula with new backpacks, school supplies, shoes, socks, and haircuts. Funding supports these essentials, plus event activities. Quality footwear ensures safety, boosts confidence, and reduces absenteeism —empowering kids to start school strong and walk confidently into their future.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* $5,000.00
Amount contributed to the Project/Program by the Applicant Organization $15,000.00
Other grants or funding already awarded for Project/Program, if any N/A $0.00
In -Kind match amount or volunteer credit hours estimated amount $1,000.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment* EXPENSES*
Shoes, Backpacks, School Supplies, Socks, etc $15,000.00 Facilities/Rent/Insurance*
Insurance Policy $100.00
Supplies*
Decorations, Crafts, Games, Activities $500.00
Services
N/A $0.00
Food*

Catering, Snacks, etc
$1,500.00
Other (i.e. Marketing, etc)*
Videographer, Photographer, Social Media
Staffing Expense
TOTAL REVENUE:
$21,000.00
Compliance

TOTAL EXPENSES
$18,100.00
$1,000.00
$2,900.00
If your organization is awarded a Community Service Funding Grant in Fiscal Year 2025-2026 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2025, and June 30, 2026.

In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation mayjeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds.

To substantiate that Fiscal Year 2025-2026 funds received from the City were spent appropriately, proper back-up documentation including the report (in the link below) with accompanying receipts/invoices, must be submitted to the City on or before due date: Monday, September 15, 2026.

Compliance Expenditure Report Form
I have read and understand the above policy that if this organization is awarded a Community Service Funding Grant in FY 2025-2026 by the City of Temecula, a compliance expenditure report is due by Monday, September 15, 2026.

• 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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:* Requested Amount:

His Little Feet Nonprofit $5,000.00
President/Authorized Officer:* E-mail:*
Phone: *
Hali Wolf [email protected] 5623970370
President/Authorized Officer Signature* Submission Date:
(., .i- We
2025-07-30 11:09:18 AM
IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY:

Name, Title, & Organization
If you have any questions, please contact:

[email protected] (951) 693-3959 or
Stacey. [email protected] (951) 694-6413

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 7/30/2025
ESL ID: 2688500544
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: 3776899
Entity Name: HIS LITTLE FEET, INC.
✓❑

1. The entity is in good standing with the Franchise Tax Board. ❑

2. The entity is not in good standing with the Franchise Tax Board. ✓❑

3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑

4. We do not have current information about the entity. ❑

5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

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).

DEPARTMENT OF THE TR.Ep►SURY

INTERNAL REVENUE SERVICE
p. o. BOX 2508
CINCINNATI, OH 45201
Date: DEC 14 2015

HIS LITTLE FEET INC

CIO BRIAN MCDONALD
7755 Ch'I+TTER AVE STE, 1111
HMUING�TON SFACH, CA 92647
Dear Applicant:
employer Identification Number:
47-3769966
DLN:
17053308318025
Contact Person:

MICHELLH A GUITZ ID# 31213
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
public Charity Status:
170 (b) (1) (A) (vi)
Form 9901990-EZ/990-N Required:

Yea
Effective Date of Exemption!
April 13, 2015
Contribution Deductibility:

Yes
Addendum Applies:

No
We're pleased to tell you we determined you're exempt from federal income tax under internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC section 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 990/90=E99iT= 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 "41221-PC" in the search bar to view Publication 4221-DC, Compliance Guide for S01(c)(3) Public Charities, which describes your recordkesping, reporting, and disclosure requirements.

Letter 947

`�'.eState of California
.-Franchise Tax Board
PO Box 1286
Rancho Cordova CA 95741-1286
HIS LITTLE FEET, INC.

Po BOX 11572
SANTA ANA CA 92711
Regarding:

Organizations. Name:

CCN:

Purpose:

R&TC Section:

Form of organization:

Accounting Period Ending:

Tax -Exempt Status Effective:

Tax -Exempt Status
HIS LITTLE FEET, INC.
3776899
Charitable
23701d
Incorporated
07/31
04/13/2015
Exempt Acknowledgement Letter
Date: 02.11.16
Case: 30820600701287076
Case Unit: 30820600701287080
In reply refer to: 760:GRW:F12o
We have received your federal determination letter that shows tax exemption under Internal Revenue Code (IRC) Section 501(c)(3).

Under California law, Revenue and Taxation Code (R&TC) Section 23701 provides that an organization is exempt from taxes imposed under Part 11 upon submission of the federal determination letter approving the organization's tax-exempt status.

Generally, the effective date of an organization's California tax-exempt status is the same date as the federal tax-exempt status.

To retain tax-exempt status, the organization must be organized and operating for nonprofit Purposes within the provisions of the above R&TC section. An inactive organization is noL 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
• Na me
• Address
FTB 9944 PASS (REV 12-2014) Exempt Application\Correspondence \LT1 001- EAL

'* California Secretary of State
` Electronic Filing
O-LIF0% '
Corporation - Statement of Information
Entity Name: HIS LITTLE FEET, INC.

Entity (File) Number: C3776899
File Date:
01/26/2022
Entity Type:

Corporation
Jurisdiction:

CALIFORNIA
Document ID:

H154843
Detailed Filing Information

1. Entity Name:

2. Business Addresses:
a. Street Address of Principal
Office in California:
b. Mailing Address:

3. Officers:
a. Chief Executive Officer:

HIS LITTLE FEET, INC.
i
Secretary of State
State of California
3445 Studebaker Rd
Long Beach, California 90808
United States of America
3445 Studebaker Rd
Long Beach, California 90808
United States of America
Hali Lynn Wolf
3445 Studebaker Rd
Long Beach, California 90808
United States of America
b. Secretary: Kristina Gallos
3445 Studebaker Rd
Long Beach, California 90808
United States of America
co
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Use bizfile.sos.ca.gov for online filings, searches, business records, and resources.

W~,`� iniesi • , •8y
W California Secretary of State
Electronic Filing
OALJFORN�*
Officers (Cont'd):
c. Chief Financial Officer:

4. Agent for Service of Process:

Gail Freedman
3445 Studebaker Rd
Long Beach, California 90808
United States of America
Hali Wolf
3445 Studebaker Rd
Long Beach, California 90808
United States of America
By signing this document, I certify that the information is true and correct and that I am authorized by California law to sign.

Electronic Signature: Hali Wolf
Use bizfile.sos.ca.gov for online filings, searches, business records, and resources. co
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FY 25/26 Community Service Funding (CSF)
Grant Application
16 HOSPICE OF THE VALLEYS

as Community Service Funding Application
R
�rke Hc.ar t aF So u t her n Cut. Foma
Wines Country
Organization
https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Applicant Organization Year Organization Website:
* *
Name: Founded: https://hospiceofthevalleys.org/
Hospice of the Valleys 1982
Mailing Address:*
41391 Kalmia Ave. Ste. 300
Murrieta, CA 92552
Contact Name:*
Melanie House
Contact Email:*
[email protected]
Number of Paid Staff:* Number of Volunteers:*
48 42
Contact Title:*
Development Coordinator
Contact Phone: *
Alternate Contact Name: Alternate Contact Email: Alternate Contact Phone:

Paul Mathias [email protected]
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? Southwest Riverside County
Business License No.*
0545S1
Copy of Business License*
2025 License - Hospice of the Valleys, SC.pdf
https://css.temeculaca.gov
L'I.E`11111.1
*
Geographic Area(s) the Project/Program Serves:*
Temecula

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$5,000,00
MAX: $5,000 PER L RG
Start Date:*
2025-07-01
ProjectlProgram Title:*
Senior Assistance Program
End Date:*
2026-06-30
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
41391 Kalmia St., Ste. 300, Murrieta, CA 92562
Make Check Payable to:*
Hospice of the Valleys

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
IRS Employer Identification Number (ElN):
95-3846314
To find IRS Deductibility Status,
click the link below:
https://apps.irs.gov/app/eos/
Provide further verification as follows:*
Date of Incorporation:*
06/29f 1983
Attach IRS Deductibility Status:*
HOV_TaxExe m ptStatus-Na m eCha nge. pdf
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) Attach First Page of Most Recent Form 990*
You might find IRS Form 990 2023 990 Page 1 HOV.pdf
on the link below: (990, 990-EZ, 990-PF, 990-T)
httpL//rc.t.doj.ca.gov/Verification/Web/Search.asp2L?
facility!
385.75KB
106.74KB

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* Hospice of the Valleys began in early 1982 by two sisters in Sun City, California who recognized the need for specialized end -of -life care for people in their community. In order to make this care available, these sisters received hospice training as volunteers and began going door-to-door raising money on their patients' behalf. After years as a volunteer -run organization, Hospice of the Valleys eventually became a full -service, nonprofit 501(c)(3) organization.

Today, Hospice of the Valleys employs a team of experienced clinicians and administrative professionals, and continues to have a group of dedicated volunteers who touch the lives of our patients each and every day. After more than 40 years of caring for hospice patients living in Southwest Riverside County and Fallbrook, Hospice of the Valleys remains committed to the mission of its founders by providing loving hospice care to all who need it, regardless of their ability to pay.

Our Mission:

We foster reverence for life, relief of suffering, and compassion in loss for the terminally ill residents and their families in the communities we serve.

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGETIFINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT MAY BE NEEDED To Understand DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
ye,q k

NAME OF PROGRAM/PROJECT
FUNDED BY THE CITY GRANT AMOUNT:*

OR SPONSORSHIP
Senior Assistance $10,138.00
Program
Senior Assistance $7,474.00
Program
MONTH +YEAR FUNDING NAME OF CITY GRANTOR

RECEIVED SPONSORSHIP
Not Yet Received
FY 24-2S
CDBG Temecula
CDDG Temecula
Senior Assistance $7,236.00 FY 23-24 CDDG Temecula
Program

Project/Program Title: Senior Assistance Program

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* The Senior Assistance Program provides compassionate hospice care to terminally ill patients and support to their families. The Program pays for the direct cost of hospice care for senior citizens and the severely disabled. Direct hospice care includes, but is not limited to, personal visits by physicians, nurses, home health aides, social workers, and spiritual care advisors; the provision of durable medical equipment, medical supplies, medication delivery, and bereavement support services. Our services are extended to our patients and their families while the patient is living and up to at least 13 months after death. After the patient passes, caregivers receive bereavement support that includes phone calls and/ or personal visits by a bereavement counselor or chaplain, access to grief support groups, bereavement books and mailings, as well as memorial services of remembrance twice per year. Hospice of the Valleys does not believe in adding to the burden of patients or their families by asking for reimbursements or co pays that are not covered by insurance. For example, Medicare does not cover a $5.00 co -pay for each medication that each of our patients are prescribed; however, Hospice of the Valleys takes care of that cost and does not pass the co -pay on to our patients. During times when end of life is imminent, we do not want our patients and their families to incur yet another expense. Our goal is to ensure no one is turned away or provided With limited hospice care simply due to their inability to pay.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

For every patient on our service, Hospice of the Valleys makes numerous visits to the the patient and their family, to wherever they call home. From nurses, to home health aides; doctors, to social workers; and even spiritual care and bereavement staff we see patients many times a Week to care for them as they near the end of their lives. These visits are all hours of the day and night, as well as on weekends and holidays. Funds will be used towards patient care and costs not covered by Medicare or other insurances. This includes, but is not limited to, provisions such as medication delivery services, incontinence supplies, overbed tables, medication co -pays, and mobile shower equipment, just to name a few. These items keep our patients comfortable; alleviate the burden to their caregivers; and help with added expenses that families shouldn't have to amass at the end of their loved one's lives. Additionally, our Hospice Hearts have become an invaluable gift we offer to our patients' families and caregivers.

When separated, the tiny inner heart can be placed with the loved one who has died as a reminder of their unbroken connection to those who remain behind. Numerous families who have received the hospice hearts have told us how meaningful they are and how they would be treasured. Hospice Hearts are $5 per and we offer an unlimited amount to families when their loved one has passed.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

We serve approximately 3SO patients a year in Southwest Riverside County, and since year 2000, 1 S% of our patients reside in Temecula. On average we are serving approximately SO Temecula patients and can estimate that at least one of these patient's family members or friends also benefited from our services (as many of the provisions we provide ease the burden for the caregiver). The patients we serve are presumed low -moderate income persons based on the fact that they are either severely disabled adults and/ or senior citizens (age 62 and above). Our patients have been diagnosed with a terminal illness and have 6 months or less to live, as certified by a physician. While we expect to serve approximately 50 total patients residing in the City of Temecula, the scope of our service extends beyond the patient. Our hospice team also assists each patient's caregiver as they journey through the dying process. Our interdisciplinary team is available to assist caregivers in making difficult end -of -life decisions and help families navigate the many issues surrounding death. Once the patient dies, Hospice of the Valleys provides comprehensive bereavement support and education to families/ caregivers, extending the number of individuals we serve.
3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJ ECTIPROG RAM:

PROJECTIPROGRAM:
5o

4. SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* The Senior Assistance Program provides compassionate hospice care to the terminally ill patients of Temecula and to support to their families. During times when end of life is imminent, we ensure no one is turned away or provided with limited hospice care simply due to their inability to pay.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $5,000.00
*
Amount contributed to the Project/Program by the Applicant Organization $1,234,110.00
*
Other grants or funding already awarded for Project/Program, if any $7,474.00
Temecula CDBG grant
*
In -Kind match amount or volunteer credit hours estimated amount $20,000.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
ToolslEquipment* EXPENSES*
Computers and phones $11,159.00
Facilities/Rentllnsurance *
Rent and insurance $57,337.00
*
Supplies*
$118,724.00
Overbed tables, full -electric beds, incontinence supplies, and medication Loa 0-1
Services*
Physician exp, mileage $110,310.00
Food*
Nla $0.00
Other (i.e. Marketing, etc)*
$110,463.00
Marketing and G&A exp
Staffing Expense
$952,660.00
TOTAL REVENUE: TOTAL EXPENSES
$1,266,584.00 $407,993.00

CHECK THE BOX TO CONFIRM
Confirm

Acknowledgement/Signature
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 50 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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
Hospice of the Valleys
President/Authorized Officer Name:*
Paul Mathias
E-mail:*
[email protected]
President/Authorized Officer Signature*
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
Marta Sarver- Martinez
Phone:*
951-200-7800
Submission Date:
2025-08-28 01:21:00 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

Docusign Envelope ID: 7533C731-3361-42F2-BAEC-CB86D372E163 Acknowledgement/Signature
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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
Hospice of the Valleys
President/Authorized Officer Name:*
Rob Crisell, Board President
E-mail: *
President/Authorized Officer Signature*
Signed by:
00455F45FFF149E...

Please confirm that the President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
Marta Sarver- Martinez
Phone: *
Submission Date:
2025-08-28 01:21:00 PM
President/Officer Confirmation:*
Verified and Confirmed
Visit https://bizfileonline.sos.ca.gov/search/business to verify.

IF DIFFERENT THAN ABOVE, APPLICATION PREPARED BY:

Melanie House, Development Coordinator, Hospice of the Valleys Name, Title, & Organization
If you have any questions, please contact: [email protected] (951 ) 693-3959 or [email protected] (951) 694-6413

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 8/28/2025
ESL ID: 3519023804
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 1131444
Entity Name: HOSPICE OF THE VALLEYS SC
✓❑

1. The entity is in good standing with the Franchise Tax Board. ❑

2. The entity is not in good standing with the Franchise Tax Board. ✓❑

3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑

4. We do not have current information about the entity. ❑

5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

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).

FROM
[ tt41al Revenue Service
strict Director
x
Dote:

D
JUN r
Hospice of Sun City
27851 Bradley Rd.

Sun City: CA 92381
Dear Applicant:

CPR I) dCT i S 2010 9: 2BiST. 7
Department of the Treasury
L player ldentiff flan Number:

Parlod
V
December 31.

Foundation bus Classification:
.509(a.)(1) and 170(b)(1)(A)(vi)
Incorporated Advance Ruling Parlod tends:

December 31, 1984
Paimon to Contact:

Contact. Telephone Nurnbgw'
(213) 688-4889
Based on inforlaatian.supplied; and assUmi.ng ycur operations will be as stated in your application for recognition we- have determined you are exempt from Federal income tax under -set on.541(c)[3) oo the .Into rnal Rerrenue Cade. 8aoause you -are a newly create organizaticn, we are not now making a final, determination of your foundation status under section 509(a) of the Code. However, we have determined that you can reasonably be expected to be a publicly supported organization desoribed in section 509(a)(1) and-179(b)(1)(A)(vi).

Accordingly, you will be- treated as a publicly supported organization, and 'not as a private foundation, during an advance ruling period, This advance ruling.period begins on the date .of your inception and,ends on the date shown above.

Within 90 darts after the, end of your advance ruling period, you must submit to .us information needed to-.de•termine whether you have met tha'requirements of the applicable support test curing. the- advance ruling period. If you establish that you have been a.Pu.blioly sppported organizsti6n,'yoga will be classified as a section 509(a)(1).or-509(a•)(} organization as long as you continue to meet the requirements ^= of the applicable support teat. If you do not inset the public support requirements during the advance ruling period, you will be classified as a private foundation for future periods. Also, if you are classified as'a private foundation, you will -be treated as a private foundation from the data of your inception for purposes of sections 507(d) aid 4940,
Grantors and donors may rely on the determination that you are not a private foundation'until 90 days after the and of your. advarioe.ruling period. If you submit the required information within the 90 days, grantors and donors .may continue to• rely on the advance determination until the Service makes a final determination of your foundation status. However, if notice that you will no longer be treated as a section 5t79(e)(l),r* organization is published in the Internal. Revenue Bulletin, grantors and donors may riot -rely on this determination after the date of such Publioation. Also,- a grantor or donor may not rely on -this determination if he or she was in part responsible for, or was aware of, the act or failure to act that resulted in 'your loss of section 509(a)(1)** status, or acquired knawledg6 that the 'Internal Revenue Service had given notice that you would be removed from classification as a - section % 509 (a) (l),rr organization•.

P.O. Box 23501 Los Angeles, Calif. 90053 Word letter 1045(DU) (6-77)

FROM CPR I) dCT i S 2010 9: 2BiST. P 2
* For tax years ending on and after December 31, lU2, organizations whose g xoss receipts are not normally more than $25,000 are excused from filing Form 990. guidance in determining if your gross receipts ,are "normally" not more than the �Ox
$25,000 limit, see the instructions for the For0990.
r
40 SEp:oF--T STATE OF CALIFORNIA
Office of the Secretary of State
w
m` STATEMENT OF INFORMATION
o;

CA NONPROFIT CORPORATION
California Secretary of State
�q iFoaN`.P' 1500 11th Street
Sacramento, California 95814
(916) 657-5448
For Office Use Only
-FILED -
File No.: BA20251733077
Date Filed: 8/27/2025
Entity Details
Corporation Name HOSPICE OF THE VALLEYS SC
Entity No. 1131444
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
41391 KALMIA ST
300
MURRIETA, CA 92562
41391 KALMIA ST
300
MURRIETA, CA 92562
Paul Mathias
Officer Name
Officer Address
Position(s)
0 Rob Crisell
41391 KALMIA ST
Chief Executive Officer
300
MURRIETA, CA 92562
0 Anthony Christopher
41391 KALMIA ST
Chief Financial Officer
300
MURRIETA, CA 92562
0 Catherine Pepe
41391 KALMIA ST
Secretary
300
MURRIETA, CA 92562
Additional Officers
Officer Name
Officer Address
Position
Stated Position
0 Anthony Christopher
41391 KALMIA ST
Vice President
300
MURRIETA, CA 92562
Agent for Service of Process
Agent Name
Agent Address

MARTA SARVER-MARTINEZ
41391 KALMIA ST
300
MURRIETA, CA 92562
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Page 1 of 2 ends

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

Paul Mathias 0812712025
Signature Date
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Page 2 of 2 ends

BUSINESS NAME: Hospice of the Valleys
BUSINESS LOCATION: 41391 Kalmia St, 300, Murrieta, CA 92562 BUSINESS OWNER: Paul Mathias

HOSPICE OF THE VALLEYS, SC

HOSPICE OF THE VALLEYS
41391 KALMIA ST, 300
MURRIETA, CA 92562

TO BE POSTED IN A CONSPICUOUS PLACE

CITY OF TEMECULA
Finance Department
41000 Main Street
Temecula, CA 92590
DESCRIPTION: Medical
Business License Number: 054551
License Fee: $4.00
Effective Date: October 17, 2024
Expiration Date: January 31, 2026
Fees paid in accordance with City Ordinance
NOT TRANSFERABLE and NON-REFUNDABLE

FY 25/26 Community Service Funding (CSF)
Grant Application
17 INTERNATIONAL

CHRISTIAN ADOPTIONS

� Community Service Funding Application
a
(rke +ica. t of S— t hc— Cup i fo https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Applicant Organization
Name:

International Christian
Adoptions
Mailing Address:*
41745 Rider Way, Suite #2,
Temecula, CA 92S90
Contact Name:*
Charlotte Paulsen
Contact Email:*
charlottep@4achi Id.org
Year Organization
* Founded:
1990
Number of Paid Staff:*
61 Website:
* 4achild.org
Contact Title:*
Vice President
Contact Phone:*
(951) 695-3336
Number of Volunteers:*
1 Alternate Contact 'Name: Alternate Contact Email: Alternate Contact Phone:

Jen Mitchell [email protected] (951) 69S-3336
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? State of California and North Carolina r r_,
Business License No.*
042918
Copy of Business License*
Business License -City of Temecula 2025-2026.p
df
https://css.temeculaca.gov

97.73KB
Geographic Area(s) the Project/Program Serves:*
Temecula Valley Residents

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$S'000,00
MAX: $5,000 PER L RG
Start Date:*
2025-07-01
ProjectlProgram Title:*
Mental Health and Education Services
End Date:*
2026-06-30
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
41745 Rider Way, Suite #2, Temecula, CA 92590
Make Check Payable to:*
International Christian Adoptions

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
State of California Entity ID:*
1664688
To find CA Entity Status Letter,
click the link below:
https://www.ftb.ca.gov/help/business/entity-
status-letter.asp7VVT.mc_id=akBEStatus
IRS Employer Identification Number (EIN):
33-0412343
To find IRS Deductibility Status,
click the link below.
https://a pps.irs.gov/a pp/eos/
Date of Incorporation:*
12/14/1990
Attach State of California Entity Status Letter:*
Entity Status Letter 9.11.25.pdf
Attach IRS Deductibility Status:*
501 C3 letter. pdf
Provide further verification as follows:*
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) Attach First Page of Most Recent Form 990*
You aright find IRS Form 990 990 Farm 2023.pdf
on the link below: (990, 990-EZ, 990-PF, 990-T)
https-//rc.t.doj.ca.gov/Verification/Web/Search.asp2L?
fac RMYY
383.44KB

89.41 KB

2.7MB

State Registry Search Tool:

Attach State Registry ❑ocumentfinfo*
https:lfrct.doj.ca.govNerification/Web/Search.aspx? State Registry Qocument_2025.pdf 284.43KB facility=Y

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* International Christian Adoptions (ICA)began in 1990 as a non-profit S01(c)(3) corporation with its principal office in Temecula, CA. ICA consists of two major divisions: International Christian Adoptions and the Institute for Children's Aid which is inclusive of the Child Trauma & Learning Center. We stand on Biblical principles in all we do, lending hospitality and sanctuary to all who are in need. We are a voice for those who cannot speak for themselves, believing that all life is sacred. Whoever you are, and whatever you need as a family, we are here to help you. ICA is dedicated in helping children and their families around the world and in the United States. Our staff is multi-lingual, multi -ethnic and professionally trained to assist in various capacities. We offer Adoption both domestically and internationally, Foster Care for domestic children and Refugee Foster Care, and Counseling services for at -risk children and youth in the community.

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGETIFINANCIAL STATEMENTS _ (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT,, MAY BE NEEDED TO Understand DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
Yes k

Project/Program Title: Mental Health and Education Services

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* The Child Trauma & Learning Center at the Temecula ICA Office offers mental health services for children and youth under the age of 18 in the Temecula Valley, specializing in foster/adoptive background, ADHD, trauma, grief/loss, addictions, anxiety, depression, and family issues. ICA has also added an Independent Living Program (ILP) for young people who have aged out of foster care and are between the ages of 18- 24-year-old but still have a need for assistance and services. ILP has monthly groups for Acculturation Sessions and Mental Health Group Therapy. The Group Therapy sessions may include focuses on: Art, Music, Horticulture/Gardening, Dance, Self -Care, etc. Some life skills taught in the Acculturation Sessions may include focuses on finances/banking/budgeting, safety skills, personal hygiene, grocery shopping, job etiquette and skills, parenting, health, transportation, legal issues, household maintenance, laundry, cooking/meal prepping, interpersonal skills, etc.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

ICA Child Trauma & Learning Center is requesting a grant of $5,000 to go towards multiple aspects, including treasure box items for the Children's Counseling Center, counseling scholarships for our clients who have a financial burden to cover therapeutic fees, who also reside within 92590, 92591 and 92592 zip codes. We also request grant monies to help with supplies, activities and snacks for the ILP Group and Acculturation Sessions. An example of some of those items might include fabric material, rice and essential oils for therapeutic rice bags for self -care sessions, horticultural/gardening supplies, musical instruments, paint brushes, variety of paints, canvases, art supplies, clay, playdough, session snacks. All items purchased for the Children's Counseling Center and the ILP Program will be purchased from Temecula Valley stores within the 92590, 92591 and 92592 zip codes.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

ICA Child Trauma & Learning Center currently has 34 Temecula clients who fall within 92590, 92591 and 92592 zip codes, that would benefit from the Temecula Grant. The services provided to our Temecula children and youth will aid in the healing, empowerment, and growth for children in our local community, families, and schools.
3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJECTIPROGRAM:

PROJECT/PROGRAM:
34 4. SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.

The Child Trauma & Learning Center wants to help those in our Temecula community by offering mental health services and acculturation life skills to local children, youth and young adults. These services provide a positive outcome on the mental health of children, youth and young adults in our community.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $5,000.00
*
Amount contributed to the Project/Program by the Applicant Organization $S,000.00
*
Other grants or funding already awarded for Project/Program, if any $0.00
*
In -Kind match amount or volunteer credit hours estimated amount $0.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equiipment* EXPENSES*
Therapeutic Items, include but is not limited to: sensory treasure box items, $8,000.00 fabric material, rice and essential oils for therapeutic rice bags for self -care sessions, horticultural/gardening supplies, musical instruments, paint brushes, variety of paints, canvases, art supplies, clay, playdough Faci I iti es/Re nt{I nsura nce *
Facilities/Rent/Insurance $12,687.15
Supplies*
$1,346.10
Office/Administrative Supplies, Computers, Desks, Phones Services*
Therapeutic Services and Acculturation Services $14,039.55 Food*
$700.00
water, snacks for clients and group sessions, lollipops Other (i.e. Marketing, etc)*
Brochures, Flyers, Design, Website $199.10
Staffing Expense
$79,000.00
TOTAL REVENUE: TOTAL EXPENSES
$10,000.00 $36,971.90

CHECK THE BOX TO CONFIRM
Confirm

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
International Christian Adoptions (ICA)
President/Authorized Officer Name:*
Charlotte Paulsen
E-mail:*
[email protected]
President/Authorized Officer Signature*
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
Vice President
Phone:*
951-695-3336
Submission Date:
2025-09-12 02:18:14 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

IF DIFFERENT THAN ABOVE, APPLICATION PREPARED BY:

Jen Mitchell, Office Manager of the Child Trauma & Learning Center, ICA Name, Title, & Organization
If you have any questions, please contact: [email protected] (951 ) 693-3959 or [email protected] (951) 694-6413

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 911112025
ESL ID: 1508371621
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 1664688
Entity Name: INTERNATIONAL CHRISTIAN ADOPTIONS
1 1

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 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).

INTERNAL REVENUE SERVICE
DISTRICT" DIRECTOR
2 CUPANIA CIRCLE
MONTEREY PARK, CA 91755-7406
Date MAY 17 1995

INTERNATIONAL CHRISTIAN ADOPTIONS

CIO LAURA DUKE
41745 RIDER 2
TEMECULA, CA 92590-4826
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number;
33-0412343
Case Number
955f30011
Contact Person:

TYRONE THOMA.S
Contact Telephone Number:
(213) 894-2209
Our Letter bated:

November 26,.1990
Addendum Applies:

No
This modifies our letter of the above date in which we stated that you would be treated as an organization that is not a private foundation until the expiration of your advance ruling period.

Your exempt status under section 501(a) of the Internal Revenue Code as an organization described in section 501(c)(3) is still in effect.. Based on the information you submitted, we have determined that you are not a private foundation within the meaning of section 509(a) of the Code because you are an organization of the type described in section 509(a)(2).

Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary. However, if you lose your section 509(a)(2) status, a grantor or contributor may not rely on this determination it he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the part of the organization that resulted in your Iona of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 509(a)(2) organization.

As of January 1, 1984, you are liable for taxes under the Federal Insurance Contributions Act (social security taxes} on remuneration of $100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA).

You are required to file Form 990 only if your gross receipts each year are normally more than $25,000. For guidance in determining whether your gross receipts. are "normally" more than $25,000, see the instructions for Form 990. if a return is required, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. A penalty of $10 a day is charged when a return is filed late, unless there is reasonable cause for the delay. However, the maximum penalty charged cannot exceed $5,000 or 5 percent of your gross receipts for the year, whichever is lose. This penalty may also be charged if a return is not complete, so please be sure your return is complete before you file it.
if we have indicated in the heading of this letter that an addendum 4%d41LOW. 4h6 rada"WAUTti- Meaolan"a Lr an La+naot*1 ramb as %hit 3.alxlsiw. - Letter 1Q50 (DO/CQ)

-z-

INTERNATIONAL CHRISTIAN ADOPTIONS
T
f
Because this letter could help resolve any questions about your private foundation status, please keep it in your permanent regorda.

If you have any questions, please contact the person whose name and telephone number are shown above.

Sincerely yours,
Richard R. Orosco
District Director
Letter loco 0>0/ca)

BUSINESS NAME: International Christian Adoptions
BUSINESS LOCATION: 41745 Rider Way, Suite 2, Temecula, CA 92590 BUSINESS OWNER: DW Duke
Laura Duke
Patrick McLogan

INTERNATIONAL CHRISTIAN ADOPTIONS
41745 RIDER WAY, SUITE 2
TEMECULA, CA 92590

TO BE POSTED IN A CONSPICUOUS PLACE

CITY OF TEMECULA
Finance Department
41000 Main Street
Temecula, CA 92590
DESCRIPTION: Non -Profit Organization
Business License Number: 042918
License Fee: $4.00
Effective Date: October 17, 2024
Expiration Date: January 31, 2026
Fees paid in accordance with City Ordinance
NOT TRANSFERABLE and NON-REFUNDABLE

SEa:oF--T STATE OF CALIFORNIA
Office of the Secretary of State
;w
o; 01 STATEMENT OF INFORMATION

CA NONPROFIT CORPORATION
' California Secretary of State
�q iFoaN`.P' 1500 11th Street
Sacramento, California 95814
(916) 653-3516
For Office Use Only
-FILED -
File No.: BA20240320485
Date Filed: 2/20/2024
Entity Details
Corporation Name INTERNATIONAL CHRISTIAN ADOPTIONS
Entity No. 1664688
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office 41745 RIDER WAY
STE. 2
TEMECULA, CA 92590
Mailing Address of Corporation
Mailing Address
Attention
Officers
41745 RIDER WAY
SUITE 2
TEMECULA, CA 92590
Officer Name
Officer Address
Position(s)

CHARLOTTE PAULSEN
41745 RIDER WAY, SUITE 2
Chief Executive Officer
TEMECULA, CA 92590
Michelle Madden
41745 Rider Way, Suite 2
Secretary
Temecula, CA 92590
0 p. Adele Chazin
41745 RIDER WAY
Chief Financial Officer
STE. 2
TEMECULA, CA 92590
Additional Officers
Officer Name Officer Address Position Stated Position
None Entered
Agent for Service of Process
Agent Name
Agent Address

DAVID DUKE
41745 RIDER WAY
SUITE 2
TEMECULA, CA 92590
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

Charlotte Paulsen
Signature
0212012024
Date

Page 1 of 1 ends

FY 25/26 Community Service Funding (CSF)
Grant Application
JACOB"S HOUSE

j 3 Community Service Funding Application
�I
l
1 •r. dear of Sow V,.:

Wine Country
Organization
https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Confirm
Applicant Organization Year Organization * Website:

Name: Founded: www.jacobshousetemecula.org
Jacob's House 2007
Mailing Address:*
Contact Name:

Dr. Lisa J. Chapman
Number of Paid Staff:*
3 Contact Email:*
[email protected]
Number of Volunteers:*
75 Contact Phone:*
9514522627
Alternate Contact Name: Alternate Contact Email: Alternate Phone:

Hunter Howe [email protected] 9514522627

CIISO I)
Ian
le�
Does the nonprofit have a current City of * Gegrap Area`s) th�nization Serves:* fl'
Temecula Business License? Temecula
Yes No
Geographic Area(s) the Project/Program Serves:*
Business License No.* Temecula
054374 CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Copy of Business License*
Jacobs House -Business License - 01.24.25-01.31.

26.pdf 576.01 KB
https://css.temeculaca.gov
Amount Requested:* Project/Program Title:*
$5,000.00 Jacob's House "Open A Door For A Family"
MAX: $5,000 PER ORG
Start Date:* End Date:* Physical Address of Project/Program*

Project/Program
Amount Requested:*
$S,000,00
MAX: $5,000 PER L RG
Start Date:*
2025-10-01
ProjectlProgram Title:*
Jacob's House "Open A Door For A Family"
End Date:*
2025-12-31
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
!Physical Address of ProjectlProgram*
31525 Jedediah Smith Road, Temecula, CA 92592
Make Check Payable to:*
Jacob's House, Inc.

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
State of California Entity ID:*
C3O137SO
To find CA Entity Status Letter,
click the link below:
https://www.ftb.ca.gov/help/business/entity-
status-letter.asp7VVT.mc_i d=a kB ESaatus
IRS Employer Identification plumber (EIN):
26-1183832
To find IRS Deductibility Status,
click the link below.
https://a pps.irs.gov/a pp/eos/
Date of Incorporation:*
08/16/2007
Attach State of California Entity Status Letter:*
Jacobs House -State of CA Entity Status Letter - 09.1' 1.25.pdf Attach IRS Deductibility Status:*
Jacobs House -IRS Letter of Determination - 11.03.08.pdf Provide further verification as follows:*
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) You aright find IRS Form 990
on the link below:
https-//rc.t.doj.ca.gov/Verification/Web/Search.asp2L?
facility=Y
Attach First Page of Most Recent Form 990*
Jacobs House -IRS 990 Tax Return (1st Page Only) - 2024.pd f
(990, 990-EZ, 990-PF, 990-T)
115MI1.1
441.84KB
261.12KB

State Registry Search Tool:

Attach State Registry ❑ocumentfinfo*
https:llrct.doj.ca.gov/Verification/Web/Search.aspx?
facility=Y
Jacobs House -State of CA Registrant Details Page - 09.11.2 242.7K6

5.pcIf

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* Jacob's House is a home of refuge where families and loved ones of those in hospitalized traumatic medical needs can find hope, comfort, peace, and inspiration. We are a community resource dedicated to serving families in crisis. We do this by providing shelter for their physical, emotional, and spiritual support.

UPON REQUEST, COPIES OF THE ORGANIZATIOWS CURRENT BUDGETIFINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED TO Understand DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
ye,q k

NAME OF PROGRAM/PROJECT

FUNDED BY THE CITY GRANT

OR SPONSORSHIP
Jacob's House
AMOUNT:*
$5,000.00
MONTH +YEAR FUNDING

RECEIVED
January 2025

NAME OF CITY GRANTOR

SPONSORSHIP
C5F Grant

Project/Program Title: Jacob's House "©pen A Door For A Family"

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* Jacob's House located at 3l S25 Jedediah Smith Road, Temecula, CA 92592 is part of a national model of healthcare hospitality homes whose goal is to provide free lodging and support for families whose loved one has been admitted into the hospital for an unforeseen traumatic medical event. We do this by partnering with 8 area hospitals in Riverside, San Diego, and San Bernardino counties (including the City of Temecula Temecula Valley hospital) who identify families who need emotional support. Doctors, nurses, case managers, social workers, and even security units can make a referral to Jacob's House for a family who had to drive, fly, or otherwise make arrangements to be at the bedside of their loved one.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

All CSF grant funds are used to provide free lodging to families experiencing a traumatic medical event, resulting in their loved one being admitted into the hospital. A grant of $5,000 will provide free lodging to families in need for 3S nights. This will include lodging, meals, ancillary resources, laundry, and emotional support.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IFAWARDED CITY FUNDING.

Jacob's House continues to meet the needs of the local community by providing the citizenry of Temecula an opportunity to give back since opening our doors in December 2012. Be it sweat equity, development, fundraising, maintenance, guest family services, service projects, and/or outreach, Jacob's House has become that vehicle for businesses, community based organizations, students, retirees, faith -based communities, and area stakeholders to utilize their experience, learn new skills, make a connection, develop new bonds, and profoundly make a difference in the lives of their brethren through community volunteerism. Temecula volunteers' role in the community is unique as it allows them to measure their resolve through their commitment to helping others. This includes, but is not limited to, helping reduce stress and financial burdens for families when they must travel far from home when their loved one has a health care emergency, which in -turn allows families the ability to stay together when their loved one is sick or injured. Another benefit to the community is when an area's citizenry is engaged in the welfare of others in the community, the community itself begins to thrive. With Jacob's House's size, mission, and scale of volunteer service opportunities. we're quickly positioned so Temecula residents can give back in meaningful ways. We believe that significant changes can and does occur with individuals, cities, and communities when the adage of "being of service" is realized through a stable, respected, and valued entity. Throughout it all, weve been able to serve residents and Temecula visitors, with the support needed during their most vulnerable times. Jacob's House is proud to serve through a network of more than 75 volunteers, 100's of businesses, CBO's, houses of worship, school districts, students, and

countless service groups, such as National Charity League, Boys & Girls Scouts, etc. in benefiting both volunteers and recipients of that kindness.
3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJ ECTIPROG RAM:

PROJECTIPROGRAM:
75 4. SUMMARY STATEMENT— SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* With the City of Temecula 2025 grant, Jacob's House will provide 700+ nights of emergency iodging for family members enduring a traumatic medical crisis, preserving their physical, emotional, and financial stability. While simultaneously providing 70 residents, businesses, community based organizations, faith - based communities, and service groups the ability to connect to our community, make a difference in the lives of families experiencing a traumatic medical event, and prove that Temecula's well earned reputation extends to both residents and visitors alike.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $5,000.00
*
Amount contributed to the Project/Program by the Applicant Organization $1 05,000.00
*
Other grants or funding already awarded for Project/Program, if any $35,50a.a0
City of Temecula $5,000; PRS Holdings Foundation $5,000; New York Life $500; Stater Bros Charities $5,000; San Manuel Band Of Mission Indians $20,000
*
In -Kind match amount or volunteer credit hours estimated amount $2,500.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
ToolsfEquipment* EXPENSES*
Landscaping, hand tools, cleaning equipment, etc. $1,000.00 Facilities/Rentflnsurance *
Maintenance, NIA Property Ins, and various repair management, etc. $2,500.00 Supplies*
$4,500.00
Includes Ad min, Janitorial, ancillary resources, etc.

Services*
$0.00
Lodgi ng
Food*
Meals, snacks, and event catering $1,500.00
Other (i.e. Marketing, etc)*
$22,000.00
Marketing Materials, Outreach Merch, Annual Reports, Utilities, Telephone, Telecommunications, Recognitions & Awards, Advertising, Interest Expense, General Merchant & Bank Fees, Staff Development, Conferences & Meetings, etc.

Staffing Expense
$0.00
TOTAL REVENUE: TOTAL EXPENSES

TOTAL REVENUE:

TOTAL EXPENSES
$ 148,000.00 $31,500.00

CHECK THE BOX TO CONFIRM
Confirm

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
Jacob's House
President/Authorized Officer Name:*
Dr. Lisa J. Chapman
E-mail:*
[email protected]
President/Authorized Officer Signature*
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
Executive Director
Phone:*
951-452-2627
Submission Date:
2025-09-15 04:01:00 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

To substantiate that Fiscal Year 2025-2026 funds received from the City were spent appropriately, proper back-up documentation including the report (in the link below) with accompanying receipts/invoices, must be submitted to the City on or before due date: Monday, September 15, 2026.

CHECK THE BOX TO CONFIRM
Confine
Acknowledgement/Signature
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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:,, Requested Amount:

Jacob's House $5,000.00
President/Authorized Officer:* E-mail: * Phone:*
Dr. Lisa J. Chapman [email protected] 951-452-2627

MEOW-Iw-
President/Authorized Officer Signature* Submission Date:
2025-09-15 04:01: M
�i?NT n A f �
VEN P
I I H , I ON EPARED BY:

Name, Title, & Organization
If you have any questions, please contact:

[email protected] (951) 693-3959 or
Stacey. [email protected] (951) 694-6413

INTEINAL REVENUE SERVICE
P. 0 BOX 2508
CINC_:NNATi, GH 45201
Date
NOV 4 3 2.00
JACOI 3' S HOUSE, INC.

CIO I "IARTiN A WEISS
ONE 73ETTERWORLD CIRCLE,
T?r'MEf_ULA, CA 92590
Dear Applicant;

DEPARTMENT OF THE TREASURY
Employer identification Number:
25-1183832
DLN:
17053106310008
Contact Person:

JOANNA YAWNEY ID## 95078
SUITE 300 Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status;.
170 (b) (1) (A) (vi)
Form 990 Reauired:

Yes
Effective Date of Exem'_otion:

August 16, 2007
Contribution Deductibility:

Yes
Addendum Applies:

L�7o
We are r)leased 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 prbiic charity under the Code section(s) listed in the heading of this lett er. .

PleE se see enclosed. Publication 4221-PC, Compliance Guide for 501 (c) (3) Public Cha2ities, for some helpful information.about your responsibilities as an exenpt organization._
Letter 947 (1)O/CG)

JAM � ` S HOUSE, INC.

Encl+)surer s Publication 4221-PC
sincerely,
Robert. Choi
Director, Exempt Organizations
Rulings and Agreements
Letter 947 (DO/CG)

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 911112025
ESL ID: 8039061212
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: 3013750
Entity Name: JAC©B'S HOUSE, INC.

E1.

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).

BUSINESS LICENSE CERTIFICATE
The person, firm or corporation named below is hereby granted this cer"fiicate pursuant to the previsions of the City Business License Ordinances of the City of Temecula, Oahemis, to engage in, carry an or conduct In the City of Temecula., California, the business, trade, calling, profession, exhibition or ocCupatlpn described belaxfor the period indicated. This ilottnae is pGornia, th onrnIsslon
ly, and is issued without vertfrcation that the license Is subject to or exempt from licensing by the State of California, nor shall such issuance be deemed a waiver of the City of Temecuta of past or future violations of such laws or ordinances, BUSINESS NAME: Jacobs House Inc.

BUSINESS LOCATION: 31525 Jededlah Smith Rd, Temecula, CA 92592 BUSINESS OWNER: Marlin Barrera-Martinez
JACOB'S HOUSE INC.

JACOB'S HOUSE INC.
31525 JEDEDIAH SMITH RD
TEMECULA. CA 92592
Bin

CITY OF TEMECUL,A
Finance Department
41000 Main Street
Temecula, CA 92590
13ESCRIPTION: Personal Services
Business License Number: 054374
License Fee: $4,00
Effective Date: January 24, 2025
Expiration Date: January 31, 2026
Fees paid in accordance with City Ordinance

SE.............
gp�...... STATE OF CALIFORNIA
. /P4.:.UPEKq" yl�s�
Office of the Secretary of State
;w
o; o STATEMENT OF INFORMATION

CA NONPROFIT CORPORATION
California Secretary of State
�q iFo_aN`.P' 1500 11th Street
Sacramento, California 95814
(916) 657-5448
Entity Details
Corporation Name JACOB'S HOUSE, INC.

Entity No. 3013750
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
For Office Use Only
-FILED -
File No.: BA20251116261
Date Filed: 5/21/2025
31525 JEDEDIAH SMITH ROAD
TEMECULA, CA 92592
31525 JEDEDIAH SMITH ROAD
TEMECULA, CA 92592

MARTIN BERRERA-MARTINEZ
Officer Name
Officer Address
Position(s)
THEEA Rosu
31525 JEDEDIAH SMITH ROAD
Chief Financial Officer
TEMCULA, CA 92592

SHAWN NELSON
31525 JEDEDIAH SMITH ROAD
Chief Executive Officer
TEMECULA, CA 92592
Jaclyn Granillo
31525 Jedediah Smith Road
Secretary
Temecula, CA 92592
Additional Officers
Officer Name
Officer Address
Position
Stated Position
0 Shawn Nelson
31525 JEDEDIAH SMITH ROAD
Chairperson of Board
TEMECULA, CA 92592
© Stephanie Nelson
31525 JEDEDIAH SMITH ROAD
Chairperson of Board
TEMECULA, CA 92592
© Jaclyn Granillo
31525 JEDEDIAH SMITH ROAD
Assistant Secretary
TEMECULA, CA 92592
© Larry Boggeln
31525 JEDEDIAH SMITH ROAD
Other
Medical Director
TEMECULA, CA 92592
0 Jia Allen
31525 JEDEDIAH SMITH ROAD
Other
Care Coordinator Director
TEMECULA, CA 92592
Gina Lowery
31525 JEDEDIAH SMITH ROAD
Other
Director of Women's Health
TEMECULA, CA 92592
Theea Rosu
31525 JEDEDIAH SMITH ROAD
Assistant Treasurer
TEMECULA, CA 92592
© Brandon Rabidou
31525 JEDEDIAH SMITH ROAD
Other
City Planner
TEMECULA, CA 92592
Agent for Service of Process
Agent Name
Agent Address

MARTIN DAVID BARRERA-MARTINEZ
31525 JEDEDIAH SMITH ROAD
TEMECULA, CA 92592

Page 1 of 2 ends

Email Notifications
Opt -in Email Notifications No, I do NOT want to receive entity notifications via email. I prefer notifications by USPS mail.

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign Jody Nottingham
Signature
0512112025
Date
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Page 2 of 2 ends

FY 25/26 Community Service Funding (CSF)
Grant Application

KENAI'S HOUSE

Aft
s Community Service Funding Application
(rke H—t of South,— CuIifo https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
_:0 - ri',TI
Applicant Organization
Name:

Kenai's House
Year Organization
* Founded:
2022
Mailing Address:* Number of Paid Staff:*
31165 Temecula Pkwy, Suite 350 0
Temecula, CA 02502
Contact Name:*
Shareen Harding
Contact Email:*
[email protected]
Website:
* www.kenalshouse.org
Contact Title:*
CEO/Founder
Contact Phone:
7604013713
Number of Volunteers:
5 Alternate Contact Name: Alternate Contact Email: Alternate Contact Phone:

Sharon Harding
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? Temecula, Murrieta, Menifee
ko
Business License No.*
055727
Copy of Business License*
business license.htmi
https://css.temeculaca.gov

25.72KB
*
Geographic Area(s) the Project/Program Serves:*
Temecula

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$S,000,00
MAX: $S,000 PER L RG
Start Date:*
2026-01-01
ProjectlProgram Title:*
Pet Retention Support Program - "Keeping Pets Home"
End Date:*
2026-07-24
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
31886 Red Pine Way, Temecula 92S92
Make Check Payable to:*
Kenai's House, Inc

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
State of California Entity ID:*
5097082
To find CA Entity Status Letter,
click the link below:
https:l/ www.ftb.ca.gov/help/business/entity-
status-letter.asp7VVT.mc_id=akBEStatus
IRS Employer Identification plumber (EIN):
88-3998252
To find IRS Deductibility Status,
click the link below.
https://a pps.irs.govla pp/eos/
Date of Incorporation:*
06/06/2022
Attach State of California Entity Status Letter:*
entity status Ietter.pdf
Attach IRS Deductibility Status:*
IRS nonprofit letter.jpg
Provide further verification as follows:*
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) Attach First Page of Most Recent Form 990*
You might find IRS Form 990 2024-form 990n-883998252--accepted. pdf on the link below: (990, 990-EZ, 990-PF, 990-T)
W11YAR91
863.35KB

httpE//rct.doj.ca.gavNeriff cationIWeb/Search.aspx?
facility=Y
State Registry search Tool: Attach State Registry ❑ocumentftnfo* https://rct.doj.ca.govNerification/Web/Search.aspx ? state registry.html 20.11KB facility=Y

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* Kenai's House is a Temecula -based SO1 (c)[3) nonprofit animal rescue dedicated to rescuing, rehabilitating, and retaining dogs to ensure they live safe, healthy, and fulfilling lives in permanent, loving homes. Our mission goes beyond traditional rescue by focusing on retention —providing training, socialization, and lifetime support to adopters so that dogs remain successfully in their homes and do not return to shelters.

Goals:

Reduce the number of dogs surrendered or rehomed in Temecula due to behavioral challenges or lack of support.

Strengthen the bond between families and their pets through education, training, and resources.

Promote responsible pet ownership within the community by offering programs open not only to our adopters, but also to families who adopted from shelters, other rescues, or breeders.

Objectives:

Offer free or low-cost community training workshops that address common behavioral challenges such as leash reactivity, anxiety, and recall.

Provide training and enrichment kits to families in need, equipping them with tools to support long-term success.

Host community adoption and education events to increase awareness, encourage responsible ownership, and connect residents with resources.

Through these efforts, Kenai's House seeks to create a more compassionate, dog -friendly Temecula where fewer dogs enter shelters and more families experience the lifelong joy of a stable, successful adoption.

UPON REQUEST, COPIES OF THE ORGANIZATIOWS CURRENT BUDGETIFINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA's AUDIT, MAY BE NEEDED TO Understand DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
Yes k

Project/Program Title: Pet Retention Support Program - "Keeping Pets Home"

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* Kenai's House is launching the Keeping Pets Home program to support Temecula families struggling With the challenges of pet ownership that often lead to surrender. Many families give up their pets not because they don't love them, but because of behavioral difficulties, financial hardship, or a lack of accessible resources. This program is designed to address those challenges head-on by providing practical tools, education, and temporary assistance to help families keep their pets where they belong — at home.

The program combines community training clinics, temporary pet food assistance, and a behavior support hotline to create a safety net for residents and their pets. Clinics will offer free or low-cost training on common issues like leash pulling, barking, or reactivity, empowering owners with knowledge and hands-on guidance. Temporary pet food assistance will help low-income families facing short-term financial hardship, ensuring no pet goes hungry. Finally, the hotline and live Q&A events will give residents direct access to expert advice when urgent behavioral challenges arise, preventing issues from escalating to surrender.

By strengthening the bond between pets and their families, this program reduces pressure on local shelters, prevents unnecessary surrenders, and promotes responsible, compassionate pet ownership in Temecula. With grant support, Kenai's House can provide these services at little to no cost, directly benefiting residents while enhancing the overall well-being of the community.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

If awarded, Kenai's House will allocate the $5,000 grant to directly support Temecula residents and their pets through the Keeping Pets Home program:

Com m unity Tra ini ng Clinics - $2,000
Purchase training supplies (leashes, harnesses, treat pouches, clickers) Cover event expenses (facility rental, signage, handouts, water/snacks for attendees) Educational materials for families (training guides, behavior tip sheets) Temporary Pet Food Assistance - $1,500
Bulk purchase of dog food and cat food from local Temecula retailers Distribution to qualifying low-income families on a short-term basis Promotes both animal welfare and support for the local economy Behavior Support Hotline 1 Live Q&A Events - $1,000
Materials and supplies for events (printing, setup, tech support for virtual sessions) Resource kits for attendees with guidance on problem -solving and training tools Community Outreach & Awareness - $500
Flyers, posters, and informational handouts for local distribution Supplies for community tabling events (pet -friendly giveaways, brochures)

Anticipated Outcomes:

Serve at least 7S families in the first year
Host 5 community clinics (free or low-cost)
Distribute 2,000 Ibs of pet food to families in need
Provide behavior support to 100+ residents through hotline and events

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

The Keeping Pets Home program directly benefits Temecula residents by addressing two of the most common reasons families surrender their pets: behavioral challenges and financial hardship. Many families in Temecula love their pets but feel forced to rehome them when issues like leash reactivity, excessive barking, or destructive behavior become overwhelming —especially when professional training is out of reach due to high costs. By offering free or low-cost community clinics, Kenai's House provides residents with the tools and knowledge they need to solve these problems and keep their pets as valued members of their families.

Financial hardship is another major factor leading to pet surrenders. When unexpected expenses arise, families may struggle to provide consistent food and care for their animals. Our temporary pet food assistance program helps bridge these gaps, ensuring that beloved pets stay nourished and remain in their homes instead of entering already overburdened shelters.

Additionally, our behavior support hotline and live Q&A events offer residents quick, accessible guidance when they face immediate challenges. This service gives families confidence and reassurance, preventing issues from escalating into crises that might otherwise lead to surrender.

For the City of Temecula, the benefits extend beyond individual families. Fewer pet surrenders mean reduced pressure on local shelters and rescues, cost savings for the community, and a healthier, happier environment for both people and animals. By empowering residents with education, resources, and support, this program fosters stronger family -pet bonds, promotes responsible pet ownership, and strengthens Temecula as a compassionate and pet -friendly community. 3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJECTIPROGRAM:

PROJECTIPROGRAM:
300
IC�

4. SUMMARY STATEMENT— SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* The Keeping Pets Home program helps Temecula residents by providing free/low-cost training, temporary pet food assistance, behavior support, and educational resources. These services reduce surrenders caused by behavioral or financial struggles, ease shelter overcrowding, and strengthen the human -animal bond, creating a more compassionate, pet -friendly community where families can successfully keep their pets.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to page2) $S 000.00
*
Amount contributed to the Project/Program by the Applicant Organization $ 1,000.00
*
Other grants or funding already awarded for Project/Program, if any $0.00
*
In -Kind match amount or volunteer credit hours estimated amount $2,000.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equiipment* EXPENSES*
Pop-up tents, tables, chairs for outdoor events, Signage, banners, and $S00.00 informational boards
*
Faci I iiti es/Re ntll nsura nce *
Business Insurance, Locations for workshops $1,200.00
*
Supplies*
$1,200.00
Leashes, head collars, treat pouches, treats, Printed training guides & handouts
*
Services*
Support Hotline/ Q & A Events, Training clinics $2,600.00 *
Food*
bulk kibble (cats and dogs) $1,500.00
*
Other (i.e. Marketing, etc)*
$ 1,000.00
Handouts/resource kits for participants, Pet -friendly giveaways (collapsible bowls, waste bag dispensers), Printed flyers for promotion Staffing Expense
TOTAL REVENUE: TOTAL EXPENSES
$8,000.00 $8,000.00
*
$0.00

CHECK THE BOX TO CONFIRM
Confirm

Acknowledgement/Signature
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 50 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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
Kenai's House
President/Authorized Officer Name:*
Shareen Harding
E-mail:*
[email protected]
President/Authorized Officer Signature*
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
CEO/Founder
Phone:*
760-401-3713
Submission Date:
2025-09-14 10:13:15 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

raDepartment of the Treasury
Internal Revenue Service
Date:
09/12/2022
Tax Exempt and Government Entities
IRS P.O. Box 2508
Cincinnati, OH 45201
Employer I D number:
88-3998252
Person to contact:

Name: Customer Service
ID number: 31954
Telephone: 877-829-5500

KENAIS HOUSE INC
Accounting period ending:
31886 RED PINE WAY
June 30
TEMECULA, CA 92592
Public charity status:
509(a)(2)
Form 990 1990-EZ 1 990-N required:

Yes
Effective date of exemption:

June 6, 2022
Contribution deductibility:

Yes
Addendum applies:

No
DLN:
26053649004372
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.

If we indicated at the top of this letter that you're required to file Form 990I990-EZ1990-N, our records show you're required to Mile 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,
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: 9/3/2025
ESL ID: 8260820457
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: 5097082
Entity blame: KENAI'S HOUSE, INC
1 1

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 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).

SEa:oF T STATE OF CALIFORNIA
Office of the Secretary of State
;w
01 STATEMENT OF INFORMATION
o;

CA NONPROFIT CORPORATION
California Secretary of State
�q iFoaN`.P' 1500 11th Street
Sacramento, California 95814
(916) 657-5448
Entity Details
Corporation Name Kenai's House, Inc
Entity No. 5097082
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
31886 RED PINE WAY
TEMECULA, CA 92592
31165 TEMECULA PKWY
STE 350
TEMECULA, CA 92592
For Office Use Only
-FILED -
File No.: BA20241257402
Date Filed: 7/7/2024
Officer Name
Officer Address
Position(s)
0 Sharon C Harding
46491 SHARON STREET
Secretary, Chief Financial Officer
TEMECULA, CA 92592
0 Shareen V Harding
31886 RED PINE WAY
Chief Executive Officer
TEMECULA, CA 92592
Additional Officers
Officer Name
Officer Address
Position
Stated Position
Henry Harding
46491 SHARON STREET
Vice President
TEMECULA, CA 92592
Stephanie Mearse
45643 SEAGULL WAY
Other
Marketing and Public Relations
TEMECULA, CA 92592
Agent for Service of Process
Agent Name
Agent Address
Shareen V Harding
31886 RED PINE WAY
TEMECULA, CA 92592
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

Shareen V Harding
Signature
0710712024
Date

Page 1 of 1 ends

FY 25/26 Community Service Funding (CSF)
Grant Application
zo
MAH LY

COMMUNITY OUTREACH

PROTECTIVE SERVICES INC

Community Service Funding Application
The Heart of Southern California
Wine Country
Organization
https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Confirm
Applicant Organization Year Organization Website:

Name: Founded: www.mahly.org
MAHLY Community Outreach 2022
Protective Services, Inc
Mailing Address:*
Contact Name:*
Dr. Jessica CH Smith
Number of Paid Staff:* Number of Volunteers:*
0 35
Contact Email:* Contact Phone:*
[email protected] 951-704-0025
Alternate Contact Name: Alternate Contact Email: Alternate Phone:

Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? Southwest Riverside County
Yes No
Business License No.*
058753
Copy of Business License*
MALHY Business License.pdf 327.21 KB
https://css.temecuIaca.gov
Geographic Area(s) the Project/Program
Serves:

Temecula, CA (92590, 92591, 92592)

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Amount Requested:* Project/Program Title:*
$5,000.00 THRIVE WELLNESS MALHY Youth Financial Literacy MAX: $5,000 PER ORG
Start Date:* End Date: * Physical Address of Project/Program *

2025-09-06 2026-09-06
41000 Main St Temecula CA 92590
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Make Check Payable to:*
MALHY Community Outreach Services, Inc.

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
State of California Entity ID:
4862948
To find CA Entity Status Letter,
click the link below:
https://www.ftb.ca.gov/help/business/entity-
status-letter.asp?WT.mc_id=a kBEStatus
IRS Employer Identification Number (EIN):
880900274
To find IRS Deductibility Status,
click the link below:
https://apps.irs.gov/app/eos/
Date of Incorporation:
03/21/2022
Attach State of California Entity Status Letter:*
MALHY Articles of Incorporation.pdf
Attach IRS Deductibility Status:*
MALHY 501 C3 Status.pdf
Provide further verification as follows:
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) 759.37KB
762.36KB

Attach First Page of Most Recent Form 990*
You might find IRS Form 990
on the link below:
https.//rct.doj.ca.gov/Verification[Web/Search.aspx?
facility=Y
State Registry Search Tool:
https://rct.doj.ca.gov/Verification/Web/Search.aspx ?
facility=Y
Application Authorization
MALHY 990-N.pdf
(990, 990-EZ, 990-PF, 990-T)
Attach State Registry Document/Info*
MALHY State Registry Document .html
294.14KB

25.34KB
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?
Yes No
Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization?
Yes No
This Application has been authorized by the organization's: * Executive Committee Board of Directors Members -at -Large Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* M.A.L.H.Y. (MALHY Community Outreach Protective Services Inc.) is dedicated to providing comprehensive support services to vulnerable individuals and families in our community. Our mission encompasses four core areas: Mental Health support through counseling and mediation services; Addiction recovery programs includingjob placement, housing, food, and clothing assistance; Love - centered services that foster meaningful connections; and Human trafficking victim support including medical exams, legal document preparation, job placement, and housing assistance.

Additionally, we are committed to Youth literacy through financial workshops, etiquette classes, and sports camps. Our free Radical Change Program offers interactive workshops and expert -led discussions on vital topics such as online grooming, sextortion, addiction prevention, financial literacy, and safety both online and offline.

Our organization's primary objective is to create lasting positive change in the lives of those we serve, with particular focus on preventing suicide among teenagers, supporting human trafficking survivors, and empowering youth through education and life skills development. We partner with cities, counties, and schools to bring our impactful programs directly to communities where they are needed most.

MALHY is needed and very unique.

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 TO DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW. Understand Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other *
sources of funding from the City of Temecula?
Yes No
Project/Program Description

RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE

ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. Understand
Project/Program Title: THRIVE WELLNESS MALHY Youth Financial Literacy

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* This Temecula grant funding will support M.A.L.H.Y.'s Youth Literacy program, specifically our Financial Workshops component. These workshops are designed to provide essential financial education to young people in the Temecula community, teaching practical money management skills including budgeting, saving, financial responsibility, and economic planning.

The Financial Workshops are part of our comprehensive Youth Literacy initiative, which also includes Etiquette Classes and Sports Camps. These workshops address the critical gap in financial education that many young people face, providing them with the foundational knowledge and skills needed to make informed financial decisions throughout their lives.

The program will be delivered through interactive, engaging sessions that make financial concepts accessible and relevant to youth participants. By focusing on practical, real -world applications, these workshops empower young people to develop healthy financial habits early in life, setting them up for future success and economic stability.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

If awarded, M.A.L.H.Y. will utilize the grant funding to enhance our Youth Financial Literacy Workshops for Temecula participants in the following areas:

Educational Speakers and Instructors: Hire qualified financial literacy professionals and expert guest speakers to lead workshops and provide specialized instruction on budgeting, saving, and financial responsibility.

Educational Materials and Take -Home Resources: Purchase financial literacy books for each participant to take home, along with workbooks, worksheets, calculators, and other educational materials that reinforce the workshop content and allow continued learning beyond the sessions.

Program Supplies: Acquire visual aids, presentation materials, and interactive learning tools needed to deliver engaging and effective financial education workshops.

Refreshments: Provide meals and snacks during workshop sessions to create a welcoming learning environment where participants can focus on the educational content without distraction.

Marketing and Community Outreach: Develop promotional materials and conduct outreach efforts to ensure maximum participation from Temecula youth and families, including flyers and community engagement activities.

These expenditures will directly support the delivery of comprehensive financial literacy education to Temecula youth, providing them with both immediate learning experiences and lasting resources for continued financial education.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

This grant funding directly benefits Temecula residents by providing essential financial literacy education to local youth who will become the community's future workforce, business owners, and civic leaders. By teaching practical money management skills including budgeting, saving, and financial responsibility, we are investing in the long-term economic stability and prosperity of Temecula.

Temecula youth who participate in these workshops will develop critical life skills that help them avoid financial pitfalls, make informed economic decisions, and contribute to a stronger local economy.

Financially literate residents are more likely to become homeowners, start businesses, and participate actively in community economic growth.

The program specifically serves Temecula residents living in zip codes 92590, 92591, and 92592, ensuring that City funding directly impacts local families. Participants receive take-home resources, including financial literacy books and materials, extending the program's impact beyond the workshop sessions into their daily lives and families.

By addressing the critical gap in financial education that many young people face, this program helps create a more financially responsible and economically stable generation of Temecula residents, ultimately strengthening the entire community's economic foundation and reducing future financial stress on local families.
3b. ESTIMATED NUMBER OF PEOPLE FROM

TEMECULA EXPECTED TO BENEFIT FROM
THIS PROJECT/PROGRAM:
320
3c. ESTIMATED NUMBER OF VOLUNTEERS
* INVOLVED IN THIS PROJECT/PROGRAM:
10 4. SUMMARY STATEMENT — SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* This grant supports M.A.L.H.Y.'s Financial Workshops for Temecula youth, funding qualified speakers, educational resources, and take-home books. The program teaches budgeting, saving, and financial responsibility to local residents in zip codes 92590-92592, developing critical life skills that strengthen individual families and contribute to Temecula's overall economic health.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* $5,000.00
Amount contributed to the Project/Program by the Applicant Organization $3,000.00
Other grants or funding already awarded for Project/Program, if any $0.00
In -Kind match amount or volunteer credit hours estimated amount $1,900.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment* EXPENSES*
Calculators, presentation equipment, visual aids $1,200.00 Facilities/Rent/Insurance*
N/A $0.00
Supplies*
Take-home books, workbooks, educational materials, worksheets $1,840.00 Services *
Financial literacy instructors and expert speakers $1,500.00 Food*
Snacks, lunch and refreshments $1,000.00
Other (i.e. Marketing, etc)*
Marketing flyers, digital billboard advertising $250.00

Staffing Expense
TOTAL REVENUE:
$9,900.00
Compliance

TOTAL EXPENSES
$5,790.00
$0.00
If your organization is awarded a Community Service Funding Grant in Fiscal Year 2025-2026 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2025, and June 30, 2026.

In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation mayjeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds.

To substantiate that Fiscal Year 2025-2026 funds received from the City were spent appropriately, proper back-up documentation including the report (in the link below) with accompanying receipts/invoices, must be submitted to the City on or before due date: Monday, September 15, 2026.

CHECK THE BOX TO CONFIRM
Confirm
Acknowledgement/Signature
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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:* Requested Amount:

MAHLY Community Outreach Protective Services, $5,000.00 Inc
President/Authorized Officer:* E-mail: *
Phone: *
DR JESSICA SMITH [email protected] 9517040025 President/Authorized Officer Signature* Submission Date:
2025-08-13 02:55:22 PM
IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY:

Name, Title, & Organization
If you have any questions, please contact:

[email protected] (951) 693-3959 or
Stacey. [email protected] (951) 694-6413

Department of the Treasury
o.t.:

Revenueand
osrzn2o22
TeX ExemP Government Entitles
lainternal Ex
Employs, ID numwr:
l�P.O. Box 2508
88-0900274
Cincinnati, OH 45201
P.Ma" to, contact
Name: Customer Services
ID number. 31954
Telephone: (877) 829-5500

MALHY COMMUNITY OUTREACH PROTECTIVE
Abe ... un9 P^N^d.pol09:

SERVICES INC
December 31
27475 YNEZ RD STE 254
Public ch.ray atrtua:

TEMECULA, CA 92591
509(a)(2)
Form 9901990-EZ / 990d1 rpuhed:

Yes
Ea.caw d.% af.A.mP11Pn:

March 21, 2022
-
Co,obutlon decuoebilNy:
- - -'-
Yes
A id.ndum .PPU-:

No
DLN:
26053536005172
Dear Applicant:

We're pleased to tell you we determined you're exempt frgm.federsHi come tax under hmemal 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 be your exempt status. Please keep it for your records. as either public charities or private
Organizations exempt under IRC Section 501(c)(3) are further classified 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 Fonn 990/99o-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). )f 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, 90 to www,'rs.gov/charities.

Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements.

Sincerely,
' - .-Stephen. A., Martin., - -
Director, Exempt Organizations
Rulings and Agreements
Letter 947 (Rev. 2-2020)
Catalog Number 35152P

SEA:F Ty.. STATE OF CALIFORNIA
s9a, Office of the Secretary of State

STATEMENT OF INFORMATION

CA NONPROFIT CORPORATION
California Secretary of State
----- 1500 11th Street
Sacramento, California 95814
(916) 657-5448
Entity Details
Corporation Name
Entity No.

Formed In
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
For Office Use Only
-FILED -
File No.: BA20241548286
Date Filed: 8/27/2024

MALHY COMMUNITY OUTREACH PROTECTIVE
SERVICES, INC.
4862948

CALIFORNIA
27475 YNEZ RD
STE 254
TEMECULA, CA 92591
27475 YNEZ ROAD SUITE 254
TEMECULA, CA 92591
Officer Name
Officer Address
Position(s)

JESSICA CH SMITH
39703 BONAIRE WAY
Chief Executive Officer
MURRIETA, CA 92563
JoyCelina V Smith
39703 BONAIRE WAY
Secretary, Chief Financial Officer
MURRIETA, CA 92563-4002, CA 92563
® The entity's bylaws allow the CEO (President) to be the Secretary or CFO (Treasurer).

Additional Officers
Officer Name Officer Address Position Stated Position
None Entered
Agent for Service of Process
Agent Name
Agent Address

JESSICA CH SMITH
27475 YNEZ ROAD SUITE 254
TEMECULA, CA 92591
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

JESSICA SMITH
Signature
0812712024
Date

Page 1 of 1 ends

11111M_ n _rx)N
ARTS-PB- 4 8 6 2 9 4 a
Secretary of State 501(c)(3)
Articles of Incorporation of a
Nonprofit Public Benefit Corporation
IMPORTANT— FILED
Read Instructions before rnmplating thin form. Secretary Of State Filing Fee - 30.00 State of Caflomia
Copy Fees - First pagttch attachm
Certification F -55.00 a aa.5o MAR 21 2022a�-`'s'
Note: A separate California Franchise Tax Stuart] application Is required to \E'L obtain tax exempt status. For more Information, go to b.cag a. ovv. 'I/Q�This Space For Office Use Only

1. Corporate Name(Go104Yww.soscaoov/businessfbanamkmsgwgt efar9enemlcorporatenamemquimmenfaandr.Wotlons.) The name of the corporation is MALHY COMMUNITY OUTREACH PROTECTIVE SERVICES, INC. e•InitlalShaet Addmm al Coryoratlan-po not enlace P.0.8az city (no ebbrevleibna)
state
Zip Cade
27475 YNEZ ROAD, SUITE 254

TEME VLA
CA
92591
b. Initial Mmnne Address of Corporation, If afferent than Item Ra City(no abbreviefo..
state
Z1p Coda

3. Service Of Process (Must provide either IndlN ual OR Corporation.) a, ...... ..n -. fat names and colfdmie street address.

F. Calfdrnia Agenfa First Name of agent b not a coipomtlm) Middle Neme
CH
Lent Name
SMITH
suffix
b.Sbea AddmasfdaaentlenNecom 0m)-Donetenbra P.D.Sox
27475 YNEZ ROAD SUITE 254
a fnoabbrwlilona)

TEMECULA
state
CA
zip Cade
92591
CORPORATION -complete Irani unly troupe me name of uw nei—ou agem wryuou. c. Califomia ex cured Coryaate Agenre Name(Insert Is a comomflon)- Po not complete item 3a or 31, mat Viz: Vne or tom apses muw.a c„wneu.

4. Purpose Statement Item tb: it etblle pio se. 1. cheduad In purpose Ien a, )r if you Intend to apply for tax-exempt staWS In California, you it
a. This corporation Is a nonprofit public benefit corporation and Is not organized for the private gain of any person. It Is organized under the rvonprofit Public Sarah Corporation Law for. ©✓ public purposes. 2 Charitable purposes. b. The specific purpose of this corporation is to provide mental health counseling and educational Programs for youth .

5. Additional Statements
a. This corporation is organized and operated exclusively for the purposes set forth In Article 4 hereof within the meaning of Internal Revenue Code section 501(c)(3).
b. No substantial part of the activldes of this corporetlon shall consist of carrying on propaganda, or otherwise attempting I, Influence feg(sladon, and this corporation shall not participate or Intervene In any political campaign (Including the publishing or distribubon of statements) on behalf of any candidate for publigo(gce.': j c. The property of this corporation Is Irrevocably dedicsted to the purposes in Article 4 hereof and no part of the net income or assets of this corporation shall ever Inure to the benefit of any -director, officer or member thereof or to the benefit of any private person. d. Upon the dissolution or winding up of this corporetionr(ts assets remaining after payment, or provision for payment, of all debts and liabilities of this corporation shall be distributed to a'nonproflt fund, foundation or corporation which is organized and operated exclusively for Charitable, educational and/or religious purposes and which has established Its tax-exempt status under Internal RevenueCode section 501 fclt31_
rM* corm must be signed by each Incorporator. See Instructions. Do not include a fifie.)

JESSICA CH SMITH
Type or Print Name
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0 FY 25/26 Community Service Funding (CSF)
Grant Application
zi

MICHELLE'S PLACE

CANCER RESOURCE CENTER

� Community Service Funding Application
(rke +ica. t of S— t hc— Cup i fo https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Applicant Organization
Name:

Michelle's Place Cancer
Resource Center
Mailing Address:*
41669 Winchester Rd 101
Temecula, CA 92591
Contact Name:*
Kim Gerrish
Contact Email:*
[email protected]
Year Organization
* Founded:
2001
Number of Paid Staff:*
10 Website:
* www.michellesplace.org
Contact Title:*
Executive Director
Contact Phone:*
9516995455
Number of Volunteers:*
161 2-1
Alternate Contact 'Name: Alternate Contact Email: Alternate Contact Phone:

Amber Berkey [email protected] 9516995455
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? Michelle's Place Cancer Resource Center Business License No.*
036098
Copy of Business License*
Business Lieencse 2025.jpg 174.43KB
*
Geographic Area(s) the Project/Program Serves:*
Temecula

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$S,000,00
MAX: $5,000 PER L RG
Start Date:*
2025-08-01
ProjectlProgram Title:*
Purple Ribbon Assistance for cancer patients
End Date:*
2026-06-30
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
41669 Winchester Rd Suite 101 Temecula, CA 92591
Make Check Payable to:*
Michelle's Place Cancer Resource Center

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
State of California Entity ID:*
2267780
To find CA Entity Status Letter,
click the link below:
https://www.ftb.ca.gov/help/business/entity-
status-letter.asp?WT.mc_i d=a kB ESaatus
Provide further verification as follows:*
Date of Incorporation:*
11/01/2001
Attach State of California Entity Status Letter:*
Entity Letter State of CA (1). pdf
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Too] (link below) Attach First Page of Most Recent Form 990*
You might find IRS Form 990 2023 990.pdf
on the link below: (990, 990-EZ, 990-PF, 990-T)
h tt ps. //rct. d o j.ca.govNe rifi c at io n/web/Sea rc h. a s px? facility YY
370.52KB
MEMO]

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* Michelle's Place Cancer Resource Center is a nonprofit organization dedicated to ensuring that no one faces cancer alone, providing no cost programs and services including navigation, support groups, behavioral health, education, and wellness activities.

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGETIFINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT MAY BE NEEDED TO Understand DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
ye,q k

NAME OF PROGRAM/PROJECT

FUNDED BY THE CITY GRANT

OR SPONSORSHIP
Purple Ribbon
Assistance
BEautiful You
AMOUNT:*
$S,000.00
$S,000.0g
MONTH +YEAR FUNDING

RECEIVED
2023
2024

NAME OF CITY GRANTOR

SPONSORSHIP
CFS Grant
CFS Grant

Project/Program Description

RECEIPTSIINVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE Understand PROJECTIPROGRAM AS DESCRIBED HERE.

Project/Program Title: Purple Ribbon Assistance for cancer patients

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* The grant will support Temecula residents undergoing active cancer treatment and their families by providing grocery gift cards as they are unable to work during treatment, creating financial strain and uncertainty about meeting basic needs. This program ensures they have consistent access to food and nutrition, helping to ease their burden and support their well-being throughout their cancerjourney.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY. 100% of the grant funds will be restricted to direct client assistance through the purchase of grocery gift cards for Temecula residents in active cancer treatment and their families.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

This grant funding will directly benefit Temecula residents undergoing active cancer treatment and their families by providing grocery gift cards to ensure reliable access to food during a time when many are unable to work. In addition to supporting local families, the funds will be spent at grocery stores and businesses within Temecula, keeping the dollars in the community and strengthening the local economy. 3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJECTIPROGRAM:

PROJECTIPROGRAM:
125

4. SUMMARY STATEMENT— SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* Michelle's Place CRC will provide grocery gift cards to Temecula residents in active cancer treatment and their families, ensuring access to food during a time of financial hardship. All funds will be spent locally, directly assisting patients while also supporting Temecula businesses and strengthening the community.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $5,000.00
*
Amount contributed to the Project/Program by the Applicant Organization $20,000.00
*
Other grants or funding already awarded for Project/Program, if any $1 QO,OQa.00
Stater Bros Charities
*
In -Kind match amount or volunteer credit hours estimated amount $2,500.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment* EXPENSES*
NIA $0.00
Facilities/Re ntf l nsuira nce *
NIA $0.00
*
Supplies*
$1,500.00
Postage, office supplies
Services*
Patient Navigation, Application Assistance $30,000.00
Food*
Thanksgiving and Christmas food boxes $6,000.00
Other (i.e. Marketing, etc)*
$90,000.00
Grocery gift cards
Staffing Expense
$ Q.00
TOTAL REVENUE: TOTAL EXPENSES
$127,S00.00 $127,500.00

CHECK THE BOX TO CONFIRM
Confirm

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
Michelle's Place Cancer Resource Center
President/Authorized Officer Name:*
Kim Gerrish
E-mail:*
[email protected]
President/Authorized Officer Signature*
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Ttle: *
Executive Director
Phone:*
951699S455
Submission Date:
2025-09-14 12:38:36 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

IF DIFFERENT THAN ABOVE, APPLICATION PREPARED BY:

Jennifer Evans, Program Manager, Michelle's Race Cancer Resource Center Name, Title, & Organization
If you have any questions, please contact: [email protected] (951 ) 693-3959 or [email protected] (951) 694-6413

STATE OF CALIFORNIA

FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 8/28/2025
ESL ID: 8478895890
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: 2267780
Entity Name: MICHELLE'S PLACE CANCER RESOURCE CENTER
1 1

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.

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).

SEa:oF T STATE OF CALIFORNIA
Office of the Secretary of State
;w
01 STATEMENT OF INFORMATION
o;

CA NONPROFIT CORPORATION
California Secretary of State
�q iFoaN`.P' 1500 11th Street
Sacramento, California 95814
(916) 657-5448
For Office Use Only
-FILED -
File No.: BA20241983816
Date Filed: 11/8/2024
Entity Details
Corporation Name MICHELLE'S PLACE CANCER RESOURCE CENTER Entity No. 2267780
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
41669 WINCHESTER RD.
101
TEMECULA, CA 92590
41669 WINCHESTER RD
101
TEMECULA, CA 92590
Officer Name
Officer Address
Position(s)
Leslie Doherty
41669 Winchester Rd
Chief Financial Officer
Temecula, CA 92590

KIMBERLY ANN GERRISH
41669 WINCHESTER RD
Chief Executive Officer
TEMECULA, CA 92590
Cyndi Light
41669 WINCHESTER RD.

Secretary
101
TEMECULA, CA 92590
® The entity's bylaws allow the CEO (President) to be the Secretary or CFO (Treasurer).

Additional Officers
Officer Name Officer Address Position Stated Position
None Entered
Agent for Service of Process
Agent Name
Agent Address

MARILYN WATSON
41669 WINCHESTER RD
101
TEMECULA, CA 92590
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

Kimberly Gerrish
Signature
1110812024
Date

Page 1 of 1 ends

FY 25/26 Community Service Funding (CSF)
Grant Application
zz

M I LVET

Aft
Community Service Funding Application

C Z'O'Z'
Wino Cou try
Organization
https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Confirm
Applicant Organization Year Organization
*
Name: (Founded:

M+Vet---------------- 2016
Storefront: 33040 Antelope Road #114 Murrieta, CA 92563 - Mailing Address: * Number of Paid Staff:*
Website:
*
www.milvet.org
Number of Volunteers: *
0 25
PO Box: 30777 Rancho California Road #892521 Temecula, CA 92591 Contact Name:* Contact Title:

Raven L Hilden CEO
Contact Email:*
[email protected]
Contact Phone:*
951-902-9681
Alternate Contact Name: Alternate Contact Email: Alternate Contact Phone:

Does the nonprofit have a current City of Geographic Area(s) the Organization Serves:* *
Temecula Business License? Temecula Valley, CA
Yes No
Business License No.*
052609
Copy of 'Business License*
Temecula Business License 2025.pdf
https://css.temeculaca.gov

93.56KB
Geographic Area(s) the Project/Program Serves:*
Temecula
*

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$5,000,00
MAX: $5,000 PER L RG
Start Date:*
2025-09-01
ProjectlProgram Title:*
Active & Deployed Military Families in Temecula
End Date:*
2026-01-01
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
30875 Rancho Vista Rd, Temecula, CA 92592
Make Check Payable to:*
MiNet

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
State of California Entity ID:*
3958913
To find CA Entity Status Letter,
click the link below:
https://www.ftb.ca.gov/help/business/entity-
status-letter.asp7VVT.mc_i d=a kB ESaatus
IRS Employer Identification Number (EIN):
37-1841663
To find IRS Deductibility Status,
click the link below.
https://a pps.irs.gov/a pp/eos/
Date of Incorporation:*
10/30/2016
Attach State of California Entity Status Letter:*
CA State Entity Status Letter 2023.pdf
Attach IRS Deductibility Status:*
MilVet 501c3.pdf
Provide further verification as follows:*
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) Attach First Page of Most Recent Form 990*
You aright find IRS Form 990 99EZ2024 MilVet Pg1.pdf
on the link below: (990, 990-EZ, 990-PF, 990-T)
https-//rc.t.doj.ca.gov/Verification/Web/Search.asp2L?
fac RMYY
370.06KB
209.41 KB

39.44KB

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* MilVet is a dedicated nonprofit organization founded in 2016, with the mission to support military personnel, veterans and their families through direct aid, advocacy, and community engagement. Over the past 8 years, MilVet has established itself as a trusted partner in serving those who serve our country.

MilVet has been recognized for their dedication to serving veterans and military members in the community. Recognition includes Nonprofit of the Year 2022 by the California State Assembly District 67, Nonprofit of the Year in 202S by the Temecula and Lake Elsinore Chamber of Commerce. Founder/CEO Raven Hilden was Woman of the Year for Riverside County District 3 in 2024.

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGETIFINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA's AUDIT MAY BE NEEDED TO Understand DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
Yes k

Project/Program Description

RECEIPTSIINVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE Understand PROJECTIPROGRAM AS DESCRIBED HERE.

Project/Program Title: Active & Deployed Military Families in Temecula

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* The Monthly MilVet Military Care Package Program is a vital initiative dedicated to supporting deployed military personnel by providing them with essential items, comfort, and a morale boost during their service abroad. Each month, the program assembles and ships customized care packages that include a variety of practical and morale -enhancing contents such as non-perishable snacks, hygiene products, entertainment items, personalized notes, and other necessities tailored to the needs of deployed troops.

The overarching goal of the program is to demonstrate ongoing appreciation and support for service members, enhance their well-being, and foster a sense of connection to home. By coordinating partnerships with local businesses, community organizations, and volunteers, MilVet ensures that each package is delivered efficiently and consistently, reaching service members regardless of location. The program not only provides tangible support but also serves to boost morale, reduce feelings of isolation, and reinforce the community's commitment to those who serve.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

The grant funding will be used to support active duty deployed service members and veterans in Temecula with military care package support and emergency food assistance. Funding will be spent in the City of Temecula and will provide military families access to food, snacks, nutritious supplies, hygiene items and letters of support.

Funded in part by grants, the Monthly MilVet Military Care Package Program aims to expand its reach, increase the number of deployed troops served, and improve the quality and diversity of donated items.

Through this initiative, we honor our service members' dedication and sacrifice by delivering a tangible reminder of home and community support during their deployment.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

Temecula military members and their families benefit from the services as it provides critical food and hygiene supplies to deployed troops and families in need. Not only do they receive items, they are also screened and introduced to resources in the community and access to programs aimed at sustainability such as access to accredited assistance with filing for VA benefits, state benefits and employment assistance post deployment. This creates a stronger economic community and opportunities for our military families to thrive in Temecula.
3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJ ECTIPROG RAM:

PROJECTIPROGRAM:
300
1,000

4. SUMMARY STATEMENT— SUMMARIZE ANSWERS 1 — 3 ABOVE IN 50 WORDS OR LESS.* The Military Care Package and Veteran Support Program provides access to nutritious food items, snacks, hygiene supplies and support, boosting morale and support for military families in the City of Temecula.

The funding will be used to purchase items in the City of Temecula for Temecula military families to ensure economic stability, volunteer opportunities and the ability to honor our brave men and women who serve our nation.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $ 5, DOD. D 0
*
Amount contributed to the Project/Program by the Applicant Organization $10,000.00
*
Other grants or funding already awarded for Project/Program, if any $4,700.00
Shipping sponsors
*
In -Kind match amount or volunteer credit hours estimated amount $12,500.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment* EXPENSES*
0 $ 0.00
*
Facilities/Rentflnsuirance *
$4,500.00
Rent
*
Supplies*
$1,200.00
Shipping supplies
*
Services*
Shipping $16,000.00
*
Food*
Care package supplies $10,000.00
*
Other (i.e. Marketing, etc)*
$5DD.00
Marketing
*
Staffing Expense
$0.00
TOTAL REVENUE: TOTAL EXPENSES
$32,200.00 $32,200.00

CHECK THE BOX TO CONFIRM
Confirm

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
Mi IVet
President/Authorized Officer Name:*
Raven Hilden
E-mail:*
[email protected]
President/Authorized Officer Signature*
<5;ear 4t, `W1 �r-1.r7`14f
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
CEO
Phone:*
951-902-9681
Submission Date:
2025-09-12 09:39:57 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

STATE OF CALIFORNIA

T )FRANCHISE TAX BOARD
BPO BOX 942857
SACRAMENTO CA 94257-0540
Entity Status Letter
Date: 9/2/2025
ESL ID: 5862392455
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 3958913
Entity Name: MILVET
�✓

1. The entity is in good standing with the Franchise Tax Board. ❑

2. The entity is not in good standing with the Franchise Tax Board. �✓

3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑

4. We do not have current information about the entity.

5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process.

Important Information
• This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1).
• The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b).

10 Department of the Treasury
Internal Revenue Service
Aare:

Tax Exem t and Government Entities
P
August 20, 2021
(ry
IR ` PO Box 2508
Employer 10 number:
1W Cincinnati, OH 45201
37-1841663
Form 990 required:
990, YES
Person to contact:

MILVET
Name: S Lenard

RAVEN L HILDEN
ID number: 0203196
30777 RANCHO CALIFORNIA RD 892521
TEMECULA, CA 92589
Dear Sir or Madam:

We're responding to your request dated August 16, 2021, about your tax-exempt status.

We issued you a determination letter in December 2016, 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 Section 509(a)(2).

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, weindicated whether you must file ao annual information return. If you're required to file a return, you must file one of the following by the 15th day of the 5th month after the end of your annual accounting period. • Form 990, Return of Organization Exempt From Income Tax • Form 990-EZ, Short Form Return of Organization Exempt From Income Tax • Form 990-N, Electronic Notice (e-Postcard) for Tax -Exempt Organizations Not Required to File Form 990 or Form 990EZ
• Form 990-PF, Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation According to IRC Section 60330), if you don't file a required annual information return or notice for 3 consecutive years, we'll revoke your tax-exempt stains on the due date of the 3rd required remm or notice.

You can get IRS forms or publications you need from our website at www.irs.gov/forms-pubs or by calling. 800-TAX- FORM (800-829-3676).

If you have questions, call 877-829-5500 between 8 a.m. and 5 p.m., local time, Monday through Friday (Alaska and - Hawaii follow Pacific time).

Thank you for you cooperation
Sincerely,
< a-. snec4aZ,
Stephen A. Martin
Director, Exempt Organizations Rulings and Agreements
Letter 4168 (Rev. 09.2020)
Catalog Numper 66666G

BUSINESS LICENSE CERTIFICATE
The re, fine or mnmation nametl berm is hereby reelect Ms artifiale brumare ore gouisions of Me al, Business HausaIX inerces of Me CM of Temecula California) to engage in, any on or conduct, in McCM1y of Temecula, Caldania, Me businere, bade, alPog, profusion. rehibmon or occupation described helm for Me paiotlindafed Th's license is pemis4on only, and is clued sibro tvesifiss& n Nat Me 4cerse is subject fo memno hen licensing by the aree of Cafforoia: nor sear wtlu issuance be deemed aenaiver of Me City of Terrea�a of pal afiuMe violadore of su li laves ou ordnances.

BUSINESS NAME: Milvet
BUSINESS LOCATION: 33040 Antelope Rd, 114, Murrieta, CA 92563 BUSINESS OWNER: Raven L Hilden
MILVET
33040 ANTELOPE RD, 114
MURRIETA, CA 92563

CITY OF TEMECULA
Finance Department
41000 Main Street
Temecula, CA 92590
DESCRIPTION: Nan -Profit
Business License Number: 052609
License Fee: $35.00
Effective Date: October 12, 2024
Expiration Date: January 31, 2026
Fees paid in accordance with City Ordinance

SEA:F Ty.. STATE OF CALIFORNIA
s9a, Office of the Secretary of State

STATEMENT OF INFORMATION

CA NONPROFIT CORPORATION
California Secretary of State
----- 1500 11th Street
Sacramento, California 95814
(916) 657-5448
Entity Details
Corporation Name MILVET
Entity No. 3958913
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
33040 ANTELOPE RD
114
MURRIETA, CA 92563
33040 ANTELOPE RD
114
MURRIETA, CA 92563
Raven Hilden
For Office Use Only
-FILED -
File No.: BA20241392168
Date Filed: 7/30/2024
Officer Name
Officer Address
Position(s)
Jackie Aponte
33040 ANTELOPE RD
Secretary
114
MURRIETA, CA 92563
© Raven Hilden
33040 ANTELOPE RD
Chief Executive Officer
114
MURRIETA, CA 92563
Mayra Lewis
33040 ANTELOPE RD
Chief Financial Officer
114
MURRIETA, CA 92563
Additional Officers
Officer Name
Officer Address
Position
Stated Position
© Sandy Word
33040 ANTELOPE RD
Chairperson of Board
114
MURRIETA, CA 92563
Agent for Service of Process
Agent Name
Agent Address

RAVEN HILDEN
30060 MERRICK LANE
MENIFEE, CA 92584
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Page 1 of 2 ends

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

Raven Hilden 0713012024
Signature Date
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Page 2 of 2 ends

FY 25/26 Community Service Funding (CSF)
Grant Application
23 MOTHERHOOD STEPS

53 Community Service Funding Application
, 4e
rhe+scartaFSo. thernC.hF., l
Wines Country
Organization
https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Applicant Organization Year Organization Website:
* *
Name: Founded: www.motherhoodsteps.org
Motherhood Steps 2021
Mailing Address:*
44731 Corte Gutierrez
Temecula CA 92592
Contact Name:*
Nikia Ellis
Contact Email:*
[email protected]
Number of Paid Staff:*
0 Contact Title:*
president
Contact Phone:
8589225133
Number of Volunteers:*
10 Alternate Contact Name: Alternate Contact Email: Alternate Contact Phone:
motherhoodstep2021 @gmail.com
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? community of Temecula
ko
A current City of Temecula Business
License may be required to submit prior to
fund disbursement.

Understand
*
Geographic Area(s) the Project/Program Serves:*
city of Temecula

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$S,000.00
MAX: $5,000 PER L RG
Start Date:*
2026-01-01
ProjectlProgram Title:*
Steps of support essentials
End Date:*
2027-06-01
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
44731 Corte Gutierrez Temecula CA 92592
Make Check Payable to:*
Nikia Ellis

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

0.tif
Provide further verification as follows:*
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) You aright find IRS Form 990
on the link below:
https-//rc.t.doj.ca.gov/Verification/Web/Search.asp2L?
facility=Y
Attach First Page of Most Recent Form 990*
Tax Exempt Organization Search Details _ Internal Revenue Service (1).pdf
(990, 990-EZ, 990-PF, 990-T)
HA71110

12.99M B

24.87KB

Mission Statement
Briefly describe the nonprofit organization's mission/goals and objectives:* Motherhood Steps is dedicated to assisting mothers in reaching self sufficiency by providing an array of resources to further enhance stability within communities.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
Yes k

Project/Program Title: Steps of support essentials

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* Motherhood Steps' Steps of Support Essentials Program will provide non-food essentials to low-income families led by mothers in the Temecula area. Each family will receive a Base Essentials Kit (toiletries, toilet paper, new underwear and socks, one basic clothing item, a pair of shoes, and packaging); families with infants identified during intake will receive a Baby Add -On (diapers, wipes, baby wash, and a onesie).

The $5,000 grant will fund procurement of items, part-time program coordination, short-term storage, volunteer packing events, distribution (pick-up/delivery) and minimal admi contingency. This short-term pilot will meet immediate needs, restore dignity, and connect families to local resources and referrals.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRAFT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

If awarded, Motherhood Steps will use the $5,000 Temecula Grant • Direct supplies — $3,06S
• Purchase 50 Base Essentials Kits (toiletries, toilet paper, new underwear & socks, one basic clothing item, one pair of shoes, packaging) and budget for approximately 20 Baby Add-Ons (diapers, wipes, baby wash, onesie) to be provided based on intake -identified need. • Program coordination & operations — $1,540
• Part-time program coordinator to manage procurement, intake, volunteer coordination, packing events, and distribution ($900).
• Transportation/delivery costs (fuel/small rental) $250. • Short-term storage rental (2 months) $1 SO.
• Volunteer support (snacks, PPE) and outreach/printing/text reminders $240. • Admin & contingency — $395
• Small admin allocation for insurance/accounting/banking fees $1 SO and contingencylunexpected expenses$245.

Total = $3,06S + $1,540 + $395 = $5,000.

These funds will directly enable procurement, safe assembly, and distribution of Essentials Kits (with baby add-ons as needed), support volunteer logistics, and cover essential coordination and minimal administrative costs.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

The Temecula Grant will directly benefit Temecula residents by funding a local pilot that provides non- food Essentials Kits to 50 low-income families led by families living in the Temecula area. These kits

address immediate needs like new underwear and socks, toiletries, a basic clothing item, shoes, toilet paper, and baby supplies when required reducing financial stress and protecting dignity for families who otherwise must choose between basics and other necessities.

Funding will be used to purchase most items from local retailers where possible, supporting Temecula small businesses, and to cover short term storage, a part-time program coordinator based locally, volunteer packing events, and distribution logistics within Temecula (pick-up sites and neighborhood deliveries). We will partner with Temecula referral organizations (schools, shelters, clinics, and social services) to identify recipients quickly and discreetly and to connect families to follow-up resources such as WIC, food assistance, and employment/referral services.

Concrete, local benefits include:
• Direct aid to 50 Temecula families (with -20 infant add-ons based on need). • Local jobs/engagement (part-time coordinator, volunteer opportunities far residents). • Strengthened community partnerships and referral pathways for ongoing support.. • Measurable outcomes reported back to the city: kits distributed, baby add-ons provided, volunteer hours, and basic client satisfaction.

In short, the grant enables immediate, dignity -preserving assistance to Temecula mothers and their children while strengthening local supports and economic activity. 3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJECT/PROGRAM:

PROJECTIPROGRAM:
s0

4. SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS.* Motherhood Steps, Steps of support program will provide 50 or more non food essentials kit (toiletries underwear, clothing, shoes and infant add on's as needed to Temecula families. The $5,000 grant will fund supplies, part time coordination, storage, packing, and local distribution directly reducing needs and connecting families to community resources.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $5,000.00
*
Amount contributed to the Project/Program by the Applicant Organization $2,000.00
*
Other grants or funding already awarded for Project/Program, if any $0.00
*
In -Kind match amount or volunteer credit hours estimated amount $0.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equiipment* EXPENSES*
plastic storge bins, dolly, label printer, tape dispensers $375.00 Facilities/Rentflnsurance *
$300.00
storage
Supplies*
essentials $2,900.00
Services*
$250.00
transportation, delivery cost, fuel
Food*
$100.00
snacks, water for volunteers
Other (i.e. Marketing, etc)*
$175.00
paper for flyers and printing
Staffing Expense
$900.00
TOTAL REVENUE: TOTAL EXPENSES
$7,000.00 $4,100.00

CHECK THE BOX TO CONFIRM
Confirm

Acknowledgement/Signature
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 50 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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
Motherhood Steps
President/Authorized Officer Name:*
Nikia Ellis
E-mail:*
[email protected]
President/Authorized Officer Signature*
f cox 6/r!r.v
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
President
Phone:*
8589225133
Submission Date:
2025-09-09 12:27:39 AM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

of the Treasury
Date:
raDepartment
Internal Revenue Service
02/16/2022
Tax Exempt and Government Entities
IRS P.O. Box 2508
Employer ID number:
87-3493543
Cincinnati, OH 45201
Person to contact:

Name: Customer Service
ID number: 31954
Telephone: 877-829-5500

MOTHERHOOD STEPS
Accounting period ending:
44731 CORTE GUTIERREZ
Dece m be r 31
TEMECULA, CA 92592
Public charity status:
509(a)(2)
Form 9901990-EZ 1990-N required:

Yes
Effective date of exemption:

October 29, 2021
Contribution deductibility:

Yes
Addendum applies:

No
DLN:
26053749002581
Dear Applicant:

We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records.

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,
,Q� a- • o, :r
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: 9/8/2025
ESL ID: 7823818110
Why You Received This Letter
According to our records, the following entity information is true and accurate as of the date of this letter.

Entity ID: 4805679
Entity blame: MOTHERHOOD STEPS
1 1

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. ❑

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).

SEa:oF--T STATE OF CALIFORNIA
Office of the Secretary of State
;w
o; 01 STATEMENT OF INFORMATION

CA NONPROFIT CORPORATION
' California Secretary of State
�q iFoaN`.P' 1500 11th Street
Sacramento, California 95814
(916) 653-3516
Entity Details
Corporation Name MOTHERHOOD STEPS
Entity No. 4805679
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office 44731 CORTE GUTIERREZ TEMECULA, CA 92592
Mailing Address of Corporation
Mailing Address
Attention
Officers
44731 CORTE GUTIERREZ
TEMECULA, CA 92592
For Office Use Only
-FILED -
File No.: BA20231759824
Date Filed: 11/17/2023
Officer Name
Officer Address
Position(s)

NIKIA ELLIS
44731 CORTE GUTIERREZ
Chief Executive Officer
TEMECULA, CA 92592
LaShundra Wigfall
4205 SE 26th Street
Secretary
Del City, OK 73115
Jerome Devereaux
2827 Drexel Street
Chief Financial Officer
Omaha, NE 68107
Additional Officers
Officer Name Officer Address Position Stated Position
None Entered
Agent for Service of Process
Agent Name
Agent Address
Nikia D Ellis
44731 CORTE GUTIERREZ
TEMECULA, CA 92592
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

Nikia Ellis
Signature
1111712023
Date

Page 1 of 1 ends

FY 25/26 Community Service Funding (CSF)
Grant Application
24 OMG YOUTH SPORTS

Aft
s Community Service Funding Application
(rke H—t of S—thc— CuIifo https://temeculaca.gov/grants

CHECK THE BOX TO CONFIRM YOU HAVE READ COMMUNITY SERVICE FUNDING GRANT PROGRAM POLICY (link above)
Applicant Organization
Name:

OMG Youth Sports
Mailing Address:*
819 N. Crescent Heights, Los
Angeles California 90046
Contact Name:*
Jonathan Owens
Contact Email:*
Year Organization
* Founded:
2017
Number of Paid Staff:*
J
Website:
www.omgsportsla.com
Contact Title:*
Executive Director
Contact Phone: *
Number of Volunteers:
1?
Alternate Contact Name: Alternate Contact Email: Alternate Contact Phone:

Rebecca Macksood [email protected]
Does the nonprofit have a current City of * Geographic Area(s) the Organization Serves:

Temecula Business License? California Statewide
ko
A current City of Temecula Business
License may be required to submit prior to
fund disbursement.

Understand
*
Geographic Area(s) the Project/Program Serves:*
Temecula

CSF GRANT MUST BE EXCLUSIVELY USED TO SERVE
TEMECULA.

Project/Program
Amount Requested:*
$S'000,00
MAX: $5,000 PER ORG
Start Date:*
2026-02-21
ProjectlProgram Title:*
Thrive360: Mindfulness and Movement in Temecula
End Date:*
2026-12-28
Preferred Payment Method:
(If grant is awarded.)
Check Mailed Check Picked Up
Electronic File Transfer
Physical Address of ProjectlProgram*
30875 Rancho Vista Road, Temecula California
Make Check Payable to:*
OMG Youth Sports

Nonprofit Status
Is the organization incorporated as a nonprofit?*
Yes No

IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING
Provide nonprofit status verification as follows:*
(one required, both preferred)
State of California Entity Status Letter
IRS Deductibility Status
IRS Employer Identification Number (ElN):
84-3019475
To find IRS Deductibility Status,
click the link below:
https://apps.irs.gov/app/eos/
Provide further verification as follows:*
Date of Incorporation:*
03/22/2022
Attach IRS Deductibility Status:*
IRS 501 c3 Dac.pdf
(one required, both preferred)
First Page of most recent IRS Form 990
Detailed info about your charity found on the State Registry Search Tool (link below) Attach First Page of Most Recent Form 990*
You might find IRS Form 990 IRS 2024 990 EZ copy.pdf
on the link below: (990, 990-EZ, 990-PF, 990-T)
httpL//rc.t.doj.ca.gov/Verification/Web/Search.asp2L?
facility!
144.75 KB
187.65KB

Mission Statement
Briefly describe the nonprofit organisation's mission/goals and objectives:* Mission 1 Goals & Objectives
OMG Youth Sports & Enrichment is a nonprofit organization committed to empowering youth of all abilities by providing inclusive, enriching, and movement -based programs. The organization believes every child deserves access to programs that nurture their physical, emotional, and creative development, regardless of financial status or special needs.

Key Objectives:

Inclusive Access: Ensure children with disabilities and neurodivergence can fully participate in tailored sports, enrichment, and wellness programs.

Skill Development & Confidence: Help youth build life skills, confidence, and emotional well-being through physical activity, teamwork, and creative exploration.

Eliminate Barriers: Remove access obstacles by offering financial aid, transportation, and flexible program models designed around participant needs.

Adventure & Enrichment: Inspire curiosity and self-expression through field trips, nature exploration, cultural activities, and hands-on learning experiences..

UPON REQUEST, COPIES OF THE ORGANIZATION'S CURRENT BUDGETIFINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), AND IF AVAILABLE CPA'S AUDIT, MAY BE NEEDED TO Understand DEMONSTRATE SOUND FINANCIAL MANAGEMENT. DO NOT SUBMIT NOW.

Funding Sources
Within the past two years, has your organization received (or is concurrently requesting) any other sources of funding from the City of Temecula?
Yes k

Project/Program Title: Thrive360: Mindfulness and Movement in Temecula

1. DESCRIBE THE PROJECT/PROGRAM THE TEMECULA GRANT FUNDING WILL SUPPORT.* Thrive360: Movement for Mental Health is a mobile, trauma -informed mental wellness initiative designed to meet the unique needs of underserved and neurodivergent youth ages 11-18. This inclusive program integrates physical activity, social -emotional learning, and mental health strategies through community - based pop-up sessions and short-term series hosted at local parks, libraries, and recreation centers.

The program is part of a larger statewide Thrive360 initiative that meets youth where they are —both physically and emotionally —by embedding culturally relevant and developmentally appropriate mental wellness supports in everyday environments. Sessions include movement -based wellness (yoga, stretching, dance), mindfulness practices (guided meditation, gratitude exercises), creative expression 0ournaling, art therapy), and group discussions led by trained facilitators. All activities are adapted for youth with disabilities, and caregivers or private therapists are welcome to attend alongside participants.

In Temecula, Thrive360 will be launched as a Saturday pop-up series or 3-session workshop, hosted at local venues like Ronald Reagan Sports Park or the Temecula Community Recreation Center. The goal is to provide a safe, welcoming space for local teens to reduce stress, build coping skills, and foster healthy connections —especially for those who may not otherwise access traditional therapy services. Each session includes healthy snacks, movement -based games, reflective exercises, and take-home wellness kits.

This grant will support program supplies, outreach, and participation for local youth. By bringing Thrive360 to Temecula, we hope to empower youth to manage their mental health through movement, connection, and joy.

2. DESCRIBE HOW THE ORGANIZATION WILL SPEND THE GRANT FUNDING, IF AWARDED.* ALSO, INCLUDE EQUIPMENT, SERVICES TO BE PURCHASED AND WHY.

If awarded, OMG Youth Sports & Enrichment will use the Temecula Community Service Grant to support the launch of the Thrive360: Movement for Mental Health program, a community -based initiative serving teens in Temecula through inclusive, trauma -informed movement, mindfulness, and wellness activities.

The grant funding will be spent in the following ways:

Program Supplies - Funds will cover essential materials such as yoga mats, stretch bands, mindfulness journals, fidget tools, art therapy materials, and wellness kits. These tools are critical for creating an inclusive and sensory -friendly environment, especially far youth with ADHD, anxiety, and other neurodiverse needs.

Workshop Delivery Costs - This includes healthy snacks for participants, setup items like portable mats and adaptive seating, printing of visual schedules and activity handouts, and light materials for pop-up sessions in community parks or wellness spaces.

Community Outreach & Registration - A small portion of the budget will support the design and printing of flyers, outreach to local schools and service providers, and preparation of registration packets to ensure equitable access for low-income families.

Program Oversight - The Program Director will oversee the planning and delivery of all Thrive360 sessions in Temecula, including volunteer coordination, parent communication, logistics, and compliance with grant reporting requirements. While no grant funds will be used for salaries, the Program Director's leadership will ensure quality and accountability across all aspects of the program.

All expenditures will strictly comply with the City ofTemecula's funding guidelines. Receipts, detailed narratives, and a full report on how the funds benefitted local youth will be submitted as required.

3. EXPLAIN HOW THIS GRANT FUNDING SPECIFICALLY BENEFITS TEMECULA RESIDENTS.* TEMECULA RESIDENTS MUST BENEFIT FROM THIS PROGRAM/PROJECT IF AWARDED CITY FUNDING.

The Thrive360: Movement for Mental Health initiative will directly serve Temecula residents by providing youth with a structured, trauma -informed wellness program designed to improve emotional regulation, reduce anxiety, and foster positive physical and mental health habits. The program will be offered free or at a significantly reduced cost depending on the amount of funding received, ensuring that cost is not a barrier for participation.

Sessions will be hosted at a local Temecula park or community center and will target youth in grades 6- 12 through school outreach, local partners, and word-of-mouth. Activities include mindfulness -based movement, breathing techniques, guided journaling, and community -building circles —creating safe spaces for healing and social -emotional development.

We are committed to hiring facilitators, mentors, and guest speakers from the Temecula area, and engaging local volunteers, including students and community leaders, to build long-term capacity and civic pride. All materials and supplies will be purchased from Temecula -based businesses whenever possible to further invest in the local economy.

This program aligns with the City's commitment to improving resident well-being and supporting youth through accessible and preventative health initiatives rooted in community. 3b. ESTIMATED NUMBER OF PEOPLE FROM 3c. ESTIMATED NUMBER OF VOLUNTEERS TEMECULA EXPECTED TO BENEFIT FROM THIS* INVOLVED IN THIS PROJECT/PROGRAM:

PROJECT/PROGRAM:
100
6 4. SUMMARY STATEMENT - SUMMARIZE ANSWERS 1 - 3 ABOVE IN 50 WORDS OR LESS. * Thrive360: Movement for Mental Health is a low-cost mobile wellness program for underserved Temecula youth, combining yoga, mindfulness, and fitness to improve mental health. Grant funds will support equipment, outreach, and staffing —benefiting 50-75 youth annually while hiring local staff and engaging local volunteers to foster resilience and inclusion.

Project/Program Budget

LIST REVENUES/INCOME FOR PROJECT/PROGRAM
Amount requested from this City of Temecula Community Services Grant REVENUES* (refer to ,page 2) $5,000.00
Amount contributed to the Project/Program by the Applicant Organization $4,000.00
Other grants or funding already awarded for Project/Program, if any $1,500.00
San Marcos Community Foundation
In -Kind match amount or volunteer credit hours estimated amount $2,000.00

LIST OF EXPENSES FOR PROJECT/PROGRAM
Tools/Equipment* EXPENSES*
Yoga mats, meditation cushions, sensory tools, etc. $1,000.00 *
Facilities/Rentlinsurance *
Rental space for rec centers, Park permits, liability insurance $13,000.00 *
Supplies*
$700.00
journals, pens, nature guides, wellness kits, visual aids *
Services*
$500.00
Outreach flyers and materials
*
Food*
$300.00
Healthy snacks for participants during sessions
Other (i.e. Marketing, etc)*
*
$400.00
Local ads, social media promotions, print materials, promotional items *
Staffing Expense
$1,300.00
TOTAL REVENUE: TOTAL EXPENSES
$12,500.00 $15,900.00

CHECK THE BOX TO CONFIRM
Confirm

Acknowledgement/Signature
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 50 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 in a previous fiscal year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete.

I hereby certify the information contained in this Application is true to the best of our knowledge and belief.

Name of Applicant Organization:*
OMG Youth Sports
President/Authorized Officer Name:*
Jonathan Owens
E-mail:*
President/Authorized Officer Signature*
Please confirm that the 'President/Authorized Officer Signing this Application is an Officer Listed on the State of California Statement of Information form:

Requested Amount:
$5,000.00
President/Authorized Officer Title:*
Chair
Phone:*
Submission Date:
2025-09-13 05:51:35 PM
President/Officer Confirmation:*
Verified and Confirmed
visit https:llbizfileonine.sos.ca.govlsearchlbusinessto verify.

of the Treasury
Oita:
raDepartment
Internal Revenue Service
03130i2022
Tax Exempt and Government Entities
Employer,D number:

IRS )'-O. Box 2505
84-3019475
Cincinnati, OH 45201
Plerson to contact.

Name, Customer Serviw
10 number: 3195'
Tetephor►P- €377-8-79-5500

OMG YOUTH SPORTS
Accounting period ceding:

CSC) JONATHAN OWENS
Qeccmber 31
819 NORTH CRESCENT HEIGHTS BL
public charity tus;
LOS ANGEL S, CA 90046
5t79(a)(2)
Firm 990 ) 9910-EZ l 990 N reared:

Yes
F#fachwo Bite of exemption:

March 02, 2022
Contribution deductibirrt�v-
Yes
Addendum ap%Aies5
No
OL N:
26053470002592
Bear Applicant:.

We're pleased to tell you we determined you're exempt from FMIcral income tax LuOcr InIcniaf 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 sifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. tlrt;��nir.,ations exert under IRC Section 501(c)(3) arc further classified as either public charities or private foundatlom- We determined you're a public charity under the IRC Section lislcd at the top ol'this letter.

If use indicated at the tog of this letter that you're required to rile Form 990/990-EZ/990-N, our records show you're required to file an annual infonnation return (Form 990 or Form Y)O-137.) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive: years, your exciript status will be automatically revoked.

If we indicated at the top of this letter that an addendum applies. the enclosed addendum is an intcgral part of this letter.

For important intiannation about your responsibilities as a tax-cxLmpt organization, go to www.irs.gov/charitics .

Enter "4221-PC" in the -, rc:h hair to view Publication 4271-PC. Compliance Guide for 501(c)('3) Public Charities, which describes your ritic:ordkeeping, relxarting, and disclosure requirements.

Sincerely,
Stephen A. Martin
Director, Exempt Organi=ions
Ruiin&.-i and A -re counts
Letter 947 (Rev. 2-2020)
,iGato, Numbw 35752P

SEp:oF--T STATE OF CALIFORNIA
Office of the Secretary of State
w
m` STATEMENT OF INFORMATION
o;

CA NONPROFIT CORPORATION
California Secretary of State
�q iFoaN`.P' 1500 11th Street
Sacramento, California 95814
(916) 657-5448
Entity Details
Corporation Name OMG YOUTH SPORTS
Entity No. 4312616
Formed In CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office 819 N. CRESCENT HTS LOS ANGELES, CA 90046
Mailing Address of Corporation
Mailing Address
Attention
Officers
For Office Use Only
-FILED -
File No.: BA20251788331
Date Filed: 9/4/2025
819 N. CRESCENT HEIGHTS BLVD.

LOS ANGELES, CA 90046
Officer Name
Officer Address
Position(s)

JONATHAN OWENS
819 N. CRESCENT HEIGHTS BLVD.

Chief Executive Officer
LOS ANGELES, CA 90046
Chris Wheeler
354 Regent Ave.

Secretary
Inglewood, CA 90232
0 Rebecca Owens
819 N. CRESCENT HEIGHTS BLVD.

Chief Financial Officer
Los Angeles, CA 90046
Additional Officers
Officer Name Officer Address Position Stated Position
None Entered
Agent for Service of Process
Agent Name
Agent Address
Jonathan Owens
819 N CRESCENT HTS
LOS ANGELES, CA 90046
Email Notifications
Opt -in Email Notifications Yes, I opt -in to receive entity notifications via email.

Electronic Signature
® By signing, I affirm that the information herein is true and correct and that I am authorized by California law to sign.

Jonathan Owens
Signature
0910412025
Date

Page 1 of 1 ends

Temecula City CouncilOctober 28, 2025

Temecula City Council
October 28, 2025