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CC - Item 3B - Community Development Proposed CDBG• • TO: HONORABLE MAYOR AND MEMBERS ROSEMEAD CITY COUNCIL FROM: ANDREW LAZZARETTO, CITY MANAG 7J~ DATE: APRIL 4, 2006 RE: PUBLIC HEARING REGARDING COMMUNITY DEVELOPMENT PROPOSED CDBG AND HOME ALLOCATION FOR FISCAL YEAR 2006-2007 Background The City of Rosemead is a federal entitlement grant recipient of Community Development Block Grant (CDBG) and HOME funds from the U.S. Department of Housing and Urban Development (HUD). As part of the process to receive funding, the City must undertake development of a Consolidated Plan and Annual Funding Plan. It is called a Consolidated Plan because it consolidates the application process for HUD's four (4) entitlement grants into one consolidated plan and application. The four grants are: Community Development Block Grant (CDBG), HOME Investment Partnership Program, Housing Opportunities for Persons with AIDS (HOPWA) and Emergency Shelter Grant (ESG). All four grants are driven by an entitlement formula process set by the federal government. The City is eligible to participate in two (2) of these programs: CDBG and HOME. As part of the requirements of the federal Consolidated Plan process, the City is required to hold a public hearing regarding the projected use of funds prior to adoption of its Consolidated Plan and Annual Funding Plan. In order to receive the FY 2006-2007 allocation, the City must comply with the following requirements of the Consolidated Plan final rule regarding presubmission requirements: Public Hearing Retarding Proposed CDBG and HOME%ocation for FY 2006, 2 1. Fulfill citizen participation requirements by conducting a public hearing to receive citizen input regarding annual funding needs; 2. Publish a draft Plan for a 30-day comment period in order to receive citizen input regarding the final document; and 3. Adopt the final Plan and the Annual Funding Plan. The Annual Funding Plan is a part of the Consolidated Plan, which takes all HUD requirements regarding planning, needs analysis, reporting, budgeting, citizen participation and certifications and incorporates them into one process. The full Consolidated Plan must be completed once every five (5) years and the Annual Action Plan must be completed annually. Discussion The City anticipates that it will receive $1,175,157 in CDBG funds and will reprogram the carryover allocation from prior years. The FY 2006-2007 grant amount is less than the amount received in FY 2005-2006. This is due to a reduced total amount appropriated by Congress. Based on grant and projected carryover amounts, the City estimates that it will have $2,756,170 available for projects in FY 2006. The City anticipates that it will receive $519,469 in HOME funds. Of the CDBG funds received, no more than 15% of the annual grant amount can be used for public services and no more than 20% of the grant amount can be used for Planning and Administrative services. More than 70% of all funds received must be used for low-to-moderate income activities. Of the HOME funds received, no more than 10% can be used for administrative and program delivery activities. 15% is set aside for Community Housing Development Organizations, as constituted under the regulations. The balance of funds are used for housing activities. On January 17, 2006, the City opened public service application taking for the FY 2006-2007 program year. The City accepted applications through February 16, 2006. The City received seven (7) applications for assistance, including the City's Senior Nutrition Program. Of those applications, one (1) was for an agency not previously funded: American Asian Pacific Ministries, Inc. The current and proposed funding amounts appear in the attachments, along with the applications. Public Hearing RAarding Proposed CDBG and HOME9location for FY 2006, 3 The following attachments are included: Attachment 1 - Table 1: Proposed CDBG Budget; Attachment 2 -Table 2: Public Service Applications; Attachment 3 -Table 3: HOME Budget; Attachment 4 - Public Service Applications. RECOMMENDATION Staff recommends, after public testimony, review and after any amendments, that the City Council approve the City's proposed CDBG and HOME programs and projected use of funds for FY 2006-2007 and authorize staff to include this in the Annual Funding Plan. 2. 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Project Manager's Telephone No. (626) 287-3475 Fax: Project Manager's Email Address: martinfcc2t7asb Describe Agency's overall function or purpose. Include history and experience in providing this service. (If more room is needed, please use additional paper and attach to the back of the application with a reference number). Function or Purpose: See Attachment I, Exhibit "A" paste 1 Has the Agency previously received funding from the City of Rosemead? YES I NO If yes, please identify the years and amounts funded: NOW "Amount 2005-2006 $ o 2004-2005 $ O 2003-2004 $ 2002-2003 $ a 6 • • PROJECT PROPOSAL AND DESCRIPTION In this section, briefly describe the project proposal, including cost estimates. Grant amount Requested: Briefly describe your proposed Project/Program goals. Your response must describe the scope of services for the project, proposed solutions to problems identified in Priority Needs: P"ect 1 Program Coals: See Attachment 11, Exhibit "A" page 2 Briefly describe and include resources dedicated to the program such as money, staff, equipment and supplies: Resources: See Attachment III, Exhibit "A" page 3 Briefly describe your proposed program Activities. Your response must describe the strategies and techniques that comprise service and outreach methodology: Methndning31• See Attachment IV, Exhibit "A" page 4 Briefly describe the direct product of the program activities. Include the volume if work accomplished such as number of: low-income households served, youth, elderly, disabled or number of loan applications processed. Goals must include numeric goals for service that will be achieved during the program year: . See Attachment V_ Exhibit "A" ;age 5-6 Can this Project /Program proceed on July 1, 2006? / YES [ ] NO 24,600.00 7 u Ll 3. PROJECT PROPOSAL AND DESCRIPTION (continued) If your proposal is for an existing Project/Program that is currently funded through the City of Rosemead, this request will: PLEASE CHECK ONLY ONE: 1. [ ] Increase Service. If so, how? 2. [ ] Replace a previous source of funding. If so, list source and reason 3. [ ] New program for FY 2005-2006 4. DQ New request (not currently funded) 4. CLIENT INTAKE INFORMATION - FOR PUBLIC SERVICE ACTIVITIES The U.S. Department of Housing and Urban Development (HUD) requires that agencies obtain intake data from each client/family served. Does your agency obtain this information? P<YES [ ] NO If yes, does your intake sheet obtain the following: ■ Name YesK No[ ] ■ Address YesK No[ J • City in which client last resided Yes, No[ ] ■ Number of Family members Yespq No[ J ■ Total family (household) income YesN No[ ] ■ Race/Ethnicity YesM No[ ] ■ Female head of household YesK No[ ] ■ Disability YesK No[ ] Describe any special characteristics of your client population. 8 • • Service are provided in English Chinese, Spanish Tagaloe Cubuano with and other Asian languages. All races are enrolled and participate in our programs. Free food is also give weekly to all clients in need. 5. CLIENT INTAKE INFORMATION - CLIENT INTAKE AND PERFORMANCE Provide the actual numbers of your total clients in the categories listed below: (for new, non-city of Rosemead funded agencies, please provide projected data for upcoming fiscal year.) Provide the actual numbers of persons served in the following age categories: (for new, non-city of Rosemead agencies, please provide projected data for upcoming fiscal year): CHILDREN YOUTH ADULT ELDERLY PERFORMANCE 0-12 13-17 18-54 55 & OVER PERIOD Roseme Agency Rosemead Agency Rosemead Agency Rosemead Agency ad 7/1/04 to 0 4 0 41 0 113 4 40 6/30/05 7/1/05 2 2 10 36 2 99 5 '15 to t 12/31/05 9 • • 6. CLIENT INTAKE INFORMATION - CLIENTS SERVED BY INCOME LEVEL Report the actual number of unduplicated number of clients your agency served from July 1, 2005 through December 31, 2005. One person can only be counted one time, even though the client may have been served many times during the reporting period. Calculate the totals and percentages for each category: Household CDBG Eligible # Served by # Of # Served # Of Rosemead Size Based on Income Agency below Rosemead by Project residents served by Limits the Income residents below the project below the Limit served by the Income Income Limit Agency below Limit the Income Limit 1 $36,700 157 82 2 $41,900 3 $47,150 4 $52,400 5 $56,600 6 $60,800 Subtotal of CDBG Eligible Households 157 82 _ Total Households Served 157 82 centage of CDBG Income 48% 52% Families Served ligible 7. CLIENT INTAKE INFORMATION - CLIENT OR PROJECT INFORMATION The source of funding for Public Service Grants comes from a Community Development Block Grant (CDBG) received through the U.S. Department of Housing and Urban Development (HUD). CDBG funds are for the specific purpose of benefiting low/moderate income households. In order to be eligible for these funds, your organization must provide a service for the residents of the City of Rosemead and be able to document that at least 51 percent of the clientele served by the project/program earn less than the following income limits: 10 • Income Limits are based on HUD Section 8 Income Guidelines: HOUSEHOLD SIZE ANNUAL INCOME LIMIT- 1 $36,700 2 $41,900 3 $47,150 4 $52,400 5 $56,600 6 $60,800 7 $65,000 8 $69,150 Please check the corresponding letter, which further describes the activity you are proposing: ■ Public Service Projects will most likely be (c), or in some cases (a), per CDBG Eligibility Requirements. a) The project will benefit a clientele that is generally presumed by HUD to be below the eligible income limits. The following groups are presumed to meet this criterion: abused children, battered* spouses, elderly persons, and illiterate persons and persons with acquired Immune Deficiency Syndrome (AIDS) b) The project information on family size and income shows that it is evident that at least 51 percent of the clientele are persons whose family income does not exceed the CDBG eligible income limit (i.e. mapping service area and demonstrating that more than 51% of persons in the service area are low-moderate income). C) The project has income limits that limit the activity exclusively to CDBG eligible income persons. 11 • 8. ADDITIONAL APPLICATION DISCLOSURE STATEMENT All organizations that submit this application must provide accurate data concerning the number and income levels of clients and/or location and nature of projects/services, as well as demonstrated site control. Estimates are unacceptable except for previously non-CDBG funded agencies. This stipulation shall apply to all organizations that are subsequently awarded funding. Any organization that falsifies information, either accidentally or intentionally shall be required to reimburse the City for any funds paid out and shall not be permitted to apply for funding in the future. The applicant hereby proposes to provide the services or projects for the City of Rosemead as stated in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state and local regulations and other assurances, as required by the City of Rosemead, will be adhered to. As the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal. DATE: -3 / - a oo~o SIGNED: 1441-5n / TITLE: iy eR,cg-d rSA - -t/`1~~e A,w I ORGANIZATION: W 12 zi II In V II M In 0 u n 0 T a 0 p r.~ a 0 a• w 0 02)~~ m n . a cn x o r v m co K 0 W Z Z - U) W S1 0 3 ~A r- CO) r- D F - 4- C a) CL :r n 0 m o C X W j 0 UJ G) m - --i r, x x x _ T Q n r ' N A M • W W 40 W O O O O pO S f!i O O A O O O O O O ar • O a CD rt, O O O 40 ~w 40 40 C' ~ O O O O O C O G O . O [1-244 40 A 40 W O 4A O f~ cc A O Q O CD O 0 O O O O O O O w M fA 40 4A N 40 Sh. i cl) ' CA - W s ~ A co p O N O O O O O A O p O , n ~ 74 40 W W A r=r . O O Oi O 0 O fD cn W O O O O O O 0 O q O --I o N o (a m 0 C FD CD CZ O C .D O M D n @ N o c 3 c _0 c m m m m ; CD m t A ~ N Q N ~ 3 Z o " G) ~ y a C C) m m m r t _ ? N m r: - W O N V N t a p1 N N N N M V ~ O M 40 ~a A N O O ~ O O O $ O fJ~ O O O O O O O O O O O $ O A. O 0 O r. C ~ G O O O O O O O O O O O C O O O O O O O C O C O (TI O 409 a V ~ N N w V 4 40 O 40 ~ ~ lw .a ~ 4w A N O 0 OOD O O O ~ O O O O O O O O O O O O O O O O O pp p A O O O O O O O C Q O O O O O O G O O O 0 O C O O O C O C O n _ v C) O O O O O O O O O O O O O N V N N w V 40 o ~ ot + 40 w A O O D OD co 0 O 0 0 O 0 0 o 0 0 N 0 0 Q 0 0 O 0 0 O 0 0 O 0 0 O 0 0 O 0 0 as 0 r 0 0 0 0 0 0 0 0 o 0 c 0 o 0 c 0 c 0 c 0 o 0 0 0 0 0 N C4Tt tD A iD OD A N i V 4 W N W O A V W O~ Q! W 4ft w A V N to V a O A N N O p► N N A O A N f0 O O = m O (n v A O O O O V C O to O O W O O W O O N1 G O O GO N O O O GO O~ 00 O O O W O O C 0 D m N V ~ ew N W W N ~ ~ N ~ W cn can N w OND w A 40 4n A ~ -.1 tV71 a O N n v ~ o O O O O O O Q O o C O C o O O O O O O O O O O O O X 2 m Z G7 C G~ EXHIBIT B -BOARD OF DIRECTORS AFFIDAV~brs of the Board of All applicant Agencies must complete this affidavit listing the me Directors and all other officers. If there are changes in the Board membership after the request is submitted, the City of Rosemead must be notified in writing. Dr. Fre3dy L. Mwtin In submitting this funding request, I, Designee) President depose and say that I am AMERICAN ASIAN PACIFIC MINISTRIES~II`17 [insert title, President, Vice President, etc.] of Insert name and address of Agency] The other members and officers a dtNlemBoard of bers and attach Directors an additional sheet, if necessary): rP)PaSe list names of _current AT: ROSEMEAD CALIFORNIA (CITY & STATE) THE APPROPRIATE AGENCY DESIGNEE MUST SIGN AND AFFIX THE SEAL (Corporate Seal) certify and declare under penalty of perjury that the foregoing is true and correct. ~R C D7 Y L m Q " Signature and Title Print Name 15 DATE: - 3 2 O61° • PROJECT/ PROGAM GOALS • ATTACHMENT IV, EXHIBIT "A" PAGE 2 This program attempts to equip the abuser with the ability to deal with his or her frustrations and cope with everyday difficulties. A positive self-image is encouraged and nurtured, better communication skills are developed and acceptable ways of resolving conflicts in a constructive manner are explored. This helps the Individual accepts the positive changes effected through community support. The success of the program depends largely on the efforts of the individual and his/her family. This program sets a list of measurable goals which are established for each client on an individual treatment plan, along with assessment tools utilized like Drug Abuse Screening Test, DSMIV Diagnostic check list, Adolescent Chemical Dependency Inventory, CRAFFT, SAQ and other clinical measurable tools. Great issues for individuals and families at risk are job skills and academic achievement. Therefore, our program is structured to create a safe environment where the client and his or her family can deal with their needs; to create greater awareness in both the individual and family, of the dangers and effects of substance abuse; to assist the individual and his/her family understand the underlying causes for the individual's involvement in substance abuse, and by helping to improve relationships within the family; to provide practical assistance for both the individual and his/her family to engage in behaviors which breaks the abuse cycle, prevent relapse, by assisting with Home work, Individual / group counseling encouraging behavior mortification. Random drug testing is part of our state protocol this will assist to develop a positive self-image on the part of the abuser. To encourage the abuser to realize the importance of education and try to make efforts to pursue a course of study. To encourage and divert the abuser's attention from drug abuse to recreational and other constructive activities within the community, like employment. ATTACHMENT III, EXHIBIT "A" page 3 RESOURCES American Asian Pacific Ministries, Inc. is presently funded partially from Los Angeles County contracts with Los Angeles Department Health, Drug and Alcohol Administration and Private Charitable Contributions. American Asian Pacific Ministries has held these two contracts for the last five (8) years an Outpatient Drug Free Medi-cal and a Day Care Habilitative Medi-cal contract with 15 enrolled. American Asian Pacific Ministries has also is also a provider for California Access to Recovery Effort (CARE) and has an MOU with Department of Drug and Alcohol. Presently, we have Proposition 36 contracts with about eighty-five (85) clients enrolled. American Asian Pack Ministries, Inc. provides services for individual and families regardless of their ability to pay on a sliding scale, therefore approximately 20% are carried as charity at no cost to the individual. American Asian Pacific Ministries, Inc. employees 8 full time staff and 4 volunteers with computer equipment and office equipment on-site to provide service for our enrollees. There is an audit of the financial operation of the program annually, either by a public accountant who is not a staff or Board member or by the funding agency. Andrew M. Smith CPA, 3711 Long Beach Blvd. Suite 809, Long Beach, California 90807 is the agency employed to do our annual audit. ATTACHMENT IV, EXHIBET "a" page 4 METHODOLOGY: This program attempts to equip the abuser with the ability to deal with his or her frustrations and cope with everyday difficulties. As a positive self-image is encouraged and nurtured, better communication skills are developed and acceptable ways of resoling conflicts in a constructive manner are explored. This helps the abuser accept the positive changes effected through Recovery Support Groups (RSG). The success of the program depends largely on the efforts of the abuser and his/her family. This program provides a planned program of education on sobriety, drug addiction, drug-related problems and recovery developed with reference to this particular population. This includes films, tapes, books, pamphlets, lectures and discussions. It deals with the physical, psychological, and social effects of drug use and resources for continued sobriety and recovery. Recovery Support Groups have proven to be most effective in helping people overcome life's controlling problems. RSGs differ from other groups in that they have specific guidelines and restrictions. Counseling is conducted in a safe, confidential place. RSGs are more than a collection of those wanting to get better, RSG participant build trust and learn to confront faulty patterns effectively, serving each other in a mutually supportive way. RSGs provide an optimal environment for honest acceptance and accountability. Every group develops through stages we call " forming, storming, norming, performing and reforming." Alcohol and Drug Abuse are serious problems in the San Gabriel Valley according to local reports, which result in an individual's physical, mental, emotional, and / or social impairment. In the United Sates there are an estimated 14.8 million people Americans currently using illicit drugs ( SAMHSA, 1999). Alcohol dependence is the second leading cause of premature deaths and disability in the San Gabriel Valley, (County of Los Angeles, Department of Health Services, 2000). It is estimated that the most serious problem facing U.S. high schools is alcohol. One in ten youth age's 12- 17 has reported the use of illicit drugs, (SAMHSA, 1999 It emphasizes the importance of the family in inculcating and maintaining constructive behavior among members. This non-sectarian program is designed to nurture, counsel and motivate adults and youth at risk, as well as to strengthen families by helping them recognize and overcome problems contributing to unacceptable behavior. Central to the program are support for both the troubled individual and their families. ATTACHMENT V EXHIBIT "A" PAGE 5 The American Asian Pack Ministries, Family Recovery Program is a structured, community-based multi-ethnic program conducted in cooperation with public authorities and other non-profit community agencies. Clients are referred by the LA County Department and CASC, SACPA Court/Criminal Justice, self- referral, family, schools, and or other Health Care Providers. It emphasizes the importance of the family in inculcating and maintaining constructive behavior among members. This non-sectarian program is designed to nurture, counsel and motivate adults and youth at risk, as well as to strengthen families by helping them recognize and overcome problems contributing to unacceptable behavior, economic issues, and job skills. Central to the program are support for both the troubled individual and their families. By providing tutoring, substance abuse treatment, family counseling for family members, with adults and or youth at risk in English, Spanish, Chinese languages. Fourteen (14) clients will be served for as total of 56 individual sessions, 672 group sessions with random drug testing. Each client will receive 13 sessions over a thirty-day period of time. This would equal 3 sessions per week, each session being 3 hours per sessions, each session equals 1 unit. Each client is given an individual treatment plan stating the clients problems, statement of goals and action plan, responsibility and method of Counseling. Each client must complete a Client's Fee Determination Statement to verify household income. Each client will be require to receive at least 1 hour session as a collaborative with the clients family members. In addition each client will receive 11/2 hours of group sessions per day, some will require tutorial assistance, some will require individual sessions, others will be placed in art therapy or tutorial programs. Random drug testing is part of our state protocol. Progress reports are given to Probation Officers, parents, Courts or other legal agencies are required. A signed release of information form must be signed by client's legal guardian, before any information concerning a client can be released. If a client does not or can not complete his / her treatment plan as directed an adjustment to the client Treatment plan maybe in order, before an adjustment can be made probation or parents are notified. If a client gives a positive drug test. In addition Drug testing is done for treatment purposes. The client is put in an individual counseling session with a counselor to evaluate the cause of the client's relapse. Upon conclusion of clients relapse triggers, client is given coping skills to prevent future triggers, thus deterring relapse. Probation/ court or legal guardian are notified of all positive drug test. If a client continues to give positive drug test 3 consecutively client will be terminated from the program. All Case files are secured in lock file cabinets. Case files are not open to the courts unless they are subpoenaed because of confidentiality, however progress reports are given as directed by Court or Probation. Staff is periodically called to court to testify is some cases. Form 990 A For the 2004 calen B Check it applicable: Address charge Name change Initial return Final return Amended return Application pending Ffetl.i of Organization Exempt from Inone Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) The organization may have to use a copy of this return to satisfy state reporting req Name of organization and street (or P.O. box if mail is not delivered to street addr) Room/suits city, town or country state ZIP code + 4 ^ ' I F • Section 501(cx3) organizations and 4947(axl) nonexempt charitable trusts must attach a completed Schedule A (Form 990 or 990-ham. G Web site: " N/A J Organization type 1 n --I., ---N ► Ix I rnnrei 3 4 (insert no.) l _I 4947(.)(1) or 11 S27 K Check here 11" if the organization's gross receipts are normally not more than $25,000. The organization need not file a return with the IRS; but if the organization received a Form 990 Package in the mail, it should file a return without financial data. Some states require a complete return. so. OMB No. 1545.0047 2004 Open to Public Inspection stion Number 6 r .-2700 Cash I I Accr H and I are not applicable to section 527 organizations. H (a) is this a group return for affiliates? El Yes ~ No H (b) If 'Yes,' enter number of affiliates H (c) Are all affiliates included? El Yes El No (If 'No.' attach a list. See instructions.) H (d) Is this a separate return filed by an ~ organization covered by a group ruling? I I Yes IX I Ne Group Exemption Number 0' M Check ► if the organization is not required to attach Schedule B (Form 990, 990-EZ, or 990-PF). 1 Contributions, gifts, grants, and similar amounts received: 045 14 1 a Direct public support . a . , b Indirect public support . 1 b nt contributions (grants) me o v e c G rrnn . 1 c 412,623. d ( ta l @ d ahlilc)s(.h $ noncash $ othrbug ) 2 Program service revenue including government fees and contracts (from Part VII, line 93) . 3 Membership dues and assessments 4 Interest on savings and temporary cash investments 5 Dividends and interest from securities 6 a Gross rents . 6 a b Less: rental expenses . 6 b c Net rental income or (loss) (subtract line 6b from line 6a) . 7 Other investment income (describe b. E (A) Securities (B) Other v 8a Gross amount from sales of assets other 8a N than inventory U E b Less; cost or other basis and sales expenses 8b c Gain or (loss) (attach schedule) 8c d Net gain or (loss) (combine line 8c, columns (A) and (B)) k here i ch i f I►EI n rom gam s 9 Special events and activities (attach schedule). If any amount g, ec a Gross revenue (not including $ of contributions reported on line la) . 9,1 b Less: direct expenses other than fundraising expenses . 9b c Net income or Coss) from special events (subtract line 9b from line 9a) 10a Gross sales of inventory, less returns and allowances . 110,1 b Less: cost of goods sold . 10 b c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line lob from line 10a) . 11 Other revenue (from Part VII, line 103) 12 Total revenue aoo lines iu, e-, J, 13 411 277 column (B)) li e 44 i f , . 13 . , n ces ( rom Program serv E x column (C)) neral (from line 44 nd t 14 45, 098. 14 . , a ge Managemen P E column (D)) m line 44 i i f 15 . 15 , ng ( s ro Fundra N s ffiliates (attach schedule) t 16 16 o a Payments E S 17 Total expenses add lines 16 and 44, column A 17 456, 375. ear (subtract line 17 from line 12) fi it) f r the d 18 -29, 707. 18 y c o Excess or ( e A d balances at beginning of year (from line 73, column (A)) f t 19 -69, 605. N S T 19 un s or Net asse es in net assets or fund balances (attach explanation) h Oth 20 T 20 ang er c s 21 Net assets or fund balances at ena or year cormmne nnes o, -a, 421 lu ~u • . • • . • • • • • • • • • - - - - - - - BAA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. TUA0101 01107/05 Form 990(2004) ,nses All organizations must complete organizations and section 4947(a)(1) nor and (D) are optional for others. Do not include amounts reported on line 6b, 8b, 9b, IOb, or 16 of Part t. (A) Total (B) Program services (C) Management and general (D) Fundraising 22 Grants and allocations (aft sch) (cash non-cash $ ) 22 - ; , k 23 24 Specific assistance to individuals (aft sch) aid to or for members (aft sch) fits B 23 24 25 p ene etc directors nsation of officers C 25 - 85, 500. 76, 950. 8, 5 -no - 26 , , ompe alaries and wages Oth 26 120 387. 108 348. 12, 039. 0 27 er s lan contributions n i P 27 28 p ens o ee benefits lo Oth 28 62, 011. 55, 810. 6, 201. 0 29 y er emp roll taxes P 29 21, 523. 19, 371. 2, 152. 0 30 ay Professional fundraising fees 30 31 fees Accountin 31 4 579. 4 121. 458. 0 32 g al fees Le 32 9 600. 8 640. 960. 0. 33 g . lies Su 33 5, 707. 5 136. 571. 0 34 . pp hone Tele 34 _ _ 35 p ping e and shi P t 35 323. 291. 32. 0 36 p os ag anc Occu 36 35, 297. 31, 767. 3, 530. 0 37 y p ment rental and maintenance ui E 37 38 p q and publications Printin 38 1, 662. 1, 496. 166. 0 39 g el T a 39 5 820. 5 238. 582. 0 40 r v and meetings conventions Conferences 40 445. 400 . 45. 0 . 41 , , Interest 41 2, 933. 2 640. 293. 0. 42 etc (attach schedule) depletion reciation De 42 43 , , p Other expenses not covered above (itemize): ut o A 43a 25, 884. 23, 295. 2, 589. 0• _ a_ _ ense E x Office b 43b 29, 502. 26, 552. 2, 950. 0. p _ _ _ nce usinc; Allowa c H 43c 39, 799. 35, 819. 3, 980. 0. _ o d Food a Hotel for Probation Clients 43d 5, 403. 5, 403. 0. 0. - e 43e 44 _ _ Total functional expenses (add lines 11 43). Organizations completing columns (B) - (D , cam these totals to lines 13 15 44 456, 375. 411, 27 7. 9 5 0 9 8. 0 Joint Costs. Check . if you are following SOP 98.2. Are any joint costs from a combined educational campaign and fundraising solicitation reported in(B) Program services? Yes © No If 'Yes,' enter 0) the aggregate amount of these joint costs $ ; (ii) the amount allocated to Program services $ ; (Iii) the amount allocated to Management and general $ ; and (iv) the amount allocated What is the organization's primary exempt purpose? a_Medical _Ou_t_patient DrucLE]L e_(ODFJ__For r and drug abusers who are over the age of 18 for Medical. (Grants and allocations $ 135, 644. ) b_ProPosition 36 -For rehabilitation provided _t_o_c_ou_r_t-_o_rd_e_re_d_alcohol a_nd_dr_ug abuse- violato_rs who_are ov_er_ the -age of-18-and-who-are-not-eligible _ _ _ _ _ _ for Medical (must have court-order) (Grants and allocations $ 276r978.) c------------------------------------------------------ (Grants and allocations $ ) d------------------------------------------------------ TEEA0102 01107/05 Form P ifll7; Balance Sheets (See Instructions) 0 Note: Where required, attached schedules and amounts within the description column should be for end-of-year amounts only. Beginning of year End(of)year arin t b i -1,223. 45 -6,721. g - e nteres 45 Cash - non- sh investments c 46 a 46 Savings and temporary 47a Accounts receivable 47a ance for doubtful accounts 47b ll b L 47c ow ess: a es receivable 48a Pled 48a g allowance for doubtful accounts b L 48b 48c ess: i bl 49 e va 49 Grants rece 50 Receivables from officers, directors, trustees, and key A hedule) h tt 50 s ac sc employees (a E h sch) bl tt i 51 a e (a ac va 51 a Other notes & loans rece T llowance for doubtful accounts b L 51 b 51c s ess: a se l f 52 or sa e or u 52 Inventories d deferred charges 53 53 Prepaid expenses an -E] Cost ❑ FMV . rities (attach schedule) 54 . 54 Investments - secu buildings, & equipment: basis . 55a Investments - land 55a 62,171. , b Less: accumulated depreciation L .5.5..Stmt....... ch schedule) tt 55b 37,331. 23,785. 55c 24,840. (a a attach schedule) th 56 er ( 56 Investments - o and equipment: basis buildings 57a Land 57a , , b Less: accumulated depreciation attach schedule) 57b 57c ( loyee Advances ribe ► Em d t 2,539. 58 2,626. p s ( esc 58 Other asse 59 Total assets add lines 45 through 58 must equal line 74 25,101. 59 20,745. ble and accrued expenses t 60 9 184. s paya 60 Accoun bl 61 L e 61 Grants paya 1 f d 62 A e revenue erre 62 De and key employees (attach schedule) trustees directors officers f L 63 L , , , oans rom 63 d liabilities (attach schedule) t b 64a I on 64a Tax-exemp . able (attach schedule) a d other notes b M t 64b E . y p or gages an s (describe ► See Line 65 Stmt ) li biliti O h 6 94,706. 65 110 873. a er es t 5 66 Total liabilities add lines 60 through 65 94,706. 66 120,057. Organizations that follow SFAS 117, check here m- and complete lines 67 through 69 and lines 73 and 74. 67 Unrestricted -69,605. 67 -99,312. A . restricted oraril 68 T m 68 . y p e 69 Permanently restricted 69 Organizations that do not follow SFAS 117, check here ' and complete lines 70 through 74. or current funds trust principal ital stock 70 Ca 70 , , p and equipment fund building or land ital surplus 71 Paid-in or ca 71 , , , p accumulated income, or other funds endowment 72 Retained earnings 72 , , 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through column (A) must equal line 19; column (B) must equal line 21) 72 -69,605. 73 -99,312. ; 74 Total liabilities and net assetslfund balances (add lines 66 and 73 25, 101. 74 20,745. Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization. How the public perceives an organization in such cases may be determined by the information presented on its return. Therefore, please make sure the return 1s complete and accurate and fully describes, in Part III, the organization's programs and accomplishments. BAA TEEA0103 01/07/05 of Revenue per Audited per Return (See instructions.) per Return a Total revenue, gains, and other support a Total expenses and losses per audite nts i i l t t per audited financial statements 1~ a eme nanc s a f a b Amounts included on line a but b Amounts included on line a but not Form 990: on line 17 not on line 12, Form 990: , (1) Net unrealized (1) Donated serv- ices and use investments $ of facilities $ (2) Donated serv- (2) Prior year adjust- ments reported on of facilities $ line 20, Form 990.... $ (3) Recoveries of prior (3) Losses reported on Form 990 $ line 20 year grants $ , (4) Other (specify): (4) Other (specify): $ Add amounts on lines (1) through (4) 0' b Add amounts on lines (1) through c Line a minus line b . . . . . . . . . . . . . . . 1~ c c Line a minus line b d Amounts included on line 12, d Amounts included on line 17, Form 990 but not on line a: Form 990 but not on line a: (1) Investment expenses (1) Investment expenses not included on line not included on line Form 990 $ 6b 6b, Form 990 $ , (2) Other (specify): (2) Other (specify): Add amounts on lines (1) and (2) I d Add amounts on lines (1) and (2) e Total revenue per line 12, Form e Total expenses per line 17, Form 990 (line c plus line d) N. a 990 line c plus lined of Expenses per Audited ments with Expenses List of Officers Directors (A) Name and address Trustees and Key M (B) Title and average hours per week devoted to position to ees List eacn one (C) Compensation Of not paid, enter -0-) even a not cum ernbd~eu, aCC IIIal1ULLNUI Ia. (D) Contributions to (E) Expense employee benefit account and other plans and deferred allowances compensation Freddy_L Martin 2249 E. Rio Verde West Covina CA 91791 resident eo 5,500. . Hollie- 4126 N. Covina U.-Go kFoxdale CA 91722 .P. 40 0,000. . . 75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations? Yes No If 'Yes,' attach schedule - see instructions. Form 990 (2004) BAA TEEA0104 01/07/05 76 Did the organization engage in any activity, not previously reported to the IRS? If 'Yes,' tion of each activity led descri h d t 76 X p e ai attac a 77 Were any changes made in the organizing or governing documents but not reported to the IRS? 77 X ' attach a conformed copy of the changes. If 'Yes , 78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? 78a X b If 'Yes,' has it filed a tax return on Form 990-T for this year? 78 b 79 Was there a liquidation, dissolution, termination, or substantial contraction during the 79 X year? If 'Yes,' attach a statement 80a Is the organization related (other than by association with a statewide or nationwide organization) through common to any other exempt or nonexempt organization? . etc officers trustees s di i b g0a X , , , e , ng o membership, govern b If 'Yes,' enter the name of the organization ► _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and check whether it is _0 exempt or nonexempt. 81 a Enter direct and indirect political expenditures. See line 81 instructions 81 a 0. b Did the organization file Form 1120-POL for this year? 81 b X 82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? 82a X b If 'Yes,' you may indicate the value of these items here. Do not include this amount as 82b " revenue in Part I or as an expense in Part II. (See instructions in Part III.) 83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a X b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b X 84a Did the organization solicit any contributions or gifts that were not tax deductible? 84a X b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were ibl 84b e. not tax deduct 85 501(c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members? 85a b Did the organization make only in-house lobbying expenditures of $2,000 or less? 5b If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year. mounts from members i il d 85c m ar a s c Dues, assessments, an 1 0 d Section 162(e) lobbying and political expenditures 85d e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e f Taxable amount of lobbying and political expenditures (line 85d less 85e) Of tion 6033(e) tax on the amount on line 85f? th e sec g Does the organization elect to pay section 6033(eX)XA) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of h If dues allocable to nondeductible lobbying and political expenditures for the following tax year? 85h 86 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on 86a line 12 b Gross receipts, included on line 12, for public use of club facilities 86b 87 501(c)(12) organizations. Enter: a Gross income from members or shareholders 87a b Gross income from other sources. (Do not net amounts due or paid to other sources 87b against amounts due or received from them.) 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If'Yes,'complete Part IX 88 X 89a 501(c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under: section 4911 ► n/a ; section 4912 ► n/a ; section 4955 ► n/a b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction ear or did it become aware of an excess benefit transaction from a prior year? If 'Yes,' attach a statement the rin d g y u explaining each transaction 89b X c Enter: Amount of tax imposed on the organization managers or disqualified persons during the t, and 4958 4955 s 4912 ti d 0 , , on year un er sec reimbursed by the organization No. above 89c li f , , ne tax on d Enter: Amount o 90a List the states with which a copy of this return is filed ► California_ _ _ _ _ tions in ) 004 S t h _ _ _ _ _ _ - 90b 5 . ( ee s ruc 12, 2 b Number of employees employed in the pay period that includes Marc 91 The books are in care of ► Rev.- Fre--y L Martin_______ Telephone number ► (626J_287_ --dd 3475__ - Locatedat► 4022 Rosemead Blvd. Rosemead CA ZIP +4► 91770-4401 . I 92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041- Check here 1 . . .nr....i rinrinn the fay vpAr - 92 Form 990 (2004) TEEA0105 01/07/05 Note: t otherw 93 a b c d e f 9 94 95 96 97 a b 98 99 100 101 102 103 b c d e 104 unreiate a business income r=xcluueu u Se ctlulI 71 G, UIJ, UI jIY (E) Inter gross amounts unless se indicated. q) Business code (g) Amount (C) Exclusion code (D) Amount Related or exempt function income Program service revenue: Medicare/Medicaid payments & contracts from government agencies . F ees dues and assessments . . Membershi p Interest on savings & temporary cash invmnts - Dividends & interest from securities . . Net rental income or (loss) from real estate: debt-financed property . . . not debt-financed property . . Net rental income or (loss) from pars prop Other investment income Gain or (loss) from sales of assets other than inventory Net income or (loss) from special events . Gross profit or (loss) from sales of inventory . Other revenue: a Subtotal (add columns (B), (D), and (E)) 105 Total (add line 104, columns (B), (D), and (E)) Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment • of the organization's exempt purposes (other than by providing funds for such purposes). Information Regarding Taxa ble Subsidiaries and Disregarded Entities See instructions. N/A (A) Name, address, and EIN of corporation, partnership, or disregarded entity (B) Percentage of ownership interest (C) Nature of activities (D) Total income (E) End-of-year assets % $ Information Regarding Transfers Associa ted with Personal Benefit Contracts (See instructions. a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? t- r,;,t .I,u n.r•oni~~finn rhvinn the vaar nav nremiums. directly or indirectly. on a personal benefit contract? H Yes Yes X X No No Note: !f 'Yes' to file Form 8870 and Form 4720 see instructions). Undo. naIt' f p 1 eclare That I have exami ed tn,s rst,,I^. ^clue c pa on all Inf f ba v and belief, it is scVA nd state" nfs. and to the st o1 my knowledge ~rmatwlc~l pmpare'~as any knowledge. Is er than otticer c true, crrect, awcoR e. Declaration of preparer (o Please ► Sign Signature of officer Date Here ► Type or print name and title. Dale Check d Preparei s SSN or PnN (See General Instruction W) Paid Preparer's signature ► 1 09/20/05 self- employed 0. F Pre- rer's a Firm's name (or EDWARD V. FUGATE CPA se G Yours if self- employed). ► 5812 TEMPLE CITY BLVD. SUITE 602 ► EIN Only ZP+4'and TEMPLE CITY CA 91780 Phoneno. ► (626 462-1955 O A A TF- A0106 10/03/03 Form 990 (2004) i SCHEDULE A Organization Exempt Under OWNo.'W-W4' (Form 990 or 990-EZ) Section 501(cX3) (Except Private Foundation and Section 501(e), 501(f), 501(k), 2~~4 501(n), or Section 4947(a)(1) Nonexempt CFhtaritable Trust Supplementary Information - (See separate instructions.) Department of the Treasury Internal Revenue Service MUST be completed by the above organizations and attached to their Form 990 or 990-EZ Emoiwi r ldantincaNon number rSpp inctrrrrtinns. List each one. If there are none, enter (a) Name and address of each employee paid more than $50,000 (b) Title and average hours per week devoted to position (c) Compensation (d) Contributions to employee benefit plans and deferred compensation (e) Expense account and other allowances none Total number of other employees paid over $50,000 none Compensation of the Five Highest Paid Independent Contractors for Professional Services rSee inctrn,rtinns I ist each one (whether individuals or firms). If there are none, enter 'None.') (a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation n21T Total number of others receiving over $50,000 for professional services None f t: , 4 k SAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-E7- Schedule A (Form 99U or 99V-t/_) ;euu4 TEEA0401 07122/04 Statements About Activities (see instructions.) 1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If 'Yes,' enter the total expenses paid or incurred in connection with the lobbying activities 0, $ ('Must equal amounts on line 38, Part VI-A, or line I of Part VI-B.) Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A. Other organizations checking 'Yes' must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities. 2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? (if the answer to any question is 'Yes,' attach a detailed statement explaining the transactions.) a Sale, exchange, or leasing of property? b Lending of money or other extension of credit? c Furnishing of goods, services, or facilities? See Part V, Form 990 d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)? e Transfer of any part of its income or assets? . 3a Do you make grants for scholarships, fellowships, student loans, etc? (If 'Yes,' attach an explanation of how you determine :hat recipients qualify to receive payments.) b Do you have a section 403(b) annuity plan for your employees? 4a Did you maintain any separate account for participating donors where donors have the right to provide advice on the use or distribution of funds? A-M nann}iarinn Qprvi[p.57 . No Reason for Non-Private Foundation Status (See instructions.) The organization is not a private foundation because it is: (Please check only ONE applicable box.) 5 A church, convention of churches, or association of churches. Section 170(b)(1)(A)(i). 6 A school. Section 170(b)(1)(A)(ii). (Also complete Part V.) 7 A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(iii). 8 A Federal, state, or local government or governmental unit. Section 170(b)(1)(A)(v). 9 A medical research organization operated in conjunction with a hospital. Section 170(b)(1)(A)(iii). Enter the hospital's name, city, andstate 1, 10 An organization operated for the benefit of a college or university owned or operated by a governmental unit. Section 170(b)(1)(A)(iv). (Also complete the Support Schedule in Part IV-A.) 11a © An organization that normally receives a substantial part of its support from a governmental unit or from the general public. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.) 11b A community trust. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.) 12 An organization that normally receives: (1) more than 33-113% of its support from contributions, membership fees, and gross receipts from activities related to its charitable, etc, functions - subject to certain exceptions, and (2) no more than 33-1i3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Also complete the Support Schedule in Part IV-A.) 13 An organization that is not controlled by any disqualified ppersons (other than foundation managers) and supports organizations described in: (1)) lines 5 through 12 above; or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2). (See section 509(a)(3).) Provide the (a) Name(s) of supported organization(s) I (b) Line number from above 14 n An organization organized and operated to test for public safety. Section 509(a)(4). (See instructions.) SAA TEa0402 07127ro4 Schedule A (Form 990 or Form 90 EZ) 2004 Support Schedule (Complete only if you checked a box online 10, 11, or 12.) Use cash method of N V_ se the worksheet in the instructions for convertin from the accrual to the cash method of accounting. ote. u L, u calendar year (or fiscal year 2003 (b) 2002 (())1 20c0 2b ((d) ~ Total (e) beginning in 15 Gifts, grants, and contributions received. (Do not include unusual rants. See line 28. - 479 493. 47419-0-5. 247 540. 344 719. 1 546 657. 16 Membership fees received 17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's 890 purpose etc charitable 890. . , , 18 Gross income from interest, dividends, amounts received from payments on securities loans (section 512(ax5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organ- 927 15 15,927. ization after June 30, 1915 . , 19 Net income from unrelated business activities not included in line 18 20 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf 21 The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to the public without charge 22 Other income. Attach a schedule. Do not include gain or (loss) from sale of 1 187. 1 1-87. capital assets 23 Total of lines 15 through 22 480 383. 490 832. 247 540. 395 906. 1,15-6-4,661. 24 Line 23 minus line 17 479, 493. 490 832. 247 540. 345 906. 1,563,771. 25 Enter 1% of line 23 4 804. 9 908. 2 475. 3 4 59. - 26 Organizations described on lines 10 or 11: a Enter 2% of amount in column (e), line 24 1. 26a 31 275. b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly supported organization) whose total gifts for 2000 through 2013 exceeded the amount shown in line 26a. Do not file this list with your ll these excess amounts f t E h t l a nter t e o a o return. c Total support for section 509(a)(1) test: Enter line 24, column (e) ► 26c 1 563 7711. d Add: Amounts from column (e) for lines: 18 15,927. 19 187. 26b 22 1 26d 17, 114 . , line 26d total) i 26 26e 1,546, 657. c m nus e Public support (line i 0. M; .urn nine ?AP (numerator) divided by line 26c (denominator)) 26f 98.91 % 27 Organizations described on line 12: a For amounts included in lines 15, )6, and 17 that were received from a 'disqualified person,' prepare a list for your records to show the name of, and total amounts received in each year from, each 'disqualified person.' Do not file this list with your return. Enter the sum of such amounts for each year: (2003) (2002)------------ (2001)------------ (2000)------------- bFor any amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000. (Include in the list organizations described in lines 5 through 11, as well as individuals.) Do not file this list with your return. After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year: (2003) (2002)------------ (2001)------------ (2000)------------- c Add: Amounts from column (e) for lines: 15 16 17 d Add: Line 27a total 20 21 and line 27b total e Public support (line 27c total minus line 27d total) . f Total support for section 509(a)(2) test: Enter amount from line 23, column (e) I 27f g Public support percentage pine 27e (numerator) divided by line 27f (denominator)) 27c 28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 2000 through 2003, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the BAA TEEA0403 07123104 Schedule A (Form 990 or 990-E2) 2004 4 Schedule A (Form 990 or 990-EZ) 2004 orican Asian Pacific Ministries. 43-1569726 Page Private School Questionnaire (See instructions.) (To be completed ONLY by schools that checked the box on line 6 in Part M N/A Yes No 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing instrument, or in a resolution of its governing body? . 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, i and scholarships? 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves? . If 'Yes,' please describe; if 'No,' please explain. (If you need more space, attach a separate statement.) 32 Does the organization maintain the following: a Records indicating the racial composition of the student body, faculty, and administrative staff? • . b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships? d Copies of all material used by the organization or on its behalf to solicit contributions? If you answered 'No' to any of the above, please explain. (If you need more space, attach a separate statement.) 33 Does the organization discriminate by race in any way with respect to: a Students' rights or privileges? b Admissions policies? c Employment of faculty or administrative staff? . d Scholarships or other financial assistance? e Educational policies? f Use of facilities? g Athletic programs? h Other extracurricular activities? If you answered 'Yes' to any of the above, please explain. (If you need more space, attach a separate statement.) 34a Does the organization receive any financial aid or assistance from a governmental agency? b Has the organization's right to such aid ever been revoked or suspended? If you answered 'Yes' to either 34a or b, please explain using an attached statement. 35 Does the organization certify that it has complied with the applicable requirements of ccrtinnc a m thmainh 4 .05 of Rev Proc 75-50, 1975-2 C.B. 587, covering racial nonaiscrlminAUUlI: 11 I`IV, GU0111 0.. BAA TEEA0404 07/23/04 Schedule A (Form 990 or Lobbying Expenditures by Electing Public Charities (see instructions.) (To be completed ONLY by an a igible organization that filed Form 5768) n/a n~__i- ;i the n•n~ni~Minn beinnns to an affiliated nroun, Check 1- b if you checked 'a' and 'limited control' provisions apply. Limits on Lobbying Expenditures (The term 'expenditures' means amounts paid or incurred.) Affiliated group totals To be completed for ALL electing organizations influence public opinion (grassroots lobbying) t dit 36 ures o 36 Total lobbying expen es to influence a legislative body (direct lobbying) dit i 37 ur ng expen 37 Total lobby s (add lines 36 and 37) dit 38 ure 38 Total lobbying expen enditures t 39 purpose exp 39 Other exemp 40 Total exempt purpose expenditures (add lines 38 and 39) 41 Lobbying nontaxable amount. Enter the amount from the following table - If the amount on line 40 is - The lobbying nontaxable amount is - Not over $500,000 20% of the amount on line 40 40 Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000 Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000 41 Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000 Over $17,000,000 $1,000,000 amount (enter 25% of line 41) bl t axa e 42 Grassroots non Enter -0- if line 42 is more than line 36 li 36 42 f 43 rom ne . 43 Subtract line 44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38 r-finn• If fflprp is an amount on either line 43 or line 44, you must file Form 4720. 44 4 -Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 45 through 50.) I Lobbying Expenditures During 4 -Year Averaging Period Calendar year for fiscal year beginning in) ► (a) 2004 (b) 2003 (c) 2002 (d) 2001 (e) Total 45 Lobbying nontaxable amount 46 Lobbying ceiling amount (150% of line 45(e)) . 47 Total lobbying expenditures 48 Grassroots non- taxable amount 49 Grassroots ceiling amount (150% of line 48(e 50 Grassroots lobbying expenditures Lobbying Activity by Nonelect (For reporting only by organizations tha ing Public Charities t id not complete Part VI-A) (See instructions.) During the year, did the organization attempt to influence national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of: Yes No Amount a Volunteers X b Paid staff or management (Include compensation in expenses reported on lines c through h.) X Media advertisements X c or the public le islators s to members ili d M X , g , ng a ublished or broadcast statements or bli ti s P X p on , u ca e anizations for lobbying purposes nts to other or I G X g ra government officials, or a legislative body their staffs islators ith le t t Di t X , , g con w rec ac g lectures, or any other means speeches conventions seminars demonstrations lli h R X , , , , es, a i Total lobbying expenditures (add lines c through h.) If 'Yes' to any of the above also attach a statement giving a detailed description of the lobbying activities. BAA Schedule A (Form 990 or 990-EZ) 2004 TEFAO405 07123/04 (i)Sales or exchanges of assets with a noncharitable exempt organization (ii)Purchases of assets from a noncharitable exempt organization 0117Rental of facilities, equipment, or other assets (iv) Reimbursement arrangements (v)Loans or loan guarantees (v7Performance of services or membership or fundraising solicitations c Sharing of facilities, equipment, mailing lists, other assets, or paid employees d If the answer to any of the above is 'Yes,' complete the following schedule. Column (b) should always show the fair ma the goods. other assets, or services given by the reporting organization. If.the organization received less than fair marl a c Line no. Amountbnvolved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements TEEA0406 11/29104 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No ([)Cash 51a X (it)Other assets a X b Other transactions: 52a Is the organization directly or indirect) affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? I- Yes © No American Asian Pacific Mires 43-1569726 . Form 990, Page 3, Part IV, Lines 55a & 55b Investments - Land, Buildings and Equipment Statement (a) Cost/Other Basis (b) Accumulated Depreciation (c) Book Value Automobiles 20,132. 14,798. 5,334. Computers 10,093. 5,453. 4,640. Furniture and Fixtures 8,231. 3,029. 5,202. Office Improvements_ 23,715. 14,051. 9,664. Total 62,171. 37,331. 24,840. Form 990, Page 3, Part IV, Line 65 Other Liabilities Statement Beginning End of Line 65 - Other Liabilities: of Year Year Auto Loan Payable 4'v'" Loans from Directors 92,636. 110,614. Total 94,706. 110,873. CDBG FUNDING APPLICATION • AGENCY INFORMATION Agency Name: Family Counseling Services of West San Gabriel Valley (A Division of Santa Anita Family Service Agency Address: 10642 Lower Azusa Suite C, El Monte CA 91731 City Administrator Telephone No.(626) 350-4400 ext 20 Fax:(626)350-4499 Project Site Address: Same As Above Number Street City Zip Code Project Manager Name: Jennifer Foote Psv D Title: Clinical Director Project Manager's Telephone No.~626) 350-4400 ext 20 Fax: 626) 350-4499 Project Manager's Email Address: tfootepsyd(cpearthlink net Describe Agency's overall function or purpose. Include history and experience in providing this service. (If more room is needed, please use additional paper and attach to the back of the apDlicatinn with [X] YES NO If yes, please identify the years and amounts funded: Has the Agency previously received funding from the City of Rosemead? 2.' PROJECT PROPOSAL AND DESCRIPTION In this section, briefly describe the project proposal, including cost estimates. Grant amount Requested: $ 40,000 Briefly describe your proposed Project/Program goals. Your response must describe the scope of services for the project, proposed solutions to problems identified in Priority Needs: Chinese. Briefly describe your proposed program Activities. Your response must describe the strategies and techniques that comprise service and outreach methodology: Briefly describe the direct product of the program activities. Include the volume if work accomplished such as number of: low-income households served, youth, elderly, disabled or number of loan applications processed. Goals must include numeric goals for service that will be achieved during the program year: Can this Project /Program proceed on July 1, 2006? [X] YES [ ] NO 7 Briefly describe and include resources dedicated to the program such as money, staff, equipment and supplies: w C..) cZ L O LL W a E m z !C a. 0 a w 0 a) z c~ Z cu V V) d rn d Q • E E~ E T - T~ ca o c o c o c 0 61 a0 a0 C-0 V 0 tad in- 1~/1 N d CD N 4) N c Q c Q m Q c O 1°0 1°0 * 1d0 ~i w 42 w ttl > N N O y N 0- N .N O f6 W CL N (l. (A t) N 0 0 0 H C N O N C y O Mn C N O O N C N C C N C O f9~ W n 1°d ru F E co y w N Y N in Yo N N 0 0 y 0 o h 4) 0 n oa apim ° ~6)C c.~ a Ix a. :2 CL :2 J! CL :2 E m ` c W U- o +V•' 0 v V . E E *C V 0 C a r 0 0 C M= C C 1 C E O N o m t5 t5 C o E c Q1 0 cp v E > m > to U (D (D t0E 0 O O ~mE O M C, O N V o 0 0 Q 00 o16~ N0 to N 0 ~ N 0 N o O O O 0 H C) z N C) 6 C N o. - 0 O 0 CO M 1 J ( 6 C C C C C C C C C ' > V °_E;oc C C y °~oc C 5 C 0EoE C C Z Q N O N 0 N ~ U N 0 N O N O C ? N 40 N O N 2 0C L 0 Q1 dZ N C y N - 7 C W:3 -(V m N M-0 30 0 d N - 7 3U .2- 1AY 21 yY> Z S T MA E .31 ~O ~jcc42 6 O.E.s L) _ V-) Z C U M CD C o T N en C a) C U > IL a Li (iQ ' w 0 c c ° o m a) 0 U U to O 0 to o o co o U a c c m tv U) 0) O " N D CD Q. a) CC L CO 0 0) 0 4] 'E a) > N E ) ai ° L L O Q u~EU c O 0 E c , tm o c (D w ° E o t. O c U 0 tU 6 U 'O 0 O 0 0 m U E to Q. to N 0 0 a) r-+ CD m (n L a) (D N Vj 'C.+ 0 L 0 0 0 a) L a ) Eo am a a) to L - 0 M o?w- ) O :3 _ E (DEc°~ v 3 ) ' : 5 a) a) - 0) o ca 0.0 o m ~ to 3~to (a C Q ~o C 0 . +L. ' O a t 3 O vi ~ N 0 °ZO~ U.cn E 00 to .C a) L .Q co U O c t a) a) I 0 F- (D r = Ec yam... (Q c CU vo ~ E 00~v0 nv O0 0) 6 U 0 r= a) a 0) .1 , N N v l C L a) Q O = C L a) Cn CL 0 Z 0 (OD E ° a) 0 U ` C .r m U a) N j CL (AOQ caw co • • 3. PROJECT PROPOSAL AND DESCRIPTION (continued) If your proposal is for an existing Project/Program that is currently funded through the City of Rosemead's General Fund, this request will: PLEASE CHECK ONLY ONE: 1. ( ] Increase Service. If so, how? 2. [ X ] Continue the existing funded program at currently funded service levels. 3. [ ] Replace a previous source of funding. If so, list source and reason 4. [ ] New program for FY 2006-2007 5. [ ] New request (not currently funded) 4. CLIENT INTAKE INFORMATION - FOR PUBLIC SERVICE ACTIVITIES The U.S. Department of Housing and Urban Development (HUD) requires that agencies obtain intake data from each client/family served. Does your agency obtain this information? [X]YES [ ] NO If yes, does your intake sheet obtain the following: ■ Name Yes[ X ] No[ ] ■ Address Yes[ X ] No[ ] ■ City in which client last resided Yes[ X ] No[ ] ■ Number of Family members Yes[ X ] No[ ] ■ Total family (household) income Yes[ X ] No[ ] ■ Race/Ethnicity Yes[ X ] No[ ] ■ Female head of household Yes[ X ] No[ ] ■ Disability Yes[ X ] No[ ] 9 Describe any special characteristics of your client economic status level, have diverse ethnic backgrounds, and/or English is often a second language. 5. CLIENT INTAKE INFORMATION - CLIENT INTAKE AND PERFORMANCE Provide the actual numbers of persons served in the following age categories: (for new, non-city of Rosemead agencies, please provide projected data for upcoming fiscal year): PERFORMANCE CHILDREN "YOUTH ADU LT ELDERLY PERIOD 0-12 13-17 18-5 4 55 & OVER Rosemead Agency Rosemead Agency Rosemead en Rosemead A enc 7/1/04 27 212 15 142 28 14 199 to n 6/30/05 7/1105 19 104 8 73 10 145 10 86 to 12/31 /05 10 Provide the actual numbers of your total clients in the categories listed below: (for new, non-city of Rosemead funded agencies, please provide projected data for upcoming fiscal year.) 0 • 6. CLIENT INTAKE INFORMATION - CLIENTS SERVED BY INCOME LEVEL Report the actual number of unduplicated number of clients your agency served from July 1, 2005 through December 31, 2005. One person can only be counted one time, even though the client may have been served many times during the reporting period. Calculate the totals and percentages for each category: Household CDBG Eligible # Served by # Of # Served # Of Rosemead Size Based on Income Agency below Rosemead by Project residents served by Limits the Income residents below the project below the Limit served by the Income Income Limit Agency below Limit the Income Limit 1 $36,700 18 2 2 2 2 $41,900 44 2 2 2 3 $47,150 45 8 8 8 4 $52,400 115 10 10 10 5 $56,600 67 12 12 12 6 $60,800 33 3 3 3 Subtotal of CDBG 322 37 37 37 Eligible Households Total Households Served 322 37 37 37 Percentage of CDBG Income 100 100 100 100 Eligible Families Served 7. CLIENT INTAKE INFORMATION - CLIENT OR PROJECT INFORMATION The source of funding for Public Service Grants comes from a Community Development Block Grant (CDBG) received through the U.S. Department of Housing and Urban Development (HUD). CDBG funds are for the specific purpose of benefiting low/moderate income households. In order to be eligible for these funds, your organization must provide a service for the residents of the City of Rosemead and be able to document that at least 51 percent of the clientele served by the project/program earn less than the following income limits: 11 Income Limits are based on HUD Section 8 Income Guidelines: HOUSEHOLD ANNUAL INCOME SIZE I LIMIT 1 $36,700 2 $41,900 3 $47,150 4 $52,400 5 $56,600 6 $60,800 7 $65,000 8 $69,150 Please check the corresponding letter, which further describes the activity you are proposing: ■ Public Service Projects will most likely be (c), or in some cases (a), per CDBG Eligibility Requirements. a) The project will benefit a clientele that is generally presumed by HUD to be below the eligible income limits. The following groups are presumed to meet this criterion: abused children, battered spouses, elderly persons, and illiterate persons and persons with acquired Immune Deficiency Syndrome (AIDS) b) X The project information on family size and income shows that it is evident that at least 51 percent of the clientele are persons whose family income does not exceed the CDBG eligible income limit (i.e. mapping service area and demonstrating that more than 51% of persons in the service area are low-moderate income). c) The project has income limits that limit the activity exclusively to CDBG eligible income persons. 12 8. ADDITIONAL APPLICATION DISCLOSURE STATEMENT All organizations that submit this application must provide accurate data concerning the number and income levels of clients and/or location and nature of projects/services, as well as demonstrated site control. Estimates are unacceptable except for previously non-CDBG funded agencies. This stipulation shall apply to all organizations that are subsequently awarded funding. Any organization that falsifies information, either accidentally or intentionally, shall be required to reimburse the City for any funds paid out and shall not be permitted to apply for funding in the future. The applicant hereby proposes to provide the services or projects for the City of Rosemead as stated in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state and local regulations and other assurances, as required by the City of Rosemead, will be adhered to. As the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal. DATE: I O1P ORGANIZATION: Family Couseling Services Of West San Gabriel Valley/ Santa Anita Family Service 13 -T ! 0 CO O O O O O t(? 1 L ` f ) Ot M O o cr O 0) 00 M U O O O r 00 C 4 U N ) N ~ t o O U C> 0 Cl O C) O O p ' V- `r 0 It C:) co CD 0 6 to to CO to It ~ ~ N M 0 cO 0 O O O O O O O O O to co 00 (0 CD co O ull n I p r- o co co ER a0, U'j co ti ~ t i 06 (V L6 CV M M O F- 0 ~ p O C) O O LO h LO p O to ~ O 00 O O O O M N N ~ d N ~ V7 ' M U O O O O M 00 0 I 000 0) O 000 O n O ~ O p qq: ~ O M t N O tA C O M 0 C) O C> O C) 0 O 0 C) O 0 LO co W m CO 1 - M 00 OOD I U) LO 00 CV ~ cc; N ~ M U F- CL M L ~ LL r T r u 4t to p j CD 0 ° E p o tp m ' c a CL ° =3 v CL a) 4) ~ c CL E m > ca v_~ _ s F- - O U ca ca (D c06 O N E p 7 C N N ` In D L v~ a c x U w Q~ a Q o- O = N m Y o ~ y O N F- c r m U N .O ~ U a N O t N > 3: W 0 M u c 0 C a m V C 0 u U m E r w H a E LL N LL fr"^' LLI V D co CD Z a W O a H m x W O U t C) LO C) p C) 0 C) N O C) O O O O ~ O O O C) 0 C) C) O M r r O N M N O U u) to _ C) ~ a 0 a 000 o qt o o O O 1- 00 P` o C> O O 00 ' 00 O t` r _ N N oz 0) Ci C) 00 00 L M J Q O co C) O O O o o c, O O o O O o co 00 6 ' 00 M F- Q - L6 vi csi N to N N f N i D D N ( 00 00 C O co ct ~ O U O LO O 0 O N O 0 O O O O O O O M CD IT _ O CD O M 0 N ~ C'i N U to = IQ 0 M C) C) o 0 't C) o C) 0 0 O 00 ~ o O O DD 00 0 N N N N LO co 'tea r 40 Q CD o C) 0 0 o C) C3 O CD 0 o C) CD o 0 C) o O O Co CD cl 0 O CD C) O O C:> C> O CO r- CO ' co co O L6 C4 .N- N L N N N i N C~ ~ co 00 0 00 Cl) V) W W W N Zv Z W cu co (L w LU (1) X W W D N CD O M Wo w m :3 CD 3 > c m m LL w m a~ °D a u) c 0 d iY - It a: M tf N 0 .C U) E co c (D N U Q O O a a. J CL J m CL. c ia - la--v ia- ia- C. 0 a) w N i- (D - 2 O a M 2 0 U O H O .s H O H O i- EXHIBIT B -BOARD OF DIRECTORS AFFIDAVIT All applicant Agencies must complete this affidavit listing the members of the Board of Directors and all other officers. If there are changes in the Board membership after the request is submitted, the City of Rosemead must be notified in writing. In submitting this funding request, I, Designee) Richard Singer depose and say that I am President [insert title, President, Vice President, etc.] of Santa Anita Family Service [Insert name and address of Agency] The other members and officers of the Board of Directors of this Agency are: (Please list names of current Board Members and attach an additional sheet, if necessary): NAME' 1. Richard Singer TITLE'.e-. President 2010 2. Christine Carlson Geno Executive Vice President 2010 3. Patricia Myers Vice President 2010 4. Timothy K. Scanlan Treasurer 2010 5. Linda Proctor Secretary 2010 6. Richard Meaglia General Counsel 2010 7. Viola Kentner Director 2010 8. Peter Hoffman Director 2010 9. Mildred Dexter Director 2010 10. Jan Marugg Director 2010 11. Kathleen Woodward Director 2010 12. Bob Proctor Director 2010 13. Christina Madrid Director 2010 14. Jill Harkema Director 2010 15. Tom Adams Director 2010 16. Diana Peterson-More Director 2010 DATE: Z ~ 6l0 AT:- M6011~VrN_ Gk- (CITY & STATE) THE APPROPRIATE AGENCY DESIGNEE MUST SIGN AND AFFIX THE SEAL (Corporate Seal) I certify and declare under penalty of perjury that the foregoing is true and correct. nn Richard Singer Print Name ignatur d Title C • Santa Anita Family Service's D & B number is 171561426. Form 990 Am of Organization Exempt fromocome Tax Under section 501(c), 527, or 4947(aXl) of the Internal Revenue Code (except black lung benefit trust or private foundation) Internal %ve ue Service 7 ► The organization may have to use a copy of this return to satisfy state reporting req A For the 2004 calendar year, or tax vear beginning 7/01 , 2004, and ending 11/30 OMB No. 1545-0047 1 2004 Open to Public Inspection B Check It applicable: D Employer IdeMiri bon Number Address don" PRlesh,e i Family Counseling Service of West 95-2469628 o; r'"! San Gabriel Valley E Telephone number N h ame c ange 10642 Lower Azusa Rd Ste C (626) 350-4400 see Initial ream as lfie El Monte, CA 91731 I A F m ngi cash X Ac«ual X Final ream bons. Amended return oar Application pending • Section 501(eX3) organizations and 4947(a)(1) nonexempt N and I are not applicable to section 527 oryan&a1kns. charitable trusts must attach a completed Schedule A H (a) Is this a group return for afnliatesZ Y. No (Form 990 or 990-E2). H (b) If ties,' enter nurnbar or rrliares . 0' G Web site: ► N/A H (c) Are all of mates Indudw? Y. No J Organization (if 'No,' attach a list. See instructlons.) l le' X h k 3 -4 (ruert no.) 4%7(a)(1) or 5Z1 (c ec on one Sol (c) H (d) Is this a separate return filed by an K Check here ► if the organization's gross receipts are normally not more than organization covered by a wow ruing. Y.. X No $25,000. The organization need not file a return with the IRS; but if the organization received a Form 990 Package in the mail, it should file a return without financial data. I Group Exemption Number... Some states require a complete return. M Check ► if the organization is not required L Gross receipts: Add lines 6b, 8b, 9b, and 10b to line 12 ► 210, 559. to attach Schedule B (Form 990, 990-E4 or 990-PF). " - Revenue Expenses, and Changes in Net Assets or Fund Balances (See Instructions) 1 Contributions, gifts, a Direct public sups b Indirect public support c Government cons 163,585 dTgrgm cr(cash 2 Program service revenue including government fees and contracts (from Part VII, line 93) 2 7,953. 3 Membership due 4 Interest on savings 5 Dividends and in 6a Gross rents.... . b Less: rental expo c Net rental income R 7 Other investment E v 8 G t f (A) Securities (8) Other ross amoun rom a e than inventory.. . U E b Less: cost or other c Gain or (loss) (attach d Net gain or poss 9 Special events and activities (attach schedule). If any amount is from gaming, check here a Gross revenue (not including $ of contributions reported on line b Less: direct expenses c Net income or Ooss) from special events (subtract line 9b from line 9a) 9c 10a Gross sales of inventory, less returns and allowances I 10a l b Less: cost of you c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) . 10c 11 Other revenue (from 12 Total revenue (a 13 Program service E x 14 Management an P E 15 Fundraising (frog N s E 16 Payments to affiliates s 17 Total expenses A 18 Excess or (deficit) s 19 Net assets or fun E T T 20 Other changes in S , 21 Net assets or fu BAA For Privacy Act and SCI 1[:'><':<~ Statement pi tunctional txpenses All organizations must complete column (A). Columns (8), (C), and (D) are required for section 501(c)(3) and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others. Do not include amounts reported on line 6b, 8b, 9b, 10b, or 16 of Part 1. 4 zf (A) Total (B) Program services (C) Management and general Fundraising g 22 Grants and allocations (att sch) (cash $ non-cash $ 22 23 specific assistance to individuals (aft sch) 23 24 Benefits paid to or for members (aft sch)........ 24 25 Compensation of officers, directors, etc 25 22,480. 21,054. 1,426. 26 Other salaries and wages 26 102 280. 99,447. 2 833 . 27 Pension plan contributions 27 28 Other employee benefits 28 8,835. 7,812. 1,023. 29 Payroll taxes 29 10,209. 9,124. 1,085. 30 Professional fundraising fees........... 30 31 Accounting fees 31 32 Legal fees 32 33 Supplies 33 2,015. 584. 1,431. 34 Telephone 34 1,775. 1,720. 55. 35 Postage and shipping 35 36 Occupancy 36 35,293. 34,041. 1,252. 37 Equipment rental and maintenance 37 480. 463. 17. 38 Printing and publications 38 39 Travel 39 391. 391. 40 Conferences, conventions, and meetings......... 40 41 Interest 41 749. 749. 42 Depreciation, depletion, etc (attach schedule)...... 42 729. 729. 43 Other expenses not covered above (itemize): a Insurance 43a 5,855. 5,034. 821. b Legal_& accounting_ 431b 6,774. 6,774. c Other expense 43c 53. 53. d Payroll service fees 43d 488. 488. e 43e 44 Total functional expenses (add lines 22 - 43 . carry a°a~rotai to i ~ 131-15 (8) . (a)' 44 198 406. 1-79,670. 1 18 736. -0. Joint Costs. Check. I"u if you are following SOP 98.2. Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services? 0"[] Yes XX No If 'Yes,' enter (0 the aggregate amount of these joint costs $ ; C0 the amount allocated to Program services $ ; Chi) the amount allocated to Management and general $ ; and (v) the amount allocated What is the organization's primary exempt purpose? ► See Statement 1 _ _ _ _ _ _ _ _ - I Program el: All organizations must describe their exempt purpose achievements in a dear and concise manner. State the number of (R ;"„W a_I_N-H_0_US_E _COU_NSELI_NG_ SERVICE _ - Multi-faceted cou_n_se_i_ng and _e_duca_tion_a_l _s_er_v_i_ces; abuse - - - do - - - sis intervention_ and~arentinq _ skills- _ - - - - - - b OUTREACH PROGRAM SERVICESCommunity _activities, educational classes, -presentations) gFoUL and counseling activities. (Grants and allocations $ ) C _ (Grants and allocations $ ) d e TEEA0102L 01107/05 BAA Form 990 (2004) Form 990 (2004) Family Counseling Service of West 95-2469628 Page 3 Balance Sheets (See Instructions) Note: Where required, attached schedules and amounts within the description column should be for end-of-year amounts only. (A) Beginning of year (B) End of year 45 Cash - non-interest-bearing 39,952. 45 44,864. 46 Savings and temporary cash investments 46 47a Accounts receivable 47a b Less: allowance for doubtful accounts 47b 4L329. , 47c 48a Pledges receivable 48a b Less: allowance for doubtful accounts 48b 48c 49 Grants receivable 95,306. 49 54,060. A s 50 Receivables from officers, directors, trustees, and key employees (attach schedule} 50 T 51 a Other notes & loans receivable (attach sch) 51 a S b Less: allowance for doubtful accounts 51 b 51 c 52 Inventories for sale or use 52 53 Prepaid expenses and deferred charges 14,239. 53 19,810. 54 Investments - securities (attach schedule) 11E] Cost[] FMV 54 55a Investments - land, buildings, & equipment: basis. 55a b Less: accumulated depreciation (attach schedule) 556 ' ' 55c 56 Investments - other (attach schedule) 56 57a Land, buildings, and equipment: basis............ 57a 41,635. b Less: accumulated depreciatio (attach schedule) Statement.2 57b 26,056. 5,718. 57c 15 579. 58 Other assets (describe ► See Statement 3 ) . 6,500. 58 6,500. 59 Total assets add lines 45 through 58) (must equal line 74 166, 044. 59 140, 813. 60 Accounts payable and accrued expenses 75,057. 60 46,006. 61 Grants payable 61 A 62 Deferred revenue 62 1 63 Loans from officers, directors, trustees, and key employees (attach schedule) 63 64a Tax-exempt bond liabilities (attach schedule) 64a e bMortgagesandofhanotes papble(attach schedule) S.ee..Statement..4...... 10,000. 64b 1,667. s 65 Other liabilities (describe ) . 65 66 Total liabilities (add lines 60 through 65 85,057. 66 47,673. A Organizations that follow SFAS 117, check here ► X and complete lines 67 through 69 and lines 73 and 74. 67 Unrestricted 73,191. '>:aE 67 69,802. 68 Temporarily restricted 7,796. 68 23,338. 69 Permanently restricted 69 Organizations that do not follow SFAS 117, check here ► and complete lines 70 through 74. 70 Capital stock, trust principal, or current funds 70 71 Paid-in or capital surplus, or land, building, and equipment fund 71 e 72 Retained earnings, endowment, accumulated income, or other funds 72 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72; column (A) must equal line 19; column (B) must equal line 21) 80,987. 73 93,140. 74 Total liabilities and netassetslfund balances (add lines 66 and 73 166, 044. 74 140, 813. Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization. How the public perceives an organization in such cases may be determined by the information presented on its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments. BAA TEEA0103L 01107/05 • . . • Form 990 (2004 Family Counseling Service of West 95-2469628 Page 4 t Reconciliation of Revenue Per Audited ai'f<t` Reconciliation of Expenses per Audited Financial Statements with Revenue Financial Statements with Expenses per Return (See instructions.) per Return a Total revenue, gains, and other support a Total expenses and losses per audited per audited financial statements......... a N/A financial statements ► . a N/A b Amounts included on line a but { ut not b Amounts included on line a b not on line 12, Form 990: i on line 17, Form 990: (1) Net unrealized : (1) Donated serv- t. ` gains on ices and use investments.... $ of facilities $ (2) Donated serv• ices and use (2) Prior year adjust- ments reported on of facilities $ Form 990 $ line 20 k? , (3) Recoveries of prior (3) Losses reported on year grants $ line 20, Form 990.... $ } (4) Other (specify): (4) Other (specify): z r - - - - - - - - - - - - - - ry` Add amounts on lines (1) through (4) b - - - - Add amounts on lines (1) through (4) 0. b c Line a minus line b c c Line a minus line b................ 10- c d Amounts included on line 12, d Amounts included on line 17, Form 990 but not on line a: Form 990 but not on line a: (1) Investment expenses (1) Investment emmes k not included on line not included on line } 6b, Form 990...... $ 6b, Form 990....... $ ; (2) Other (specify): (2) Other (specify): $ AK ..i. .........I.hv . Add amounts on lines (1) and (2).. d Add amounts on lines (1) and (2)... d e Total revenue per line 12, Form a Total expenses per line 17, Form 990 pine c plus lined , a 990 pine c plus line e List of Officers Directors Trustees and Key Emp loyees st each one even if not coin nsa ted; see instructions. (B) Title and average hours k d t d (C) Compensation id f t (D) Contributions to l b fit (E) Expense t d th (A) Name and address per wee evo e , ( no pa ene emp oyee accoun an o er to position enter-0-) plans and deferr ed allowances compensation See Statement -5 - - - - - - - - _ 22,480. 0. 0. 75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations? 0, ❑ Yes XX No If 'Yes,' attach schedule - see instructions. BAA Form 990 (2004) TEEA0104L 01107105 • . . i 76 Did the organization engage in any activity not previously reported to the IRS? If 'Yes,' attach a detailed description of each activity 77 Were any changes made in the organizing or governing documents but not reported to the IRS? If 'Yes,' attach a conformed copy of the changes. 78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return?.... b If 'Yes,' has it filed a tax return on Form 990-7 for this year? . . 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If 'Yes,' attach a statement 80a Is the organization related (other than by association with a statewide or nationwide organization) through common membership, governing bodies, trustees, officers, etc, to any other r,xempt or nonexempt organization? b If 'Yes,' enter the name of the organization ► N/A and check whether it is exempt or nonexempt. 81 a Enter direct and indirect political expenditures. See line 81 instructions 181 al 0. b Did the organization file Form 1120-POL for this year? 82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? b If 'Yes,' you may indicate the value of these items here. Do not include this amount as revenue in Part I or as an expense in Part II. (See instructions in Part III.) I 82bl N12 83a Did the organization comply with the public inspection requirements for returns and exemption applications? b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 84a Did the organization solicit any contributions or gifts that were not tax deductible? b If 'Yes,' did the oranization include with every solicitation an express statement that such contributions or gifts were not tax deductible? 84b N A 85 501(c)(4),(5), or (6) organizations. & Were substantially all dues nondeductible by members? 85a NA b Did the organization make only in-house lobbying expenditures of $2,000 or less? 85b N A If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a j waiver for proxy tax owed for the prior year. c Dues, assessments, and similar amounts from members 85c N/A d Section 162(e) lobbying and political expenditures . 85d N/A e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e N/A f Taxable amount of lobbying and political expenditures (line 85d less 85e) 85f N/A g Does the organization'elect to pay the section 6033(e) tax on the amount on line 85f7 85g N A h If section 6033(exl)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? 86 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 12 86a N12 b Gross receipts, included on line 12, for public use of club facilities . 86b N12 87 501(c)(12) organizations. Enter: a Gross income from members or shareholders Val N/1 b Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If'Yes,'complete Part IX 89a 501(c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under: section 4911 ► 0 . ; section 4912 ► 0 . ; section 4955 ► 0. b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year? If 'Yes,' attach a statement explaining each transaction c Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 ► 0. d Enter: Amount of tax on line 89c, above, reimbursed by the organization ► 0. 90a List the states with which a copy of this return is filed ► California b Number of employees employed in the pay period that includes March 12, 2004 (See instructions.) . . . . . . . 90b 0 91 The books are in care of ► Family Counseling Service _ Telephone number ► (626)350-440.0 Located at ► 10642 Lower Azusa Rd Ste C El Monte CA ZIP + 4 ► 91731 92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041- Check here N/. A ► u and enter the amount of tax-exempt interest received or accrued during the tax year ►l 92 l N/A BAA Form 990 (2004) TEEA0105L 01107!05 L Note: Enter gross amounts unless otherwise indicated. (B) Amount (C) Exclusion code Related or exempt function income 7 93 Program service revenue: a Client Counseling Fee b d e f Medicare/Medicaid payments....... . g Fees & contracts from government agencies 94 Membership dues and assessments.. 95 Interest on savings & temporary cash invmnts.. 96 Dividends & interest from securities . . 97 Net rental income or (loss) from real estate: a debt-financed property b not debt-financed property.......... . 98 Net rental income or (loss) from pers prop 99 Other investment income........... . 100 Gain or poss) from sales of assets other than inventory 101 Net income or (loss) from special events 102 Gross profit or (loss) from sales of Inventory 103 Other revenue: a b Royalty income c d e 104 Subtotal (add columns (8), (D), and (E))..... 105 Total (add line 104, columns (B), (D), ount on line 12. Part 1. Une No. I Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes). A' X d Information Regarding Taxa ble Subsidiar ies and Disregarded Entiti es See instructions. (A) Name, address, and EIN of corporation, partnership, or disregarded entity (B) Percentage of ownership interest (C) Nature of activities (D) Total income (E) End-of-year assets N/A % g a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? H Yes N No b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? Yes N No Please ► Sign Here ► Paid Preparer's Pre- signature ► parer's Firm's name (or yours H self- Use eZloyed), ► a d Only sds, an ZIP U I to the best of my loiowbdge and belief, it is kn~ Z 3 _OS~ a ay es SSN or PTIN (S H eral Instruction Nt) lock if a]N/A ,payed N ► N/A ,oneno. ► (626) 683-0515 TEEAD106L 101M M Form 990 (2 0 Organization Gxem t Unde* OMB NO. 1545-00 (Form S~ ~9sA Section 501(c~(3) (Except Private Foundation) and Section 501(e~ 501(f), 501(k), 2~ 04 501(n), or Section 4947(a)(1) Nonexempt Charitable Trust Supplementary Information - (See separate instructions.) in~evtem~ we ein the sew ry ► MUST be completed by the above organizations and attached to their Form 990 or 990-E7- Name of rf* organization Family Counseling Service of West (See instructions. List each one. If there are none, enter 'None.') (a) Name and address of each employee paid more than $50,000 (b) Title and average hours per week devoted to position (c) Compensation (d) Contributions to employee, benefit plans and eferred compensation (e) Expense account and other allowances None Total number of other employees paid over $50,000 0 ?ttt Compensation of the Five Highest Paid Independent Contractors for Professional Services (See instructions. List each one (whether individuals or firms). If there are none, enter 'None.') (a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation None over Notice, see the Instructions for Form 990 and Form 990-EZ. Schedule A (Form 990 or TEEAW01L 07/22/04 Schedule A (Form 990 or 990 2004 Famil Counselin Service of West 95-2469628 Page 2 ?`<>?<z Statements About Activities (See instructions.) Yes No 1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If 'Yes,' enter the total expenses paid or incurred in connection with the lobbying activities 11 $ N/A (Must equal amounts on line 38, Part VI-A, or line i of Part VI-B.) 1 X Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A. Other organizations checking Yes' must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities. 2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any o th an ffi l b i f il t d t t k f th r wi ors, o cers, crea oyees, or mem ers o e r am ies, y ees, irec ors, ey emp substantial contributors, trus taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? (If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions.) a Sale, exchange, or leasing of property? 2a _ X b Lending of money or other extension of credit? 2b X c Furnishing of goods, services, or facilities? 2c X d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)2 2d X e Transfer of any part of its income or assets? 2e X 3a Do you make grants for scholarships, fellowships, student loans, etc? (If 'Yes ' attach an explanation of how you determine that recipients qualify to receive payments.] 3a X b Do you have a section 403(b) annuity plan for your employees? 3b X 4a Did you maintain any separate account for participating donors where donors have the right to provide advice on the use or distribution of funds? T X b Do you provide credit counseling, debt management, credit repair, or debt negotiation services? b X rt!#V'<-. Reason for Non-Private Foundation Status (See instructions.) The organization is not a private foundation because it is: (Please check only ONE applicable box.) 5 A church, convention of churches, or association of churches. Section 170(b)(1)(A)(). 6 A school. Section 170(b)(1)(A)(ii). (Also complete Part V.) 7 A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(iii). 8 A Federal, state, or local government or governmental unit. Section 170(b)(1)(A)(v). 9 A medical research organization operated in conjunction with a hospital. Section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state I - 10 An organization operated for the benefit of a college or university owned or operated by a governmental unit. Section 170(b)(1)(A)(iv). (Also complete the Support Schedule in Part IV-A.) 11a X❑ An organization that normally receives a substantial part of its support from a governmental unit or from the general public. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.) 11 b A community trust. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.) 12 An organization that normally receives: (1) more than 33-1131/6 of its support from contributions, membership fees, and gross receipts from activities related to its charitable, etc, functions - subject to certain exceptions, and (2) no more than 33-113% of its support from gross investment income and unrelated business taxable income pess section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Also complete the Support Schedule in Part IV-A.) 13 An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in: (1) lines 5 through 12 above; or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2). (See section 509(a)(3).) (a) Name(s) of supported organization(s) I (b) Line number from above 14 n An organization organized and operated to test for public safety. Section 509(a)(4). (See instructions.) BAA TEEAo4o2L 07roro4 Schedule A (Form 990 or Form 990-EZ) 2004 LJ • V, t:.`:?(5uppott 5ehedule (Complete only if you checked a box online 10, 11, or 12.) Use cash rrrefhodofaccourrting. Note: You may use the worksheet in the instrucLons for conv ertor from the accru al to the cash method or accounting. Calendar year (or fiscal year ► (a) (b) (c) 00 (d) (e) T t l beginning in) 2003 2002 1 2 2000 o a 15 dieutions ece d n DDo not ncl r ( i u ive unusual rants. See line 28.... 466 978. 472 673. 551 341. 580 300. 2,071,292. 16 Membership fees received 17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's charitable etc, purpose 34,983. 42,680. 39,330. 50,037. 167, 030. 18 Gross income from interest, dividends, amounts received from payments on securities loans (section 512(aX5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organ- ization after June 30, 1975 67. 2,658. 2,725. 19 Net income from unrelated business activities not included in line 18 20 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf 21 The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to the public without charge 22 Other income. Attach a schedule. Do not include cagain ital asse s. See . Stmt..6. 16,425. 8,330. 11574. 26,329. 23 Total of lines 15 through 22.... 518 386. 515, 353. 599, 06B. 634 569. 2, 267, 376. 24 Line 23 minus line 17.......... 483, 403. 472 673. 559, 738. 564 532. 2,100, 346. 25 Enter 1% of line 23............ 5 184 . 5,154. 1 5,991. 1 6 3 46. < 26 Organizations described on lines 10 or 11: a Enter 2% of amount in column (e), line 24 ► 26a 42,007. b Prepare alist for your records to show the name of and amount contributed b each person other than a mental unit or Yo by ( tl~ publicly supported organization) whose total gifts for 2000 through 2003 exceeded the amount shown in line 26a. Do not file this list with your return. Enter the total of all these excess amounts 26b 26,279. c Total support for section 509(a)(1) test: Enter line 24, column (e) ► 26c 2 100 346 . d Add: Amounts from column (e) for lines: 18 2,725. 19 22 26,329. 26b 26,279. 26d 55,333. e Public support (line 26c minus line 26d total) ► 26e 2, 045, 013. f Public support percentage (line 26e (numerator) divided by line 26c (denominator)) ~ _26f G! 17 ~r 27 Organizations described on line 12 N/A a For amounts included in lines 15, 16, and 17 that were received from a 'disqualified person,' prepare a list for your records to show the name of, and total amounts received in each year from, each 'disqualified person.' Do not file this list with your return. Enter the sum of such amounts for each year: (2003) (2002)------------(2001)------------ (2000) - - - - - - - - - - - - - bFor any amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000. (Include in the list organizations described in lines 5 through 11, as well as individuals.) Do not file this list with your return. After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year: (2003) MM------------ (2001)------------ M) c Add: Amounts from column (e) for lines: 15 16 17 20 21 I Z7 c j d Add: Line 27a total..... and line 27b total. e Public support pine 27c total minus line 27d total) ► f Total support for section 509(a)(2) test: Enter amount from line 23, column (e) 27( g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) ► 27 h Investment income percentage pine 18. column (e) (numerator) divided by line Z71 (denominator)) ► 27 h 28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 2000 through 2003, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the BAA TEEA0403L ozroroa Schedule A (Form 990 or 990-EZ) 2004 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing instrument, or in a resolution of its governing body? 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships? 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves? If 'Yes,' please describe; if 'No,' please explain. (If you need more space, attach a separate statement.) 32 Does the organization maintain the following: a Records indicating the racial composition of the student body, faculty, and administrative staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? c Co ies of all catalogues, brochures, announcements, and other written communications to the public dealing 3 student admissions, programs, and scholarships? d Copies of all material used by the organization or on its behalf to solicit contributions? If you answered 'No' to any of the above, please explain. (If you need more space, attach a separate statement.) No 33 Does the organization discriminate by race in any way with respect to: j a Students' rights or privileges? b Admissions policies? c Employment of faculty or administrative staff? . d Scholarships or other financial assistance? . e Educational policies? f Use of facilities? g Athletic programs? h Other extracurricular activities? 33h If you answered 'Yes' to any of the above, please explain. (If you need more space, attach a separate statement.) 34a Does the organization receive any financial aid or assistance from a governmental agency? b Has the organization's right to such aid ever been revoked or suspended? If you answered 'Yes' to either 34a or b, please explain using an attached statement. 35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev Proc 75.50, 1975-2 C.B. 587, covering racial BAA TEEAD404L 07rr3M Schedule A (Form 990 or Lobbying Expenditures by Electing Public Charities (See instructions.) (To be completed ONLY by an eligible organization that filed Form 5768) N/A Limits on Lobbying Expenditures Affiliated group To be completed (The term 'expenditures' means amounts paid or incurred.) totals for ALL electing organizations 36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37 38 Total lobbying expenditures (add lines 36 and 37) 38 39 Other exempt purpose expenditures 39 40 Total exempt purpose expenditures (add lines 38 and 39) 40 41 Lobbying nontaxable amount. Enter the amount from the following table - If the amount on line 40 is - The lobbying nontaxable amount is - Not over $500,000 20% of the amount on line 40 Over $500,000 but not over $1,000,000........... $100,000 plus 15% of the excess over 2500,000 Over $1,000,000 but not over $I,500,OOQ $175,000 plus 10% of the excess over $1,000,000 41 Over $1,500,000 but not over $17,000,000......... $225,000 plus 5% of the excess over $1,500,000 Over $17,000,000 $1,000,000...................... 42 Grassroots nontaxable amount (enter 25% of line 41) 43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36 43 44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38 44 4 -Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 45 through 50.) Lobbying Expenditures During 4 -Year Averaging Period (a) I (b) I (c) I (d) I (e) 2004 2003 2002 2001 Total 45 Lobbying nontaxable amount 46 Lobbying ceilingg amount (ISO% of line 45(e)) 47 Total lobbying expenditures......... 48 Grassroots non- taxable amount....... 49 Grassroots ceiling amount (150% of line 48(e)) 50 Grassroots lobbying expenditures (For reporting only by organizations that did not complete Part VI-A) (See instructions.) N/A During the year, did the organization attempt to influence national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of: a Volunteers b Paid staff or management (Include compensation in expenses reported on lines c through h.).......... c Media advertisements Yes No Amount :»::>i;r<>;«:<:>::::>:<:: d Mailings to members, legislators, or the public e Publications, or published or broadcast statements f Grants to other organizations for lobbying purposes g Direct contact with legislators, their staffs, government officials, or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means 1 Total lobbying expenditures add lines c through h. If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities . BAA Schedule A (Form 990 or 990-E2) 2004 TEEA0405L 07r2ND4 (i)Sales or exchanges of assets with a noncharitable exempt organization QoPurchases of assets from a noncharitable exempt organization 0H)Rental of facilities, equipment, or other assets Qv) Reimbursement arrangements (v)Loans or loan guarantees (vi)Performance of services or membership or fundraising solicitations c Sharing of facilities, equipment, mailing lists, other assets, or paid employees . d If the answer to any of the above is 'Yes.' comolete the following schedule. Column (b) should always show the fair m (a) I (b) I jc) I (d) Line no. Amount involved Name of noncharitab a exempt organization Description of transfers, transactions, and suing arrangements TEEA0406L I 1 r29= 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No M Cash 51 a i X 0) Other assets a n X b Other transactions: 52a Is the organization directly or indirectly affiliated with, or related to one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? Yes ❑ X No • Schedule B (Form 990, 990-EZ, or 990-PF) Department of the Treasury Internal Revenue Service Name of oryaninfim p, Organization type (check one): Filers of: Form 990 or 990-EZ E Schedule of Contributors Service of West OMB No. 1W W47 2004 Section: n527 501(c)( 3 ) (enter number) organization 4947(a)(1) nonexempt charitable trust not treated as a private foundation political organization Form 990-PF 501(c)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated as a private foundation 501(c)(3) taxable private foundation Check if your organization is covered by the General Rule or a Special Rule. (Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule - see instructions.) General Rule - r] For organizations filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (n money or property) from any one contributor. (Complete Parts I and II.) Special Rules - X❑ For a section 501(c)(3) organization filing Form 990, or Form 990-EZ, that met the 33-113% support test of the regulations under sections 509(a)(1)l170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the greater of $5,000 or 2% of the amount on line 1 of these forms. (Complete Parts I and II.) ❑ For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from any one contributor, during the year, aggregate contributions or bequests of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. (Complete Parts I, 11, and III.) F] For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from any one contributor, during the year, some contributions for use exclusively for religious, charitable, etc, purposes, but these contributions did not aggregate to more than $1,000. (If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc, purpose. Do not complete any of the Parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc, contributions of $5,000 or more during the year.) 0' $ Caution: Organizations that are not covered by the Q 990-PQ but they must check the box in the heading c not meet the riling requirements of Schedule B (Form Pules do not file Schedule B (Form 990, 990-EZ, or or on line 2 of their Form 990-PF, to certify that they do BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990, Form 990-EZ, and Fonn 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (2004) TEEA0701L 11!24104 (a) (b) (c) (D Number Name, address, and DP +4 Aggregate Type of contribution contributions 1 United Way_____________________________ Person X Payroll 523 W. Sixth St. 15L225_ Noncash (Complete Part II if there Los AngeleS,_ CA 90014 _ is a noncash contribution.) (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate contributions Type of contribution 2 Whitecap Foundation______________________ Person X 800 Wilshire B1vd.L X1010__________________ 20L893_ Payroll Noncash (Complete Part II if there Los An eles CA 90017 is a noncash contribution.) (a) Number Name, address, and ZIP + 4 Aggregate contributions Type of contribution 3 County of_Los_ Pa roll 714 W_ Olympic y Los Angeles,_ C (Complete Part 11 if there (a) Number Name, address, and ZIP + 4 Aggregate contributions Type of contribution 4 _ty of Rosemead 8838 E. Valle Payroll Rosemead1_CA S (a) Number Name, address, and ZIP + 4 Aggregate contributions Type of contribution 5 County of-Los_ 3175 W. Sixth_ Payroll Los Ancgeles,_ C (Complete Part 11 if there (a) Number Name, address, and 23P + 4 Aggregate contributions Type of contribution Person Payroll Noncash (Complete Part 11 if there BAA Contributors (See Specific Instructions.) No. from Part 1 Description of non(c)ash property given FMV (or estimate) (see instructions) Date r(ecceived N/A - (a from Part 1 Description of nonca) sh property given FMV (or estimate (see instructions; Date r(ecceived - No(from Part I Description of noncash property given FMV (or estimate (see instructions; Date received - - - - - - - (a) No, from Part I (b) Description of noncash property given (c) FMV (or estimate (see Instructions (d) Date received - (a) No. from Part I (b) Description of noncash property given (c) FMV (or estimate (see instructions; (d) Date received - (a) No. from Part 1 (b) Description o(nonwsh property given (c) FMV (or estimate) (see instructions) (d) Date received - BAA Schedule B (Form 990, 990-EZ, or 990-PF) (2004) TEEA0703L 09113/06 Noncash Property (See Specific Instructions.) I - r~ Exclusively religious, charitable, etc, individual contributions to section 501(c)(7),(8), or (10) organizations aggregating more than $1,000 for the year (Complete cols (a) through (e) and the following line entry.) For organizations completing Part III, enter total of exclusively religious, charitable, etc, contributions of $1,000 or less for the year. (Enter this information once - see instructions.)............ $ N/A (a) No. from Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held - N/A (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No. from Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held - (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No. from Part l (b) Purpose of gift (c) Use of gift (d) Description of how gift is held - (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No. from part 1 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held - (a) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee BAA Schedule B (Form 990, 990-E7, or 990-PF7 (2004) TEEAD704L 09113M • CDBG FUNDING APPLICATION 1. AGENCY INFORMATION Agency Name: Administrator Telephone NoL z ' Fax:~496 - a5C1(5 I/) lW/ Project Manager Name: LfQ~~ J9/I)J) Title: Project Manager's Telephone No.'$~;~ h!9 Fax: Project Manager's Email Address: l I)AC, U C, _ m,4AQ Describe Agency's overall function or purpose. Include history and experience in providing this service. (If more room is needed, please use additional paper and attach to the back of the application with a reference number). Has the Agency previously received funding from the City of Rosemead? 0 YES NO If yes, please identify the years and amounts funded.- 2003-2004 2002-2003 6 PROJECT PROPOSAL AND DESCRIPTION In this section, briefly describe the project proposal, including cost estimates. Grant amount Requested: 0 ~U Briefly describe your proposed Project/Program goals. Your response must describe the scope of services for the project, proposed solutions to problems identified in Priority Needs: Briefly describe and include resources dedicated to the program such as money, staff, equipment and supplies: Z± I Briefly describe your proposed program Activities. Your response must describe the strategies and techniques that comprise service and outreach methodology: J Briefly describe the direct product of the program activities. Include the volume if work accomplished such as number of: low-income households served, youth, elderly, disabled or number of loan applications processed. Goals must include numeric goals for service that will be achieved during the program year- c') J Can this Project /Program proceed on July 1, 2006? S YES [ ] NO 7 co • M-0 K -DOcn~ cD CD n c (D m ~ (D =r C c~cnvm W c n< c CD o°-u`<ID O o;2 5v3o30°0 ~0m~.CtoDo 0 CD mac( 0cn<. 1 N CD 3 , . CD - 00 (D 0 CD CD ~ 0 O I : cD cD _ _ cf) Z3 0 , CD 0 0) Cr CD cD 3 cA O N cD n CD 3 - -'(D CD n ~ O ~ ).v zr CD =r a a cn o 0 CD 0 o r- - o~ co O CD cl- ? cn c CL o ~ ocn ~a CD (D c 3 n_ f1 . CD cD cp cn c 0)(D~CDa co CDO3iu`< CD 0 CD CL E O w cD CD (O vi 0 0 0) Co CD N 0 c (n =m 0 c • o 3 3 c o c m =3 0o°O 0 - cD O .n+ :E C c 5' 3 0 O c 0 s ' C c g o CD m -0 0 3 CD = o cn O v 0 ?3 m 0 3 c CD n cD m 0 w 0 Q- 0 cD cD N (D n C° s o co o CL o W o c w CD cD 0 3 m d o c D • C s o~ o o s t-j C ~l ~ o o n o o. ~ b b CIO, L C) C4 I~~ 0 0 ?rn- CL 0 a CA -ITS Cj) 0 1 T S ~ ~0 4 u) p ~z sl O a R ~cz, ~i r 4, P can ~o C3 j(! ~ a ;F C 0 b ~ A yO~ g 1 a C o 0 W 3 Z. 13 9 1t~ ,7~• ~y s ` 1 4- 5, Qs. b CIS 0 O a CD N C ~j ~rl(~ 0 P 4 ~~c S Cf) . c1, © Pa p "yc O o 1 d s b'6~ N < N S C1- C) m 0 V t I~ ALI o ,`fib A C i (N- IV m M D z m m c m m z N m D z O c O m CO) Cl) D m m z • • 3. PROJECT PROPOSAL AND DESCRIPTION (continued) If your proposal is for an existing Project/Program that is currently funded through the City of Rosemead's General Fund, this request will: PLEASE CHECK ONLY ONE: 1.j Increase Service. If so, how? w~~ /,(1 C' f3sL mot` iT r~°~~ 2. [ ] Continue the existing funded program at currently funded service levels. 3. [ ] Replace a previous source of funding. If so, list source and reason 4. [ ] New program for FY 2006-2007 5. [ ] New request (not currently funded) 4. CLIENT INTAKE INFORMATION - FOR PUBLIC SERVICE ACTIVITIES The U.S. Department of Housing and Urban Development (HUD) requires that agencies obtain intake data from each client/family served. Does your agency obtain this information? K] YES [ ] NO If yes, does your intake sheet obtain the following: ■ Name Yespq No[ ] ■ Address Yes(] No[ ] ■ City in which client last resided YesDd No[ ] ■ Number of Family members YesM No[ ] ■ Total family (household) income YesM No[ ] ■ Race/Ethnicity YesM No[ ] ■ Female head of household YesN No[ ] ■ Disability Yes(] No[ ] 9 CDBG GRANT OUTLINE AGENCY INFORMATION (cover page) People For People is a non-profit food program. We began operations on March 1, 1984 and since then we have served the unemployed, welfare mothers and fathers, low-income families, the elderly, homeless families and individuals. We serve the cities of Alhambra, San Gabriel, Rosemead, Temple City, Monterey Park, and all the unincorporated county areas within our service boundaries. Our purpose is to help people on a monthly basis, providing food, clothing, job opportunities and moral support. We are funded by local churches, service groups, and individuals in our service area. We also have a thrift store that provides free clothing to those in need. The thrift store helps support the food program. People For People is a project of the West San Gabriel Valley Church Council which was incorporated in 1949 under the name of Alhambra Area Church Council to meet the assessed need of the community churches, by providing this local distribution center. The first location was the First Baptist Church at Walnut Grove and Mission Drive in Rosemead. We moved to our present location, 860 E. Mission Drive, San Gabriel in 1985. Norene Rand began serving as Executive Director at that time. The thrift store opened a few months later. The staffs of volunteers from churches, service organizations and local businesses are experienced in working with people and have a caring heart for those less fortunate in our society. We support the Los Angeles County Courts by accepting appointed community service workers to fulfill their obligation to the system. We also work with the local schools to provide community service skills to their students. • • 2. PROJECT PROPOSAL AND DESCRIPTION (A) Briefly describe your proposed Project/Program goals. Your response must describe the scope of services for the project, proposed solutions to problems identified in Priority Needs: The object of our program is to continue to serve qualified people with supplemental food, clothing, including counseling on a one to one basis according to their needs. We also provide job search and follow up to clients who need employment. In 2006 we will continue delivering food boxes to the seniors, disabled, and shut in individuals in Rosemead. The homeless are given food, clothing, hygiene kits, and blankets on a needed basis. On Wednesdays (when the food program is closed) we provide a sack lunch, and offer clothing and help finding work. During the Christmas holidays, our families are treated to a Christmas box which has a turkey and all the trimmings. The children enjoy a Christmas party where each child receives a gift from Santa; they can hear the story of Christmas and join in the fun by making Christmas crafts. The homeless are given gift certificates to In-Out Burgers and McDonalds for breakfast and dinner, plus socks, hats, hygiene kits and blankets We also have the Adopt - A - Family for the Holidays program. Each client fills out an application with their needs for the family for the holidays. Some children have received computers, TV. Bikes and school clothing, parents are given gifts like dishes, bedding, baby clothes, cribs and beds for the children. Many groups from the business community, schools, churches and individuals have been blessed by adopting families. Our target population is low-income families, the elderly, homeless families and individuals, single parent families, the undocumented families, and those who do not fit in any other programs. We will continue the job program each person who finds employment benefits not only himself but the community at large. 2. PROJECT PROPOSAL AND DESCRIPTION (continued) (B) Briefly describe and include resources dedicated to the program such as money, staff, equipment and supplies: Churches, single donors, and service groups give food, money, and volunteer on a monthly basis. The Adamma Foundation, Edison and CDBG grants are received annually. The Postal Workers Annual Food Drive in May comprises 80% of our foods collected each year. We buy food and receive USDA products free of charge from LA Regional Food Bank, and produce from the Charity Dock in LA, a great source of fresh vegetables. We also collect bread and dairy products from Albertsons Market and Trader Joe's Market on a daily basis. Pizza Hut and Starbuck's, a local donut shop and Claro's Deli. contribute their products weekly. We have one full time Executive Director and two part time employees. The two part time staff, included in this grant, as both serve the clients of the City of Rosemead, with intake procedure and job help. The job clerk also picks up from the food bank, the Charity Dock and will be delivering food to the seniors and shut-in in Rosemead. Our staff, volunteers and Board members help coordinate the food drive, Golf tournament and all other activities related to this program, and they work in the thrift store and food room when needed. • • 2. PROJECT PROPOSAL AND DESCRIPTION (continued) (C) Briefly describe your proposed program Activities. Your response must describe the strategies and techniques that comprise service and outreach methodology. Clients are interviewed and a personal file is created with information about that family, job income level and any special needs or foods that the family might need. We try to meet all needs, if we cannot; we refer them to other organizations, such as Family Counseling, Boys and Girls club, etc. The job program information is collected as to their skills and what kind of work they want to do? Which location is good for them, do they have transportation? Are they capable of lifting heavy items? Those type of questions that may be asked by a potential employer or someone interviewing that person. The community is very aware of and responding to our program ie: Attendance of our Fund Raisers such as our Annual Golf Tournament, Annual Postal Workers Food Drive, Fire Works Stand on the 4`h of July, Adopt-a-Family for the Holidays ( 50 families in 2005). We receive donations of clothing, household items, books, etc. for our Thrift Store. People refer friends to our program, both clients and donors. We enjoy a good relationship with local Chambers and news agencies that promote our program. PROJECT PROPOSAL AND DESCRIPTION (continued) (D) Briefly describe the direct product of the program activities. Include the volume if work accomplished such as number of: low-income households served, youth, elderly, disabled or number of loan applications processed. Goals must include numeric goals for service that will be achieved during the program year. Food, clothing, hygiene kits, job help, bus tokens, and referral to other resources and a kind word of encouragement are given to each individual coming to our program. Low in-come households Youth Elderly /Disabled 2005 2006/07 2005 2006/07 2005 2006/07 2,906 3,106 3,103 3,303 11870 2,070 We have estimated our numeric goals for 2006/07 by adding 200 to households, 200 to youth, and 200 to elderly and disabled. This may vary according to the following statement. Our goal is for our numbers to go down, not up, lower numbers means the family unit has been successful in finding a job and affordable housing for their families. The elderly population will continue to rise as the elderly are out of the work force and may be in poor health. • 0 5. CLIENT INTAKE INFORMATION - CLIENT INTAKE AND PERFORMANCE Provide the actual numbers of your total clients in the categories listed below: (for new, non-city of Rosemead funded agencies, please provide projected data for upcoming fiscal year.) TIME PERIOD AGENCY ROSEMEAD YOUTH WOMEN AT-RISK YOUTH AT-RISK SENIORS DISABLED HOMELESS 7/1/04 to X86' ~3 ~Z3 q59 - _a~ ads ~i3 6130/05 711/05 to 12/31 0 5 1 Provide the actual numbers of persons served in the following age categories: (for new, non-city of Rosemead agencies, please provide projected data for upcoming fiscal year): 10 E 2 6. CLIENT INTAKE INFORMATION - CLIENTS SERVED BY INCOME LEVEL Report the actual number of unduplicated number of clients your agency served from July 1, 2005 through December 31, 2005. One person can only be counted one time, even though the client may have been served many times during the reporting period. Calculate the totals and percentages for each category: Household CDBG Eligible # Served by # Of # Served # Of Rosemead Size Based on Income Agency below Rosemead by Project residents served by Limits the Income residents below the project below the Limit served by the Income Income Limit Agency below Limit the Income Limit 1 $36,700 2 $41,900 3 $47,150 4 $52,400 5 $56,600 6 $60,800 Subtotal of CDBG -Eligible Households 0 /D /0 Total Households Served L2 /P 9 51 9 Q e Percentage of CDBG Income Eligible Families Served D 1 J o 7 16 7. CLIENT INTAKE INFORMATION - CLIENT OR PROJECT INFORMATION The source of funding for Public Service Grants comes from a Community Development Block Grant (CDBG) received through the U.S. Department of Housing and Urban Development (HUD). CDBG funds are for the specific purpose of benefiting low/moderate income households. In order to be eligible for these funds, your organization must provide a service for the residents of the City of Rosemead and be able to document that at least 51 percent of the clientele served by the project/program earn less than the following income limits: 11 17J 0 Income Limits are based on HUD Section 8 Income Guidelines: 700 3 8 Please check the corresponding letter, which further describes the activity you are proposing: ■ Public Service Projects will most likely be (c), or in some cases (a), per CDBG Eligibility Requirements. a) The project will benefit a clientele that is generally presumed by HUD to be below the eligible income limits. The following groups are presumed to meet this criterion: abused children, battered spouses, elderly persons, and illiterate persons and \ persons with acquired Immune Deficiency Syndrome (AIDS) b) y The project information on family size and income shows that it is evident that at least 51 percent of the clientele are persons whose family income does not exceed the CDBG eligible income limit (i.e. mapping service area and demonstrating that more than 51 % of persons in the service area are low-moderate income). C) The project has income limits that limit the activity exclusively to CDBG eligible income persons. 12 8. ADDITIONAL APPLICATION DISCLOSURE STATEMENT All organizations that submit this application must provide accurate data concerning the number and income levels of clients and/or location and nature of projects/services, as well as demonstrated site control. Estimates are unacceptable except for previously non-CDBG funded agencies. This stipulation shall apply to all organizations that are subsequently awarded funding. Any organization that falsifies information, either accidentally or intentionally, shall be required to reimburse the City for any funds paid out and shall not be permitted to apply for funding in the future. The applicant hereby proposes to provide the services or projects for the City of Rosemead as stated in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state and local regulations and other assurances, as required by the City of Rosemead, will be adhered to. As the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal. DATEr,2- SIGNED: TITLE: `v X e,,() ORGANIZATION: D 13 c r. 3 v m 3 a m m CL 2 I W C v m O O CA D r O O o c m 7) a CD r r 0 > 5 5 n 5 m = Cl) 3 (n ~ m o CD O m m m 3 At Ir X O ° 7 < cn C F' con Q . lr: CD 3 z (D cn cn m (D 3 - m ca C m r m O U) 100 C4 o a. o S m A l:, Q~) ICE) Q ~1! Y „ a a+ O S, m )C 2 7~0 Z v m 11 • EXHIBIT B -BOARD OF DIRECTORS AFFIDAVIT All applicant Agencies must complete this affidavit listing the members of the Board of Directors and all other officers. If there are changes in the Board membership after the request is submitted, the City of Rosemead must be notified in writing. In submitting this funding request, I, C depose and say that I am EXa rd o [insert title, President, Vice President, The other members and officers of the Board of Directors of this Agency are: (Please list names of current Board Members and attach an additional sheet, if necessary): DATE: AT: A~_4 (CITY & STATE) THE APPROPRIATE AGENCY DESIGNEE MUST SIGN AND AFFIX THE SEAL (Corporate Seal) I certify and declare under penalty of perjury that the foregoing is true and correct. Print Name Ob; Signature and Title J'IV oe 410D V95 iv tvhtrc np-L ivis n ~6- (6Z k:~ '~s e, CDY)4 V P~ g-) Feb 09 06 02:38p 02/69/2006 14:16 0R E262650a6a 66103-6949 =E0-.-'LE FOR PEOPLE EXHIBIT B -BOARD OF DIRECTORS AFFIDAVIT All applicant Agencies must complete this affidavit listing the members of the Board of Diredors and all other officers. If there are changes in the Board membership after the request is submittad, the City of Rosemead must be notified in writing. In submitting this funding depose and say that I am (insert title, President. Vic The other members and officers of the Board of Directors of this Agency are: (Please list names of _Qv_ nt Board Members and attach an additional sheet, if necessary): THE APPROPRIATE AGENCY DESIGNEE MUST SIGN AND AFFIX THE SEAL {Gorporata Seal) P.I PEG= I certify and deciare under penalty of perjury that the foregoing is true and correct. Print Name Signature and Title DATE: AT: _ (CITY alit STATE) • 6. ID - ~ l~.GcwZul 009 c.tcaAJ~Lm-~k~vB~e) T.LUaZuJ ~~~9 aooy ~-a-d1740 Form 990 *urn of Organization Exempt From I0 ncome Tax OMB No. 1545-0047 Under section 501(c), 527, or 4947(a}(1) of the Internal Revenue Code (except black lung 2004 benefit trust or private foundation) Department of the Treasury Open to Public Internal Revenue service ► The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection A For the 2004 calendar year, or tax year beginning , 2004, and ending .20 B Check if applicable: Plows C Name of organization D Employer Identification number ❑ Address change mar WEST SAN GABRIEL VALLEY CHURCH 95-1904060 ❑ Name change prfrrt or Number and street (or P.O. box If mall is not delivered to street address) Room/sulte E Telephone number ty~ ❑ Initial return s ee 860 E MISSION DR (626)285-2549 ❑ Final return Instruc- pec"Ic City or town, state or count and ZIP • 1 7• F Amantkg method: ®Cash ❑ Accrual ❑ Amended return dare. SAN GABRI E 7 7 6-2 7 57 ❑ other (specify) ► ❑ Application pending a Secdom 501(c)(3) org-Ratans H and 1 are not applicable to section 527 organizations. tests must attach a ompbted Schedule A H(a) Is this a group return for affiliates? ❑ Yes (@ No H(b) If 'Yes; enter number of affiliates ► G Webstte: ► H(c) Are all affiliates Included? ❑ Yes ❑ No J Organization type (check only one) ► ® 501(c)( 3 ) (insert no.) ❑ 4947(aXl) or ❑ 527 (if'No,' attach a list. See instructions.) - 1A Isase rate return K Check here 0, El If the organization's gross receipts are normally not more than $25,000. The y ortani atic! a overed b filed by an g by a group ruling? ❑ Yes ®No organization need not file a return with the IRS: but If the organization received a Form 990 Package 1 Group Exemption Number ► in the mall, it should file a return without financial data. Same states require acomplete rehm m Check ► ® if the organization is not required L Gross receipts: Add lines 6b, 8b, 9b, and 10b to line 12 ► 135,398 to attach Sch. B (Form 990, 990-EZ, or 990-PF). [Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances (See page 18 of the instructions.) 1 Contributions, gifts, grants, and similar amounts received: a Direct public support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a 135,355 b Indirect public support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b c Government contributions (grants) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c d Total (add lines 1 a through 1 c) (cash S 13 5 , 3 5 5 noncash $ ) . . . . . . . . . . . . . . l d 135,355 2 Program service revenue including government fees and contracts (from Part VII, line 93) . . . . . . . . . . . . . . 2 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Interest on savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 43 5 Dividends and interest from securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6a Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a b Less: rental expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b c Net rental income or (loss) (subtract line 6b from line 6a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sc R 7 Other investment income (describe ► ) 7 e 8a Gross amount from sales of assets other v (A) Securities (B) Other e than inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a m b Less: cost or other basis and sales expenses . . . . . . . . . . . . . 8b u e c Gain or (loss) (attach schedule) . . . . . . . . . . . . . . . . . . . . 8c d Net gain or (loss) (combine line 8c, columns (A) and (B)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8d 9 Special events and activities (attach schedule). If any amount is from gaming, check here ► ❑ a Gross revenue (not including $ of contributions reported on line 1a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9a b Less: direct expenses other than fundraising expenses . . . . . . . . . . . . . . . . . . 9b c Net income or (loss) from special events (subtract line 9b from line 9a) . . . . . . . . . . . . . . . . . . . . . 9c 10a Gross sales of inventory, less returns and allowances . . . . . . . . . . . . . . . . . . . 10a b Less: cost of goods sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10b c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) . . . . . . . . . . . 10c 11 Other revenue (from Part VII, line 103) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Total revenue (add lines 1d, 2. 3, 4, S. 6c. 7, 8d, 9c, 10c, and 11) it 12 135,398 E 13 Program services (from line 44, column (B)) . 13 1 881 p 14 Management and general (from line 44, column (C)) . . . . 14 104,970 n 15 Fundraising (from line 44, column (D)) . . . . . . . . . . . . . . . . . 28 384 16 Paym ents to affiliates (attach schedule) e k20 s 17 Total expenses (add lines 16 and 44, column (A)) 13 5 2 3 5 N 18 Excess or (deficit) for the year (subtract line 17 from line 12) . 163 s 19 Net assets or fund balances at beginning of year (from line 73, column (A)) . . . . . . . . . . . . . . . . . . . . . 2 2 2 4 0 s 20 Other changes in net assets or fund balances (attach explanation) . 21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 22, 403 For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2004) EEA Form990(2004) WEST SAN GAEL VALLEY CHURCH 0 95-1904060 Page2 arf It! Statement of All organizations must complete column (A). Columns (B), (C), and (D) are required for section 501(cy(3) and (4) organizations Functional Expenses and section 4947(a)(1) nonexempt charitable trusts but optional for others. (See page 22 of the instructions.) Do not include amounts reported on line 6b, 8b, 9b, 10b, or 16 of Part I. (A) Total (B) Program services (C) Management and general (D) Fundraising 22 Grants and allocations (attach schedule) (cash $ noncash $ ) 22 23 Specific assistance to individuals (attach schedule) 23 24 Benefits paid to or for members (attach schedule) . . . . . 24 25 Compensation of officers, directors, etc.. . . . . . . . . . 25 21,743 21 743 26 Other salaries and wages . . . . . . . . . . . . . . 26 16,039 16 039 27 Pension plan contributions . . . . . . . . . . . . . . 27 28 Other employee benefits . . . . . . . . . . . . . . . . 28 29 Payroll taxes 29 10,680 10 680 30 Professional fundraising fees . . . . . . . . . . . . . . . 30 31 Accounting fees . . . . . . . . . . . . . . . . . . . . . 31 345 345 32 Legal fees . . . . . . . . . . . . . . . . . . . . 32 33 Supplies 33 1,428 1,428 34 Telephone . . . . . . . . . . . . . . . . . . . . 34 1,903 11`903 35 Postage and shipping . . . . . . . . . . . . . . . . . . . 35 480 480 36 Occupancy 36 25,666 25, 666 37 Equipment rental and maintenance . . . . . . . . . . . . 37 7 171 7 171 18 Printing and publications . . . . . . . . . . . . . . . . . 38 349 349 19 Travel . . . . . . . . . . . . . . . . . . . . . . . . . . 39 10 Conferences, conventions, and meetings . . . . . . . . . 40 11 Interest . . . . . . . . . . . . . . . . . . . . . . . . 41 12 Depreciation, depletion, etc. (attach schedule) . . . . . , . 42 13 Other expenses not covered above (itemize): a SALES TAX 43a 1 915 1,915 b TRUCK AND DELIVERY SERVICE 43b 1,788 1,788 c INSURANCE-LIAB,EMPLOYEE 43c 15,463 15,463 d FOOD BANK AND FOOD PURCHASE 43d 1,881 1,881 e FUND RAISER 43e 28,384 28 384 4 Total furctlonal expernrs (add Ilnes 22 through 43). Organizations carpbting cohn.tis (B)-(D), carry these totats to tines 13- is 44 135,235 1,8 81 10 4,9701 , 28,384 dvint ws[s. t.necK ► L__I it you are TOuo ing SuF- 9tl-Z. Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services? . . . . . . ► ❑ Yes ❑ No If "Yes." enter (1) the aggregate amount of these joint costs $ ; (ii) the amount allocated to Program services $ (iii) the amount allocated to Management and general $ and (iv) the amount allocated to Fundraising $ rs- 1#1 _t . . Whi All c of c orgy a b c d e If Total of Program Service Expenses (should equal line 44, column (B), Program services) . . . . . . . . 11, 11881 EEA Form 990(2004) page t is the organization's primary exempt purpose? Do- PROVIDE FOOD FOR THE HOMELESS Program Service rganizations must describe their exempt purpose achievements in a clear and concise manner. State the number Ex o s eS ents served, publications issued, etc. Discuss achievements that are not measurable. (Section 501(cX3) and (4) (Requl p 50 H3)and (4) orgs., and 4947(ay 1) nizations and 4947(aX1) nonexempt charitable trusts must also enter the amount of r ants and allocations to others.) trusts; but optional for others. FOODBANK AND FOOD PURCHASES FOOD FOR THE POOR AND HOMELESS (Grants and allocations $ ) 1,881 (Grants and allocations $ ) (Grants and allocations $ ) (Grants and allocations $ ) Other program services (attach schedule) (Grants and allocations $ ) i i Note: Where required, attached schedules and amounts within the description (A) (B) column should be for end-of-year amounts only. Beginning of year End of year 45 Cash - non-interest-bearing . . . . . . . . . . . . . . . . . . . . 4,416 45 2,652 46 Savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . 5 2 2 2 46 1,953 47 a Accounts receivable . . . . . . . . . . . . . . . . . 47a b Less: allowance for doubtful accounts . . . . . . . . 47b 47c 48 a Pledges receivable . . . . . . . . . . . . . . . . . . 48a b Less: allowance for doubtful accounts . . . . . . . 48b 48c 49 Grants receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 50 Receivables from officers, directors, trustees, and key employees (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 A 51 a Other notes and loans receivable (attach s schedule) . . . . . . . . . . . . . . . . . . . . . . . 51a s b Less: allowance for doubtful accounts . . . . . . . . 51b 51c e 52 Inventories for sale or use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 t 53 Prepaid expenses and deferred charges . . . . . . . . . . . . . . . . . . . . . 53 s 54 Investments - securities (attach schedule) . . . . . . . . . ► ❑ Cost ❑ FMV 54 55 a Investments - land, buildings, and equipment: basis . . . . . . . . . . . . . . . . . . . 55a b Less: accumulated depreciation (attach schedule) . . . . . . . . . . . . . . . . . . . . . 55b 55c 56 Investments - other (attach schedule) . . . . . . . . . . . . . . . . . . . . . 56 57 a Land, buildings, and equipment: basis . . . . . . . . 57a b Less: accumulated depreciation (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . 57b 57c 58 Other assets (describe ► FURNITURE ) 12,602 58 12,602 59 Total assets (add lines 45 through 58) (must equal line 74) . . . . . . . 22,240 59 17,207 60 Accounts payable and accrued expenses . . . . . . . . . . . . . . . . . . . . 60 L i 61 Grants payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 a 62 Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 b t 63 Loans from officers, directors. trustees, and key employees (attach I schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 i 64 a Tax-exempt bond liabilities (attach schedule) . . . . . . . . . . . . . . . . . . 64a t b Mortgages and other notes payable (attach schedule) . . . . . . . . . . . . . . 64b t 65 Other liabilities (describe ► ) 65 e s 66 Total liabilities (add lines 60 through 65) 66 Organizations that follow SFAS 117, check here 0, and complete lines 67 through 69 and lines 73 and 74. F 67 Unrestricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 u 68 Temporarily restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 n d 69 Permanently restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Organizations that do not follow SFAS 117, check here ► ® and B complete lines 70 through 74. a 70 Capital stock, trust principal, or current funds . . . . . . . . . . . . . . . . . . . 70 a 71 Paid-in or capital surplus, or land, building, and equipment fund. . . . . . . . . . 71 n c 72 Retained earnings, endowment, accumulated income, or other funds . . . . . . . 22,240 72 17,207 e 73 Total net assets or fund balances (add lines 67 through 69 or lines s 70 through 72; column (A) must equal line 19; column (B) must equal line 21) . . . . . . . . . . 22,240 73 17 207 74 Total liabilities and net assets / fund balances (add lines 66 and 73) . . . . . . 22,240 74 17,207 Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization. How the public perceives an organization in such cases may be determined by the information presented on its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments. EEA Form 990 (2004) WE61' SAN URtit' 1r Lj VIALiL El k-rl PartJV-A Reconciliation of Revenue per Audited Financial Statements with Revenue per Return (See page 27 of the instructions.) a Total revenue. gains, and other support per audited financial statements . . . ► a 135 , 39 b Amounts included on line a but not on line 12, Form 990: (1) Net unrealized gains on investments : (2) Donated services and use of facilities . $ (3) Recoveries of prior i year grants . . . . S (4) Other (specify): f Add amounts on lines (1) through (4) ► C Line a minus line b . . . . . . . . . ► c 13b d Amounts included on line 12, Form 990 but not on line a: (1) Investment expenses not included on line i 6b, Form 990 . . . . $ (2) Other (specify): Add amounts on lines (1) and (2) . . . ► d e Total revenue per line 12, Form 990 (line c olus line d). . . . . ► e 135 4 Add amounts on lines (1) and (2) . . . ► d e Total expenses per line 17, Form 990 (line c plus line d). . . . ► e 135123E Employees (List each one even 9 not compensated; see page 27 of (A) Name and address (B) Title and average hours per week devoted to position P Compensation (tf rot p~• ert m -0_, Contributions to employee benefit plans & deferred com nsation (E) Expense account and other allowances MARY NOREEN RA ND DIRECTOR 860 E MISSION SAN GABRIEL CA 40 25,500 0 0 DELIA BARRETT CLERK 860 E MISSION SAN GABRIEL CA 40 9,651 0 0 WATHENA MORRISON TREASURER 860 E MISSION SAN GABRIEL CA 8 0 0 0 THOMAS RAND DRIVER 860 E MISSION SAN GABRIEL CA 40 9,273 0 0 75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than 5100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations? ► 11 Yes ❑X No If "Yes," attach schedule - see page 28 of the instructions. EEA Form 990(2004) 0 SAN CHURCH J -1904060 Page 5 PBtt'f'1) Other Information (See page 28 of the instructions.) Tes no 76 Did the organization engage in any activity not previously reported to the IRS? If 'Yes' attach a detailed description of each activity . . . . . 76 X 77 Were any changes made in the organizing or governing documents but not reported to the IRS? . . . . . . . . . . . 77 X_ If "Yes," attach a conformed copy of the changes. 78a Did the organization have unrelated business gross income of 51,000 or more during the year covered by this return? 78a X b If "Yes," has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . . . . . . . . . . . . . . 78b X 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If "Yes," attach a statement 79 X 80a Is the organization related (other than by association with a statewide or nationwide organization) through common membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? . . . . . . . . 80a X b If "Yes," enter the name of the organization ► and check whether it is exempt or nonexempt. 81a Enter direct and indirect political expenditures. See line 81 instructions . . . . . . . . . . 81a b Did the organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81b X 82a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82a X b If "Yes," you may indicate the value of these items here. Do not include this amount as revenue in Part I or as an expense in Part II. (See instructions in Part III.) . . . . . . . . 82b i 83a Did the organization comply with the public inspection requirements for returns and exemption applications? . . . . . 83a X b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? . . . . . . . . . 83b X 84a Did the organization solicit any contributions or gifts that were not tax deductible? . . . . . . . . . . . . . . . . . . . 84a X b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84b X 85 501(cX4), (5), or (6) organizations. a Were substantially all dues nondeductible by members? . . . . . . . . . . . . . 85a X b Did the organization make only in-house lobbying expenditures of $2,000 or less? . . . . . . . . . . . . . . . . . 85b X If "Yes" was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year. e Dues, assessments, and similar amounts from members . . . . . . . . . . . . . . . . . 85c d Section 162(e) lobbying and political expenditures . . . . . . . . . . . . . . . . . . . . . 85d e Aggregate nondeductible amount of section 6033(eX 1 XA) dues notices . . . . . . . . . . 85e If Taxable amount of lobbying and political expenditures (line 85d less 85e) . . . . . . . . . 851 g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f? . . . . . . . . . . . . . . . . . 85 X h If section 6033(eX1 XA) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? 85h X 86 501(cX7) orgs. Enter: a Initiation fees and capital contributions included on line 12 . . . . 86a b Gross receipts, included on line 12, for public use of club facilities . . . . . . . . . . . . . 86b 87 501(cX12) orgs. Enter: a Gross income from members or shareholders . . . . . . . . . . 87a b Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) . . . . . . . . . . . . . . . . . . . 87b ° 88 At any time during the year, did the organization own a 50 / or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Part IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 X 89a 501(cX3) organizations. Enter: Amount of tax imposed on the organization during the year under: section 4911 ► ; section 4912 ► ; section 4955 ► b 501(cX3) and 501(cX4) orgs. Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year? If "Yes," attach a statement explaining each transaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89b X c Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► d Enter: Amount of tax on line 89c, above, reimbursed by the organization . . . . . . . . . . . . . . . . . . . . . . ► 90a List the states with which a copy of this return is filed ► CALIFORNIA b Number of employees employed in the pay period that includes March 12, 2004 (See instructions.) . . . . . 90b 3 91 The books are in care of ► WATHENA MORRISON Telephone no. ► 626-285-2549 Locatedat ► 860 E MISSION SAN GABRIEL CA ZIP+4 ► 91776 92 Section 4947(aX 1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 - Check here . . . . . . . . . . . . . . . . . ► and enter the amount of tax-exempt interest received or accrued during the tax year . . ► 192 EEA Form 990(2004) Form990(2004) WEST SAN GIRRIEL VALLEY C111JRCH 0 95-1904060 Page6 I Part VII Annlvsis of Ineomp-Producina Activities iSee Daae 33 of the instructions.) Note: Enter gross amounts unless otherwise unrelated business Income Excluded by section 512, 513. or 514 (E) indicated. 93 Program service revenue: (A) Business code (B) Amount (C) Exclusion code (D) Amount Related r exempt func function Income a b c d e f Medicare/Medicaid payments . . . . . . . . . . . . g Fees and contracts from government agencies . . . 94 Membership dues and assessments . . . . . . . . 95 Interest on savings and temporary cash investments 96 Dividends and interest from securities . . . . . . . . 97 Net rental income or (loss) from real estate: a debt-financed property . . . . . . . . . . . . . . b not debt-financed property . . . . . . . . . . . . 98 Net rental income or (loss) from personal property . . 99 Other investment income . . . . . . . . . . . . . . 100 Gain or (loss) from sales of assets other than inventory 101 Net income or (loss) from special events . . . . . . 102 Gross profit or (loss) from sales of inventory . . . . 103 Other revenue: a b c d e 104 Subtotal (add columns (B), (D), and (E)) . . i 105 Total (add line 104, columns (B), (D). and (E)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► Note: Line 105 Ous line 1d, Part I, should equal the amount on line 12, Part I. PartVIII Relationship of Activities to the Accomplishment of Exempt Purposes (See page 34 of the instructions.) Line No. V Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes). A Part IX ! Information Regarding Taxable 5ubsidiaries and Disreqarded Entities (See page 34 of the instructions.) A Name, address, and EIN of corporation, partnership, or disregarded entity B Percentage of ownership interest C Nature of activities D Total income E End-of-year assets o~ a~ ~P>X;I Information Regarding Transfers Associated with Personal Benefit Contracts (See page 34 of the instructions.) (a) Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums an a personal benefit contract? . . , . . . ❑ Yes ® No (b) Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . . . . ❑ Yes ® No Please Sign , Signature of officer Here Paid Preparer's Use Only Preparer's signature Firm's name (or yours ' if self-employed) address, and ZIP . 4 and complete. Declaration of preparer (other than :neauies ana statements, ana to the nest or my Knowleat on all information of which preparer has arty knowledge. If 91789 EEA Do, no. ► 451-02-0772 909-594-9866 Form 990(2004) SCHEDULE A (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Service ► MUST be WEST SAN GABRIEL 01 501(c)(3) Organization Exempt Under Section (Except Private Foundation) and Section 501(e), 501(f), 501(k), 501(n), or Section 4947(aK1) Nonexempt Charitable Trust Supplementary Information --(See separate instructions.) the above organizations and attached to their OMB No 1545-1047 2004 For Paperwork Reduction Act Notice. we the hrstrucOorat for Form 990 and Form 990-EZ EEA Schedule A (Form 990 or 990-EZT) 2004 • 95-1904060 WEST SAN GABRIEL VAREY CHURCH Schedule A (Form 990 or 990-EZ) 2004 Page 2 III Statements About Activities (See page 2 of the instructions.) .FPir Yes No 1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If "Yes," enter the total expenses paid or incurred in connection with the lobbying activities (Must equal amounts on line 38. . . . . . . . . . . . . . • • • • . • . • • " " ' • • . • • . . . . . • i of Part VI-B li ) VI A P 1 X . . . . . . - ne , or art Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A. Other organizations checking "Yes" must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities. 2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? (If the answer to any question is "Yes," attach a detailed statement explaining the transactions.) L . . . . . . . . . . . . . . . . . . . • • . • • • • • • • • • • • • • • • ert ? r leasin of ro n S h l X . . . y g p p ge, o a e, exc a a X or other extension of credit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f b L di 2b ng o money en or facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . services ods f F i hi 2c X , ng o go , urn s c ensation (or payment or reimbursement of expenses if more than $1,000)? . . . . . . . . . . . . . . ment of com d P 2d X p ay art of its income or assets? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n r f T f 2e X e ra s o any p e 3a Do you make grants for scholarships, fellowships, student loans, etc.? (If "Yes," attach an explanation of how ine that recipients qualify to receive payments.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . det 3a X you erm ou have a section 403(b) annuity plan for your employees? . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Do 3b X y 4 a Did you maintain any separate account for participating donors where donors have the right to provide advice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . se or distribution of funds? th 4a X . on e u b Do you provide credit counseling, debt management, credit repair, or debt negotiation services? . . 4b X Part lY Reason for Non-Private Foundation Status (See pages 3 through 6 of the instructions.) The organization is not a private foundation because it is: (Please check only ONE applicable box.) 5 ® A church, convention of churches, or association of churches. Section 170(bX1 XAXi). 6 ❑ A school. Section 170(bX1 XAXii). (Also complete Part V.) 7 ❑ A hospital or a cooperative hospital service organization. Section 170(bX1XAXiii). 8 ❑ A Federal, state, or local government or governmental unit. Section 170(bX 1 XAXv). 9 ❑ A medical research organization operated in conjunction with a hospital. Section 170(bX1 XAXiii). Enter the hospital's name, city, and state ► 10 ❑ An organization operated for the benefit of a college or university owned or operated by a governmental unit. Section 170(bX1XAXiv). (Also complete the Support Schedule in Part IV-A.) 11a ❑ An organization that normally receives a substantial part of its support from a governmental unit or from the general public. Section 170(bX 1 XAXvi). (Also complete the Support Schedule in Part IV-A.) 11b ❑ A community trust. Section 170(bX 1 XAXvi). (Also complete the Support Schedule in Part IV-A.) 12 ❑ An organization that normally receives: (1) more than 33 11316 of its support from contributions, membership fees, and gross receipts from activities related to its charitable, etc., functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(aX2). (Also complete the Support Schedule in Part IV-A.) 13 ❑ An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in: (1) lines 5 through 12 above; or (2) section 501(cX4), (5), or (6). if they meet the test of section 509(aX2). (See section 509(aX30 Provide the following information about the supported organizations. (See page 5 of the instructions.) (b) Line number (a) Name(s) of supported organization(s) from above 14 ❑ An organization organized and operated to test for public safety. Section 509(aX4). (See page 5 of the instructions.) E E A SchedWe A (Form 990 or 990-En 200 0 WEST SAN GABRIEL VALLEY CHURCH 95-1904060 Schedule A (Form 990 or 990-EZ) 2004 Page 5 L#~ Y) A Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions.) (To be completed ONLY by an eligible organization that filed Form 5768) Check ► a if the orqanization belongs to an affiliated group. Check ► b if you checked "a" and "limited control" provisions apply. Limits on Lobbying Expenditures Affiliated group totals (The term "expenditures" means amounts paid or incurred. ) 36 Total lobbying expenditures to influence public opinion (grassroots lobbying) . . . . . . . . . 36 37 Total lobbying expenditures to influence a legislative body (direct lobbying) . . . . . . . . . . 37 38 Total lobbying expenditures (add lines 36 and 37) . . . . . . . . . . . . . . . . . . . . . . . 38 39 Other exempt purpose expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 40 Total exempt purpose expenditures (add lines 38 and 39) . . . . . . . . . . . . . . . . . . . 40 41 Lobbying nontaxable amount. Enter the amount from the following table- If the amount on line 40 is- The lobbying nontaxable amount is- Not over $500,000 . . . . . . . . . . . . 20% of the amount on line 40. . . . . . . . . . Over $500,000 but not over $1,000,000. $100,000 plus 15°1 of the excess over $500,000 Over $1,000,000 but not over $1,500,000. 5175,000 plus 10% of the excess over $1,000,000 41 Over $1,500.000 but not over $17.000,000. $225,000 plus 5% of the excess over $1,500,000 Over $17,000,000 . . . . . . . . . . . . . $1,000,000 . . . . . . . . . . . . . . . . . . 42 Grassroots nontaxable amount (enter 25% of line 41) . . . . . . . . . . . . . . . . . . . 42 43 Subtract line 42 from line 36. Enter -0- 0 line 42 is more than line 36 . . . . . . . . . . . . . r 44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38 . . . . . . . . . . . . (b) 44 To be completed for ALL electing organizations Caution: If there is an amount on either line 43 or line 44, you must file Form 4720. 4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 45 throuqh 50 on page 11 of the instructions.) Lobbying Expenditures During 4-Year Averaging Period Calendar 45 46 amount . . . . . . . . . amount (150°/ of line 2004 47 Total lobbying expenditures 48 Grassroots nontaxable amount . . . . . . . . 49 Grassroots ceiling amount (150% of line 50 Grassroots lobbyinq expenditures . . . . . . . During the year, did the organization attempt to influence national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of: Yes No Amount a b Volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Paid staff or management (Include compensation in expenses reported on lines c through h.) . . . . . . . . X c Media advertisements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Mailings to members, legislators, or the public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X e Publications, or published or broadcast statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . X f Grants to other organizations for lobbying purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . X g Direct contact with legislators, their staffs, government officials, or a legislative body . . . . . . . . . . . . . X h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means . . . . . . . . . . X i Total lobbying expenditures (Add lines c through h.) . . . . . . . . . . . . . . . . . . . . . . . . . . . If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities. E E A Schedule A (Form 990 or 990-EZ) 2004 Exempt Organizations (See page 11 of the instructions.) 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(cX3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitable exempt organization of: (i) Cash (ii) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Other transactions: (i) Sales or exchanges of assets with a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . b(i) X (ii) Purchases of assets from a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . . . . . . b(iii) X (iii) Rental of facilities, equipment, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (iv) Reimbursement arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b(iv) X (v) Loans or ban guarantees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b(v) X NO Performance of services or membership or fundraising solicitations . . . . . . . . . . . . . . . . . . . . . . . b(vii) X c Sharing of facilities, equipment, mailing lists, other assets, or paid employees . . . . . . . . . . . . . . . . . . . . d If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value of the goods, other assets, or services given by the reporting organization. If the organization received less than fair market value in any described in section 501(c) of the Code (other than section 501(cX3)) or in section 527? . . . . . . . . . . . . . p. ❑ Yes ❑ No E E A Schedule A (Form 990 or 490-EZ) 2004 YEAR California Exempt Organization FORM 2004 Annual Information Return 199 IMPORTANT: Your number is required. A Final return? U Yes. Check applicable box. DQ No California corporation number reral employer identification number FEIN e ❑ Dissolved ❑ Withdrawn ❑ Merged/ Reorganized (attach explanation) 95-1904060 If a box is checked, enter date • Corporatlon/Organization name B Check forms filed this year: State: ❑ 109 ❑ 100 ❑ 1005 ❑ 10ow Federal: ® 990 ❑ 990EZ ❑ 9907 ❑ 990PF ❑ 1041 ❑ 1120H ❑ 1120 C If organization is exempt under R&TC Section 23701d and is a school, public charity, religious organization, or is controlled by a religious operation, check WEST SAN GABRIEL VALLEY CHURCH box. See General Instruction F. NofWNfeeisreyulred.... • Address PMB no. D Is this a group filing? See General Instruction N . . . . . . ❑ Yes ® No 860 E MISSION DR E Accounting method used CASH City State ZIP Code F Type of organization 1❑1 Exempt under Section 23701 (insert letter) SAN GABRIEL CA 91776-2757 I IIPCSection4947(a)(1)trust Part I Complete Part I unless not required to file this form. See General Instructions B and C. 1 Gross sales or receipts from other sources. From Side 2, Part II, line 8 . . . . . . . . . . . . . . • 1 135, 398. 2 Gross dues and assessments from rnembers and affiliates . . . . . . . . . . . . . . . . . . . . • 2 Rec*ft and 3 Gross contributions, gifts, grants, and similar amounts received. See instructions . . . . . . . . . • 3 Revenues 4 Total gross receipts for filing requirement test. Add line 1 through line 3 This line must be completed. If the result is less than $25,000, see General Instruction C 4 135 398. (Enclose, but not staple any payment) an 5 6 Cost of goods sold . . . . . . . . . . . . . . . . . . . . . . . . Cost or other basis, and sales expenses of assets sold . . . . . . 5 6 7 Total costs. Add line 5 and line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 Total gross income. Subtract line 7 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . 6 135, 398. 9 Total expenses and disbursements. From Side 2, Part II, line 18 . . . . . . . . . . . . . . . . 9 135, 235. E1tPernes 10 Excess of receipts over expenses and disbursements. Subtract line 9 from line 8 . 10 163. 11 Filing fee S10 or $25. See General Instruction F . . . . . . . . . . . . . . . . . . . . . . . . . . 11 10. Filing Fee 12 Penalty for failure to file on time. See General Instruction L . . . . . . . . . . . . . . . . . . . . . 12 13 Use tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • 13 14 Balance due. Add line 11, line 12 , and line 13 . 14 1.0. 15 If exempt under R&TC Section 23701d, has the organization during the year: (1) participated in any political campaign or (2) attempted to influence legislation or any ballot measure, or (3) made an election under R&TC Section 23704.5 (relating to lobbying by public charities)? If "Yes," complete and attach form FTB 3509, Political or Legislative Activities by Section 23701d Organizations . . . . ❑ Yes ® No 16 Did the organization have any changes in its activities, governing instrument, articles of incorporation, or bylaws that have not been reported to the Franchise Tax Board? If "Yes," complete an explanation and attach copies of revised documents . . . . . . ❑ Yes ® No 17 Is the organization exempt under R&TC Section 23701g? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ® No If "Yes," enter amount of gross receipts from nonmember sources $ 18 Did the organization file Form 100, Form 100S, 100W, or Form 109 to report taxable income? . . . . . . . . . . . . . . . . . . ❑ Yes ® No If "Yes," enter amount of total income reported $ 19 The financial records are in care of WATHENA MORRI SON Daytime telephone ( 62 6) 2 85-2 549 located at860 EMISSION DR SAN GABRIEL CA 91776 Please Sign Here Paid Preparer's Use Only Under penalties of perjury. I declare that I have examined this return, Including accompanying schedules and statements. and to the best of my knowledge and belief, it is true, correct. and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. 110. Signature of officer Paid Preparer's signature ► Firm's name (or yours. if ► self-employed) and address For Privacy Act Notice, get form FT B 1131. ► •1(626)285-2549 Title Daytime telephone Date Check If Paid Preparer's SSN or PTIN self-employed X* 51-02-0772 ld Steen FEIN Calbourne DR. • ut CA 917891. Daytimetelephone909-594-9866 19904104043 F Form 199012004 Side1 Part 11 Organizations with gross receipts of more than $25,000 and private foundations regardless of amount of gross receipts - complete Part II or furnish substitute information. See Specific Line Instructions. 1 Gross sales or receipts from all business activities. See instructions . . . . . . . . . . . . . . . . . . . . 2 1 135,355. Interest 2 43. t~eoet Pits 3 Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3 from Oth Gross rents 4 er Sources 5 Gross royalties . . . . . . . . . . . . . . 6 5 Gross amount received from sale of assets 7 Other income. Attach schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . 8 Total gross sales or receipts from other sources. Add line 1 through line 7 . E nter here and on Side 1, Part I, line 1 . 8 135 398. 9 Contributions, gifts. grants, and similar amounts paid. Attach schedule . . . . . . . . . . . . . . . . . . . 10 Di 9 , sbursements to or for members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 C 10 ompensation of officers, directors. and trustees. Attach schedule . . . . . . . . . . . . . . . . . . . . . 12 h 11 21 743. E ea Ot er salaries and wages . . . . . . . . . . . . . . . . . . . . . 12 16 039 and 13 . Disburse- Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 T 13 meres axes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 14 10 680. Rents 16 D 15 21, 874. epreciation and depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 O 16 ther. Attach schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 T l 17 64, 899. ota expenses and disbursements. Add line 9 through line 17. Enter here and on Side 1, Part I, line 9 18 1 1 S _ 9'1 S _ L Balance As sets ~ 1 Cash . . . . . . . . . . . . . . . . . . . . . . 2 Net accounts receivable . . . . . . . . . . . . 3 Net notes receivable. Attach schedule . . . . . 4 Inventories . . . . . . . . . . . . . . . . . . . 5 Federal and state government obligations . . . . 6 Investrents in other bonds. Attach schedule 7 Investments in stock. Attach schedule 8 Mortgage bans (number of loans ) 9 Other investments. Attach schedule . . . . . . 10 a Depreciable assets . . . . . . . . . . . . . b Less accumulated depreciation . . . . . . . 11 Land 12 Other assets. Attach schedule . . . . . . . . . 13 Total assets . . . . . . . . . . . . . . . . . . Liabilities and net worth 14 Accounts payable . . . . . . . . . . . . . . . 15 Contributions, gifts, or grants payable . . . . . 16 Bonds and notes payable. Attach schedule . . . 17 Mortgages payable . . . . . . . . . . . 18 Other liabilities. Attach schedule . . . . . . . . 19 Capital stock or principle fund . . . . . . . . . 20 Paid-in or capital surplus. Attach reconciliation 21 Retained earnings or income fund 22 Total liabilities and net worth . Schedule M-1 Reconciliation of income per books with Do not complete this schedule if the amour 1 Net income per books . . . . . . . . . . . . . 2 Federal income tax . . . . . . . . . . . . . . . 3 Excess of capital losses over capital gains . . . 4 Income not recorded on books this year. Attach schedule . . . . . . . . . . . . . . 5 Expenses recorded on books this year not deducted in this return. Attach schedule . . . . 6 Total. Add line 1 through line 5 . . . . . . . . . . . Side 2 Form 199 C1 2004 Of taxable 4 me per return Schedule L. line 13, column (d), is less than $25,000 7 Income recorded on books this year not included in this return. Attach schedule . . . . . . . . . . . . . 8 Deductions in this return not charged against book income this year. Attach schedule . . . . . . . . . . . . . 9 Total. Add line 7 and line 8. . . . . . . . 10 Net income per return. Subtract line 9 from line 6 . . . . . . . . _1 19904204043 r- California Overflow State rn~t 2004 Name(s) as shown on return Social Security Number WEST SAN GABRIEL VALLEY CHURCH 95-1904060 Worksheet for CA State Entries DESCRIPTION ACCOUNTING SERVICES SUPPLIES TELEPHONE POSTAGE AND SHIPPING EQUIPMENT RENTAL AND MAINTENANCE ADVERTISING AND PRINTING SALES TAX TRUCK AND DELIVERY SERVICE INSURANCE- LIABILITY, EMPLOYEE, STATE COMPENSATION.......... FOOD BANK AND FOOD PURCHASE FUND RAISER UTILITIES TOTAL: AMOUNT 345 1 428 1, 903 480 7, 171 349 1, 915 1, 788 15, 463 1, 881 28, 384 3, 792 64,899 CAOVFLOWLD 0 . & 0 STATE OF CALIFORNIA FRANCHISE TAX BOARD EXEMPT ORGANIZATIONS SECTION PO BOX 1286 RANCHO CORDOVA CA 95741-1286 TELEPHONE: (916) 845-4171 Political or Legislative Activities By Section 23701d Organizations Name EL VALLEY CHURCH Corporate Number Number and Street Federal Identification Number 860 E MISSION DR 195-1904060 City or Town State Zip Code SAN GABRIEL CA 91776-2757 I (a) Have you participated or intervened in any political campaign on behalf of any candidate for elective public office? If so, attach a detailed description of the activity and copies of any material published in connection with such activity. (b) Have you contributed funds to support or oppose any individual candidate for public office or to any organization formed to support or oppose a candidate for public office? If yes, attach a detailed description of the activity and a schedule of the amount paid, including dates and name(s) of the individual(s) or organization(s). II (a) Have you attempted to influence any national, state or local legislation or ballot measure? If yes, attach a detailed description of such activities, copies of any materials published in connection with the activities and a schedule of expenditures. III Public Charities -Election to make expenditures to influence legislation (a) Have you filed a federal election to make expenditures to influence legislation? If so, furnish a copy of the Form 5768 filed with the Internal Revenue Service if not previously furnished. The furnishing of the copy of the federal election constitutes the filing of an electron for state purposes. NOTE: An election is not permitted if you are a church. an integrated auxiliary of a church or a private foundation. State and federal law is the same with regard to this election, except that state law does not provide for an excise tax on excess lobbying expenditures. (b) Organizations that have elected to make expenditures to influence legislation must furnish the following financial information for the taxable year: EXEMPT PURPOSE EXPENDITURES (The total amount paid or incurred to accomplish the charitable, educational, religious, etc. purpose) 2. LOBBYING EXPENDITURES (The total amount expended for the purpose of influencing legislation through communication with any member or employee of a legislative body or any government official or employee who may participate in the formation of legislation) 3. GRASS ROOTS EXPENDITURES (The amount expended to influence any legislation through attempts to affect the opinions of the general public or any segment thereof) Please Check (x) YES NO X X X X s s S FTB 3509 (REV 09-2000) CDBG FUNDING APPLICATION AGENCY INFORMATION Agency Name: Rosemead School District Agency Address: Number CA 91770 Zip Administrator Telephone No. 626-312-2900 Fax: 626-312-2913 Project Site Address: Same as Above Number Street City Zip Code Project Manager Name: Julie Ho Project Manager's Telephone No. Project Manager's Email Address: Title: Director of Special Education Fax: 626-312-2913 ;ad.kl2.ca.us Describe Agency's overall function or purpose. Include history and experience in providing this service. (If more room is needed, please use additional paper and attach to the back of the application with a reference number). See page 6a Has the Agency previously received funding from the City of Rosemead? YES NO If yes, please identify the years and amounts funded: Year Amount 2005-2006 $ 12,134.00 2004-2005 $ 12 134.00 2003-2004 $ 12 134.00 2002-2003 $ 12,134.00 6 • DESCRIBE AGENCY'S OVERALL FUNCTION: Rosemead School District provides a challenging academic learning environment, which encourages lifelong learning. In partnership with parents and community, our mission is to nurture the intellect, aesthetic, physical and emotional growth of each child to be prepared for new horizons. In 1995, Rosemead School District conducted conflict resolution training for students funded through a California Safe Schools Grant. In 1996, Shuey School received funding through a Conflict Resolution School Violence Reduction Program Grant to provide classroom instruction to students and an after school program. In 1996, the District was awarded Community Development Block Grant funds to provide training in conflict resolution to the City of Rosemead Park and Recreation leaders, as well as, families in the community. The funding was renewed through 2006, and additional parents were trained. This has proven to be an extremely successful program. Evaluations indicate a high degree of satisfaction with the services and express a desire for additional training. In 1998, besides training groups of parents throughout the city, a Peace Fair was held on May 2, 1998. This conference event brought clients together for a refresher course, as requested in a needs assessment. To date, more than 1,250 clients have attended the now annual Peace Fair that has brought city services and educational resources to our Rosemead families. The program, funded by the City Development Grant, has been so successful that it is the model of Rosemead School District's Family RAP (Reaching Aspirations and Potential) program. This is the same course that is being duplicated in El Monte City School District, El Monte Union High School District, and Garvey School District. 6a 2. PROJECT PROPOSAL AND DESCRIPTION In this section, briefly describe the project proposal, including cost estimates. Grant amount Requested: $ 12,134. 00 Briefly describe your proposed Project/Program goals. Your response must describe the scope of services for the project, proposed solutions to problems identified in Priority Needs: Provide training in effective conflict resolution and discipline to increase Briefly describe and include resources dedicated to the program such as money, staff, equipment and supplies: Psychologists/counselors and teachers provide instruction with community liaisons translating in Chin a and Spanish- Migrant F.di, atinn prnuidps financial gj1ppnrt fnr cjippl i ~g and fnoL-t.i t}+ ~ar~i tiQnZj 0-ppOYt from Title IV funds as needed. Briefly describe your proposed program Activities. Your response must describe the strategies and techniques that comprise service and outreach methodology: Conflict Resolution classes at each of the five school sites and the Peace Fair - a community outreach program with education and city resources for families. Briefly describe the direct product of the program activities. Include the volume if work accomplished such as number of: low-income households served, youth, elderly, disabled or number of loan applications processed. Goals must include numeric goals for service that will be achieved during the program year: 150 parents and 50 youth from low income households will be served through Conflict Resolution training and the Peace Fair. Can this Project /Program proceed on July 1, 2006? ® YES [ ] NO 7 OD • ma -DOcn -0 < Ip r: 0 C CD =I. m < t7 = a G M (D 30-m w , 10 N O -a T O ? n Q O O I = I ;0 CD Con CD - m =r -f- 3 cn~93c~0 , . Q 0 I ~ m N 0 03vCr rnM u,omm~a - (a 3 cn. tow z. ~ 7 0 0 o 0 0) m O ~ M a w < .•r a : = a 0' -0 o ca m-m o C~(c~r• C O N N (MD _ --an 3::*,=a U) fD, w CD Cr In o003m (D O rt ~ a ^M cD cn 0 N w eta ~ O C U) 0 c fl? ? (D o 3 c 3 n 0 w N a 0 0 cD 0 -0 O' N O 0 C O 3 C C O O 0 =F r• o CD 0 -0 C) co 0 m r: o 5 3 co cD w o h O n (D O ~ 3 O (D O f% w <m o a -r F' (a 0 -0 Ow (D 1 (D co (D cn co a "0 N 00_ N (D =r C CD CL 8 (D 3 'v m O E w E I r M. u pr fD n 9 O rt b 1 r G b r.. •b 7 r• M . M CL 1 r fD •t I O C N C r 1 lC V C U) r rt w W t r co 00 a r• m w w roCi] 1 w h a< -CSI dH7dc] O W- rr fC x R R rD H. rn r w H rr 0 rt w"0 r w C O w w CO w w a F w n M O i r r m w r• V r rr 0 ? w m r• O G Z M b r• G r• o O H H. w rD b A O w r D * n j a O fD O rt V r'• fD W. Ov r rr r V 0 ~ (D IQ 8 Rn - o m 4 (IQ w 0 < 0 Un r•, ; r• v,w 1.0? O M 9 G z L i ~7 O l 00 O r, 4 . p n w m -1 rt ti w n 0 0 -a •rS td i3 a o+ w V 3 e o, t r. w M O 1 0 o w 3 a, R- rr CL ~ N C fD O r• 0 nrD w rt CL a o w n , w 0 (D m r rr w w + P. ~ I G r r rt W co r• a o 7~ ~7 ,y ri w V G m 0 r. I,. rt 0 ~C ID w 3 N? rt r- a w.rorr n 3 n m rt P, o a O w G o w o M 3 ~t 3 n w rr w o rD a ,0 3 pq ta. U) CD N WM G 3~ w M n rro CL n w C r o to 0 X w A r o w b L 0 0 rt n w w o n V C rt = ° t i1 0 V (IQ r H. a `C n N w CV rn ]C c7 r• rt H w G 0 G a w f' n 99 A w A h w r O D) -r• cn o w ? C O , rt M 7 w V 3 a ( ~14 n '°3 ~•y f D w rt w rt V rr 0 00 C fD O R 7C r• w C. 0 O rL w w C=1 H w a cn C W r• w M ~ G O r ~ r r 0 0 f0 O O m w n rt rt D 1C CD ( W. M w r [=7 r rt C •V Is r G O c r, rt r%r n Oo a o lb D3 U) O r 1.- 1 9D ~4 rt w v1 M w w 0 "i 01 O w rr w w n w to w A rt rt W. rl (D `C V ID fD •V n A O O rt O a fD Tma Z ty ((D M M M m A rt r• C H r'1 O G O• ci O M r r• n rT PO m w O r C rr . 1, m In O 3 Z m m D ch c M m z m D O C -i O m N U) D m m • 0 3. PROJECT PROPOSAL AND DESCRIPTION (continued) If your proposal is for an existing Project/Program that is currently funded through the City of Rosemead's General Fund, this request will: PLEASE CHECK ONLY ONE: 1. [ ] Increase Service. If so, how? 2. [ Continue the existing funded program at currently funded service levels. 3. [ ] Replace a previous source of funding. If so, list source and reason 4. [ ] New program for FY 2006-2007 5. [ ] New request (not currently funded) 4. CLIENT INTAKE INFORMATION - FOR PUBLIC SERVICE ACTIVITIES The U.S. Department of Housing and Urban Development (HUD) requires that agencies obtain intake data from each client/family served. Does your agency obtain this information? [ x ] YES [ ] NO If yes, does your intake sheet obtain the following: ■ Name Yes[ x1 No[ ] • Address Yes[ x] No[ ] • City in which client last resided Yes[x] No[ ] ■ Number of Family members Yes[x] No[ ] ■ Total family (household) income Yes[x] No[ ] ■ Race/Ethnicity Yes[x] No[ ] ■ Female head of household Yes[x] No[ ] ■ Disability Yes[x] No[ ] 9 • 0 Describe any special characteristics of your client population. 74% of the District families qualify for free and reduced lunch program. 5. CLIENT INTAKE INFORMATION - CLIENT INTAKE AND PERFORMANCE Provide the actual numbers of your total clients in the categories listed below: (for new, non-city of Rosemead funded agencies, please provide projected data for upcoming fiscal year.) TIME PERIOD AGENCY ROSEMEAD YOUTH WOMEN AT-RISK YOUTH AT-RISK SENIORS DISABLED HOMELESS 7/ 1 /04 to 77 186 66 6/30/05 7/ 1 /05 to 20 23 12/31/05 Provide the actual numbers of persons served in the following age categories: (for new, non-city of Rosemead agencies, please provide projected data for upcoming fiscal year): PERFORMANCE CHILDREN YOUTH ADULT ELDERLY PERIOD 0-12 13-17 18-54 55 & OVER Rosemead Agency Rosemead Agency Rosemead Agency Rosemead Agency 7/1104 to 6/30/05 40 18 7 1 186 77 7/1/05 to 23 20 12/31105 10 i • 6. CLIENT INTAKE INFORMATION - CLIENTS SERVED BY INCOME LEVEL Report the actual number of unduplicated number of clients your agency served from July 1, 2005 through December 31, 2005. One person can only be counted one time, even though the client may have been served many times during the reporting period. Calculate the totals and percentages for each category: Household CDBG Eligible # Served by # Of # Served # Of Rosemead Size Based on Income Agency below Rosemead by Project residents served by Limits the Income residents below the project below the Limit served by the Income Income Limit Agency below Limit the Income Limit 1 $36,700 19 20 19 2 2 $41,900 3 $47,150 2 2 4 $52,400 5 $56,600 6 $60,800 Subtotal of CDBG Eligible Households 23 23 Total Households Served 20 23 20 23 Percentage of CDBG Income -Eligible Families Served 10070 10070 A total of 43 persons were served, all of them below the income limit. Of those 43 people, 23 are Rosemead residents and CDBG eligible. 7. CLIENT INTAKE INFORMATION - CLIENT OR PROJECT INFORMATION The source of funding for Public Service Grants comes from a Community Development Block Grant (CDBG) received through the U.S. Department of Housing and Urban Development (HUD). CDBG funds are for the specific purpose of benefiting low/moderate income households. In order to be eligible for these funds, your organization must provide a service for the residents of the City of Rosemead and be able to document that at least 51 percent of the clientele served by the project/program earn less than the following income limits: 11 Income Limits are based on HUD Section 8 Income Guidelines: HOUSEHOLD SIZE 1 2 AMNWAL INCOME LIMIT _ $36,700 $41,900 3 $47,150 4 $52,400 5 $56,600 6 $60,800 7 $65,000 8 $69,150 Please check the corresponding letter, which further describes the activity you are proposing: ■ Public Service Projects will most likely be (c), or in some cases (a), per CDBG Eligibility Requirements. a) The project will benefit a clientele that is generally presumed by HUD to be below the eligible income limits. The following groups are presumed to meet this criterion: abused children, battered spouses, elderly persons, and illiterate persons and persons with acquired Immune Deficiency Syndrome (AIDS) b) x The project information on family size and income shows that it is evident that at least 51 percent of the clientele are persons whose family income does not exceed the CDBG eligible income limit (i.e. mapping service area and demonstrating that more than 51 % of persons in the service area are low-moderate income). C) The project has income limits that limit the activity exclusively to CDBG eligible income persons. 12 8. ADDITIONAL APPLICATION DISCLOSURE STATEMENT All organizations that submit this application must provide accurate data concerning the number and income levels of clients and/or location and nature of projectstservices, as well as demonstrated site control. Estimates are unacceptable except for previously non-CDBG funded agencies. This stipulation shall apply to all organizations that are subsequently awarded funding. Any organization that falsifies information, either accidentally or intentionally, shall be required to reimburse the City for any funds paid out and shall not be permitted to apply for funding in the future. The applicant hereby proposes to provide the services or projects for the City of Rosemead as stated in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state and local regulations and other assurances, as required by the City of Rosemead, will be adhered to. As the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal. DATE: Oa-16- SIGNED: 'l w TITLE: Superintendent ORGANIZATION: Rosemead School District 13 F- 00 0 Cl 0 Gd y ' cn w cn C ."y C: i m !A o to co -e C .b to r w 0+ K A y to CA 0 =r ~ O ~ 0 CA o O. n y q :3 v ~ w ~ CL d ~ k x i O y x X n be b9 69 69 b4 604 N N 00 A ~ t-j O N O 01 O W A ~O N V W t/i W -11 v 00 oo 00 ,p O y (0 O C) O 0 O 0 O C) O O o O O O b Cl o O 0 0 A bA ~ A~ C3 W O R. O A S ►Ot O ti ■e eo 0 rZA_ b3 C6 b9 604 65 b5 b9 b9 ►C N can W W "r J 00 00 00 7-i N 0°0 O O n 9 0 0 0 0 0 0 0 0 o rQO9 69 b9 69 609 b9 69 b3 b9 Eon N W O n o J 00 00 O N A a, O y t/i W W ~-j 00 00 ,O O sy O O O O O O O O O O bA b O O y a EA 69 b9 69 b9 64 69 69 6e b9 N ~ N Q, W► W ,p to to W W J 000 PO r- O PO A ~o O O O O O O O O O O O I to OWN y d y O d O r • 0 O r M O G1 v ) -1 O r Q m x 0 Z m J n C CL 5i~ c a _ N ' D r c O c D N o D ° < CD w v •D O ~p : o o m - ~ 3 v D O n -a N - D m a• Sl CD 3 m o :3 c CD m n v w cn X v (D cD (A 0 n Z N m N C v W O O r o O o O r 0 ° O 0 vi 0 c 0 D r rn -4 0 C r w r r o O -4 w 4- ° 0 O ° o 0 ° o _ m M r n N I I I r O O O W ~ I I I 0 v o Q~ o ~ r W r r W O O vl O O 0 0 0 0 0 0 o o D r M r O W r r o ~ m w In ° o ° o o o 0 M O 00 0 2 m v M CD C v m r N n I 1 I r O O O I I 1 ~ O m m T O m z G) 00 v m i • • EXHIBIT B -BOARD OF DIRECTORS AFFIDAVIT All applicant Agencies must complete this affidavit listing the members of the Board of Directors and all other officers. If there are changes in the Board membership after the request is submitted, the City of Rosemead must be notified in writing. In submitting this funding request, (,(Designee) Dr Am4, Rnmmnrn-Pore 7 depose and say that I am superintendent [insert title, President, Vice President, etc.] of Rosemead school Di crri rr 3907 Rosemead Blvd., Rosemead, CA 91710 [Insert name and address of Agency] The other members and officers of the Board of Directors of this Agency are: (Please list names of current Board Members and attach an additional sheet, if necessary): NAME TITLE TERM EXPIRES 1. Linda Clark-Molina 2. Ronald Esquivel Clerk December, 2007 3. Randall Cantrell 4. Fred Mascorro Denpmher, 9009 5. Dennis McDonald AT: Rosemead, California (CITY & STATE) THE APPROPRIATE AGENCY DESIGNEE MUST SIGN AND AFFIX THE SEAL (Corporate Seal) I certify and declare under penalty of perjury that the foregoing is true and correct. Amy Enomoto-Perez, Ph.D. Print Name Signature and itle ROSEMEAD SCHOOL DISTRICT LOS ANGELES COUNTY REPORT ON AUDIT OF FINANCIAL STATEMENTS AND SUPPLEMENTARY INFORMATION INCLUDING REPORTS ON COMPLIANCE June 30, 2005 SCHOOL `lu.talcl F•R r Q' 9n, cx ti SCHOOL DISTRICT AUDIT REPORT June 30, 2005 CONTENTS • Page FINANCIAL SECTION Independent Auditors' Report Management's Discussion and Analysis i-xiv Basic Financial Statements: Government-wide Financial Statements: Statement of Net Assets I Statement of Activities Fund f''tnancial Statements: Balance Sheet - Governmental Funds 3 Reconciliation of the Governmental Funds Balance Sheet to the Statement of Net Assets 4 Statement of Revenues, Expenditures, and Changes in Fund Balance - Governmental Funds 5 Reconciliation of the Governmental Funds Statement of Revenues, Expenditures and Changes in Fund Balance to the Statement of Activities b Statement of Fund Net Assets - Fiduciary Funds 7 Statement of Changes in Fund Net Assets - Fiduciary Funds 8 Notes to the Financial Statements 9-38 SUPPLEMENTARY INFORMATION SECTION History and Organization 39 Combining Statements and Individual Fund Schedules: Combining Statements - Non-Major Funds: Non-Major Debt Service Funds Combining Balance Sheet 40 Combining Statement of Revenues, Expenditures, and Changes in Fund Balance 41 Non-Major Special Revenue Funds Combining Balance Sheet 42 Combining Statement of Revenues, Expenditures, and Changes in Fund Balance 43 ROSEMEAD SCHOOL DISTRICT AUDIT REPORT June 30, 2005 CONTENTS Page SUPPLEMENTARY INFORMATION SECTION (continued) Non-Major Capital Projects Funds Balance Sheet 44 Statement of Revenues, Expenditures, and Changes in Fund Balances 45 Fiduciary Fund Types - Trust and Agency Funds Combining Balance Sheet 46 Combining Statement of Revenues, Expenditures, and Changes in Fund Balances 47 Schedule of Budgetary Comparison for the General Fund 48 Schedule of Average Dail Attendance ADA 49 Schedule of Instructional Time 50 Schedule of Expenditures of Federal Awards 51 Reconciliation of Annual Financial and Budget Report With Audited Financial Statements 52 Schedule of Financial Trends and Analysis 53 Schedule of Charter Schools 54 Notes to Supplementary Information 55-57 Report on Internal Control over Financial Reporting and on Compliance and Other Matters Based on an Audit of Financial Statements Performed in Accordance with Government Auditing Standards 58-59 Report on Compliance with Requirements Applicable to Each Major Program and on Internal Control over Compliance in Accordance with OMB Circular A-133............ 60-61 Report on State Compliance 62-64 Schedule of Findings and Questioned Costs - Summary of Auditor Results 65 Schedule of Findings and Questioned Costs - Related to Financial Statements 66-67 Schedule of Findings and Questioned Costs - Related to Federal Awards 68 Status of Prior Year Findings and Questioned Costs 69 STATISTICAL SECTION 70 * LLOYD B S I N E Chairman ROYCE A. STUTZMAN INDEPENDENT AUDITORS' REPORT Principal JERI A. WENGER 1 - Board of Editation Rosemead School District 3907 N. Rosemead Blvd. Rosemead, California 91770 TZMANLLP A N D C P A s Parhrers PETER F. GAUTREAU RENEE S. GRAVES WAGE N. MCMULLEN KARIN HECKMAN NELSON CARL PON GEMA M. PTAsINSKI MARY ANN QUAY LINDA M. SADDLEMIRE Senior Managers JANETTE CAMPS CLAUDETTE ELIAS RAIN TIMOTHY D. EVANS PRISCILLA OSBORNE FLORES PHEBE M. MCCUTCHEON SHARI PROSSER COLLEEN K. TAYLOR We have audited the accompanying financial statements of the governmental activities, each major fund, and the aggregate remaining fund information of the Rosemead School District as of and for the year ended June 30, 2005 as listed in the table of contents. These financial statements are the responsibility of the District's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall basic financial statement presentation. We believe that our audit provides a reasonable basis for our opinions. In our opinion, the financial statements referred to above present fairly, in all material respects, the respective financial position of the governmental activities, each major fund, and the aggregate remaining fund information of the Rosemead School District as of June 30, 2005, and the respective changes in financial position for the fiscal year then ended in conformity with accounting principles generally accepted in the United States of America. 2210 E. ROUTE 66, GLENDORA, CA 91740 Tel 626.857.7300 Fax 626.857.7302 Web WWW.VLSLLP.COM E-Mail INFO@VLSLLP.COM Board of Education Rosemead School District In accordance with Government Auditing Standards, we have also issued our report dated November 9, 2005 on our consideration of the Rosemead School District's internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements and other matters. The purpose of that report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards and should be considered in assessing the results of our audit. The management's discussion and analysis and budgetary comparison information are not a required part of the basic financial statements but are supplementary information required by accounting principles generally accepted in the United States of America. We have applied certain limited procedures, consisting principally of inquiries of management regarding the methods of measurement and presentation of the required supplementary information. However, we did not audit the information and express no opinion on it. Our audit was conducted for the purpose of forming opinions on the financial statements that collectively comprise the Rosemead School District basic financial statements. The management's discussion and analysis, combining and individual non-major fund financial statements, supplementary schedules and statistical tables are presented for purposes of additional analysis and are not a required part of the basic financial statements. The accompanying schedule of expenditures of federal awards is presented for purposes of additional analysis as required by U.S. Office of Management and Budget Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations, and is also not a required part of the basic financial statements of Rosemead School District. The combining and individual non-major fund financial statements and supplementary section, including the schedule of expenditures of federal awards have been subjected to the auditing procedures applied in the audit of the basic financial statements and, in our opinion, is fairly stated, in all material respects, in relation to the basic financial statements taken as a whole. The management's discussion and analysis and statistical tables have not been subjected to the auditing procedures applied in the audit of the basic financial statements and, accordingly, we express no opinion on them. SAJ,74~ Up 2 VICENTI, LLOYD & STUTZMAN LLP November 9, 2005 ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Introduction The following discussion and analysis provides an overview of the financial position and activities of the District for the year that ended June 30, 2005. This discussion has been prepared by management and should be read in conjunction with the financial statements and notes thereto which follow this section. The Management Discussion and Analysis (MD&A) is an element of the reporting model adopted by the Governmental Accounting Standards Board (GASB) in its Statements No. 34 (Basic Financial Statements- and Managergqpt's Discussion and Analysis-for State and Local Governments) issued June 1999. Certain Comparative information between the current and the prior year Statements of Net Assets and Activities is required to be presented in the MD&A. In addition to this MD&A, GASB Statement No. 34 also requires the creation and inclusion of Government-Wide Statement of Net Assets and Statement of Activities as the basic financial statements of the District. These statements use a full accrual basis of accounting, which is more similar to accounting used by private business than to traditional governmental accounting. Users of these statements will find the explanations in the Notes to Financial Statements on Pages 9 to 38 helpful in understanding this new reporting format. Please note these statements focus on all governmental activities of the District but do not include funds for which the District only acts as an agent. The agency funds consist of student body funds and are reported in a separate Statement of Net Assets and Statement of Changes in Net Assets for Fiduciary Funds included in this report. Organization of this Presentation Topics discussed in this Management Discussion and Analysis is as follows: History, Mission & Goals This includes a brief overview of the history, mission, and current goals of the District. Enrollment Student enrollment determines both the level of operations and the funding for the District. This section gives a brief look at enrollment trends. -i- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Fixed Assets and Long-Term Debt One of the major changes under GASB Statement No. 34 is the incorporation of fixed assets and long-term debt into the basic financial statements of the District. This section looks at the impact of the District's facilities construction program on both assets and debt. It also looks at funding sources for payments on long-term debt. Governmental Funds This section looks at the major funds of the District under the new reporting model. District-wide Statements The Statement of Net Assets and Statement of Activities more closely resemble statements used by the private sector. This section includes a brief discussion of these reports. General Fund This section looks at budget revisions made to the General Fund during the year and concerns regarding balancing income and expenditures. Future Expectations This presentation concludes with a brief discussion of factors that might economically impact the district. -ii- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS - June 30, 2005 History, Mission, and Goals The Rosemead School District was originally founded in 1859 and has been in operation over 146 years. The District serves pre-kindergarten through eighth grade students living in portions of the cities of El Monte, San Gabriel, Temple City and Rosemead in the County of Los Angeles. The District maintains four elementary schools and one middle school and serves over three thousand students. The mission of the Rosemead School District is to provide a challenging academic learning environment, which encourages lifelong learning. In partnership with parents and community, our mission is to nurture the intellectual, aesthetic, physical, emotional and ethical growth of each child to be prepared for new horizons. Our current goals focus on the following areas: • Student achievement • Technology • Work force environment • Modern facilities • Parents and community partnerships -iii- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Enrollment As a starting point for discussion, as in the previous year, we will discuss enrollment first, because the number of pupils the District serves is a basis for most revenues that flow into the District. The most consistent measurement of enrollment by school districts in California is the enrollment count in October of each year. This enrollment is called CBEDS. The count in October is enough after the start of the school year to give districts a consistent number for year-to-year analysis. The following reflects the District enrollment trend for the last five years. District Enrollment for Fiscal Years 2001 through 2005 3500 3450 3400 3350 3300 3250 3200 3150- 3100- 3050 2000-01 2001-02 2002-03 2003-04 2004-05 ■ P2 ADA 3272 3301 3267 3287 3210 ■ Enrollment 3421 3439 3403 3355 3302 The District is going through a declining enrollment cycle. This appears to be due to lower birth rates and higher housing prices. The District is monitoring enrollment and making staff reductions to accommodate the lower student population. District funding is primarily based on Average Daily Attendance. This is average daily enrollment less student absences and was 3,210 for 2004-05. This compares to the 2004-05 CBEDS enrollment of 3,302. The District has partially mitigated the financial impact of declining enrollment by improving attendance. -iv- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Fixed Assets and Long-Term Debt GASB Statement No. 34 also requires the inclusion of fixed assets, related depreciation, and long-term debt into the basic financial statements. In accomplishing this for fixed assets, the District is using a capitalization threshold of $5,000. Items with original costs less than $5,000 are expensed. Depreciation is computed on a straight-line basis over the estimated useful life of the asset as follows: • Buildings and Improvements 25-50 Years • Furniture and Equipment 10-15 Years • Vehicles 5-8 Years The following reflects the comparison of balances in these accounts: Balance Balance Land Building and improvements Machinery Construction in progress Totals at historical cost Less accumulated depreciation for: Buildings and improvements Machinery, equipment and vehicles Total accumulated depreciation Governmental activities capital assets, net June 30, 2004 June 30, 2005 $ 958,706 $ 958,706 13,931,258 15,612,611 635,981 647,888 954,524 2,387,463 $ 16,480,469 $ 19,606,668 3,810,884 4,131,475 308,869 392,457 4,119,753 4,523,932 $ 12,360,716 $ 15,082,736 These accounts are being affected and will continue to be affected by the District's ongoing facilities modernization and improvement program. In 2000, the District's voters approved $30,000,000 in general obligation bonds both to repair and rehabilitate schools and for construction and acquisition of new classrooms and facilities. The District has issued $18 million of these bonds to date. During the year, approximately $1.7 million in modernization and improvements were completed. Work still under construction totaled $2,387,463 at year-end and consists mainly of modernization projects throughout the District. -v- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 With regard to long-term debt, the following items reflect balances in these accounts at year-end: 2004 2005 COPs-1996 $ 2,320,000 $ 2,270,000 COPs-1997 1,615,000 1,530,000 Capital Leases 100,927 General Obligation Bonds-Series A 7,540,000 7,405,000 General Obligation Bonds-Series B 10,000,000 10,000,000 Qualified Zone Academy Bonds 5,000,000 5,000,000 Early Retirement 108,249 156,122 Compensated Absences 160,282 169,446 Total $ 26,844,458 $ 26,530,568 Sources of payment for long-term debt obligations are as follows. Certificates of Participation (COPS) and Capital Leases - Beginning in 2004-05, a portion of the debt payments attributable to new building and facilities acquisition was paid from the District's Capital Facilities Fund. The remainder will be paid from the General Fund. General Obligation Bonds - Under California law, principal and interest payments for voter approved general obligation bonds are paid by a separate ad valorem tax levy. The County of Los Angeles collects the levy and makes all interest and principal payments and District officials do not have access to these funds. Tax revenues and related interest and principal payments are reflected in the Bond Interest and Redemption Fund in the Non-Major Debt Services Funds section of the audit report. Current assessed values and the largest property owners in the District are included in the statistical section on page 70 of the audit report. Qualified Zone Academy Bonds - The District has deposited $1.9 million in a Guaranteed Investment Contract (GIC) and is required to make further annual payments of $75,000 to the GIC through 2017. The GIC balance is reflected as investments in the Special Reserve Fund on the Balance Sheet-Governmental Funds. The $75,000 annual payment is paid from the General Fund of the District. In addition to budgeting the current year payment, the District has designated $75,000 in the General Fund ending balance for future years' payments. -vi- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Early Retirement - The District has a Retiree Health Benefits Fund to pay for the currently recognized liability of its retirees. Payments made in 2004-05 total $56,004. Fund reserves available to cover the remaining future liability are $349,524. The fund is presented in the Non-Major Special Revenue Funds section of the report. Compensated Absences - These are paid as vacation and are used by the fund in which the employee works. This includes the General Fund, Cafeteria Fund and Child Development Fund. Reporting the School District's Major Funds Fund-Based Financial Statements The District's fund-based financial statements provide detailed information about the District's most significant funds. Some funds are required to be established by State law and bond covenants. However, the District establishes many other funds as needed to control and manage money for specific purposes. The major governmental funds of Rosemead are individually presented and consist of the General Fund and the Building Fund. The remaining District funds are grouped together as Other Governmental Funds. These funds are reported individually in the Combining Statements for Non-Major Funds in the supplemental section of this report. Governmental Funds The two major funds, like most funds of the District, are governmental funds. Governmental fund reporting focuses on how money flows into and out of the funds and the balances that remain at year-end. A modified accrual basis of accounting measures cash and all other financial assets that can readily be converted to cash. The governmental fund statements provide a detailed short-term view of the District's operations and services. Governmental fund information, helps to determine the level of financial resources available in the near future to finance the District's programs. Fiduciary Funds The District is the trustee, or fiduciary, for its student activity funds. All of the District's fiduciary activities are reported in a separate Statement of Fund Net Assets and Statement of Changes in Fund Net Assets. We exclude these activities from the District's other financial statements because the District cannot use these assets to finance its operation. The District is responsible for ensuring that the assets reported in these funds are used for their intended purposes. -vii- • ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Report the School District as a Whole One of the most important Questions about the District is, "Is the District as a whole better off or worse off financially as a result of the year's activities?" The Statement of Net Assets and the Statement of Activities, which appear first in the District's financial statements, report information on the District as a whole and its activities in a way that helps you answer this question. The statements were prepared to include all assets and liabilities using the full accrual basis of accounting that is similar to the accounting used by most private sector companies. This basis of accounting takes into account all of the current year's revenues and expenses regardless of when cash is received or paid. Both statements report the District's net assets and any related changes. The difference between assets and liabilities as reported in the Statement of Net Assets, is one way to measure the District's financial health, or financial position. Over time, the increases or decreases in the District's net assets, as reported in the Statement of Activities, are an additional indicator of whether its financial health is improving or deteriorating. The relationship between revenues and expenses indicates the District's operating results. However, the District's goal is to provide services to our students, not to generate profits, as is the goal for commercial entities. One must consider many other non-financial factors, such as the quality of the education provided and the safety of the schools, to assess the overall health of the District. -viii- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Statement of Net Assets The District's net assets were $11,632,395 at June 30, 2005. Of this amount, $1,010,018 represents the amount invested in ca4Zital assets owned by the DistricNet of the related debt. June 30, 2004 June 30, 2005 Assets Current Assets Non Current Assets: Land Construction in Progress Depreciable Assets, Net Total Non Current Assets Total Assets Liabilities Accounts Payable and Other Current Liabilities Deferred Revenue Current Portion of Long-Term Liabilities Non-Current Portion of Long-Term Liabilities Total Liabilities Net Assets Invested in Capital Assets, Net of Related Debt Restricted for: Debt Service Educational Programs Unrestricted Total Net Assets $ 23,990,808 958,706 954,524 10,447,486 12,360,716 36,351,524 $ 2,296,566 340,945 359,511 26,484,947 29,481,969 740,599 2,470,214 290,380 3,368,362 $ 6,869,555 $ 25,577,383 958,706 2,387,463 11,736,567 15,082,736 40,660,119 $ 2,692,430 208,049 416,708 25,710,537 29,027,724 1,010,018 3,113,205 759,859 6,749,313 $ 11,632,395 The increase in total assets primarily reflects bond monies being used in construction. -ix- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Comparison of Net Assets: The following graph indicates the change in net assets between the 2003-04 and the 2004-05 fiscal year: Net Assets 8 000 000 , , 7 0 000 ,0 0, - 6,000,000- 5,000,000 4 000 00 , 0 , 3,000,000 2,000,000- 1,000,000- 0 Invested in Capital Assets, Net of Related Restricted for Debt Service Restricted for Educational Programs Unrestricted ■ 2003-04 740,599 2,470,214 290,380 3,368,362 ■2004-05 1,018,018 3,113,205 759,859 6,749,313 -X- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Statement of Activities Direct instructional expenses were 58.15% of all expenses, while general administrative expenses were 6.25% of total expenses. The District's net asset position increased in the fiscal year by $4,762,840. This is due to the increase in state funding and decreases in overall District expenditures. June 30, 2004 June 30, 2005 Revenues Program Revenue: Charges for Services $ 317,404 $ 355,009 Operating and Capital Grants and Contributions 7,007,817 10,127,437 General Revenues: Property Taxes Levied for: General Purposes 4,587,875 2,682,521 Debt Service 655,744 1,134,908 Other Specific Purposes 8,666 7,566 Federal and State Aid not Restricted to Specific Programs 12,070,844 14,622,919 Interest and Investment Earnings 238,485 552,653 Miscellaneous 425,047 821,984 Total Revenues 25,311,882 30,304,997 Expenses Instruction 15,486,622 14,852,600 Instruction-Related Services 2,560,618 2,346,748 Pupil Services 2,612,632 2,678,270 Enterprise 52,405 56,004 General Administration 1,716,817 1,597,101 Plant Services 2,015,926 1,723,705 Ancillary Services 1,619 Other Outgo 480,402 619,446 Debt Serv ice-Interest 496,418 1,264,104 Amortization (unallocated) 35,071 Depreciation (unallocated) 361,842 404,179 Total Expenses 25,820,372 25,542,157 Increase (Decrease) in Net Assets (508,490) 4,762,840 Net Assets, Beginning of Year After Restatement 7,378,045 6,869,555 Net Assets, End of Year $ 6,869,555 $ 11,632,395 -x1- • J ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Comparison of Revenues The following graph indicates the changes in revenues between the 2003-04 fiscal year and the 2004-05 fiscal year: Revenues 15,000,000- - 10,000,000- 5,000,000- 0- Grants & Federal & All Other Property Taxes Contributions State Aid Revenue 2003-04 7,007,817 5,252,285 12,070,844 980,936 2004-05 10,127,437 3,824,995 14,622,919 1,729,646 The decrease in property tax revenue primarily reflects the shift of ERAF taxes to State aid apportionment. -xii- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 Comparison of Expenditures The following graph indicates the changes in expenditures between the 2003-04 fiscal year and the 2004-05 fiscal year: Expenditures 20,000,000 15,000,000 10,000,000 5,000,000 0 Instruction- General Other Plant services Instruction related Pupil Services administration Expenditures services I M2003-04 15,486,222 2,560,618 2,612,632 1,716,817 2,015,926 1,427,757 ■ 2004-05 14,852,600 2,346,748 2,678,270 1,597,101 1,723,705 2,343,733 -xlii- ROSEMEAD SCHOOL DISTRICT MANAGEMENT'S DISCUSSION AND ANALYSIS June 30, 2005 General Fund Budget During the fiscal year, the Board of Education authorized revisions to the original budget to accommodate known changes. A budgetary comparison schedule is presented in this report: Variances between the original budget and final budget amounts were created by: • Increases in restricted income and expenses due to prior year carryovers. Carryover amounts were not known at the time of original budget adoption. • Changes to budgeted unrestricted income and expenditures. Solvency For the past four years, expenditures have exceeded revenues. This is primarily due to State funding reductions, declining enrollment, fringe benefits, and contracted services increases. In the current budget year, the District has reduced teaching positions and administrative positions to reduce deficit spending. Available General Fund reserves are about 6.51% of expenditures. The State recommends a minimum reserve of 3%. Expectation in Future Years The State of California's fiscal condition continues to be a cause of concern. However, the impact of the State fiscal crisis on District finances cannot be predicted at this time. District administration is incorporating the long-term enrollment trend into District plans, budgets, and hiring. The District will continue to monitor the budget and make reductions as appropriate to balance income and expenditures. The District will continue modernizing facilities over the next several years. This will primarily be financed through additional issues of general obligation bonds. Contacting the District's Financial Management This financial report is designed to provide the community, investors, creditors, etc. with a general overview of the District's financial condition and to show the District's accountability for the funding it receives. If you have questions regarding this report or need additional financial information, contact: Vera McNaught, Business Manager 3907 Rosemead Blvd. Rosemead, CA 91770-1984 Tel: (626) 312-2900 Extension 227 -xiv- • ROSEMEAD SCHOOL DISTRICT STATEMENT OF NET ASSETS June 30, 2005 • Governmental Activities Assets Cash in county treasury S 16,179,935 Cash on hand and in banks 60,000 Cash in revolving fund 23,700 Cash with fiscal agent 4;476,816 Investments 2,316,167 Accounts receivable: Federal and State governments 1,821,578 Miscellaneous 617,540 Inventories 81,647 Land 958,706 Construction in progress 2,387,463 _ Depreciable assets, net 11,736,567 Total Assets 40,660,119 Liabilities Accounts payable and other current liabilities 2,692,430 Deferred revenue 208,049 Current portion of long-term liabilities: General obligation bonds payable 230,000 Certificate of participation payable 140,000 Retiree benefits payable 46,708 Non-current portion of long-term liabilities: General obligation bonds payable 17,175,000 Qualified zone academy bond payable 5,000,000 Less deferred charge for issue costs and discount (403,323) Certificate of participation payable 3,660,000 Retiree benefits payable 109,414 Compensated absences 169,446 Total Liabilities 29,027,724 Net Assets Invested in capital assets, net of related debt 1,010,018 Restricted for: Debt service 3,113,205 Educational programs 759,859 Unrestricted 6,749,313 Total Net Assets $ 11,632,395 See the accompanying notes to the financial statements. 4- • ROSEMEAD SCHOOL DISTRICT STATEMENT OF ACTIVITIES For the Fiscal Year Ended June 30, 2005 C Net (Expense) Functions Governmental Activities Instruction Instruction - related services Pupil services Enterprise General administration Plant services Other outgo Debt service - interest Depreciation (unallocated) Total School District Revenue and Changes in Net Program Revenues Assets Operating Capital Grants Charges for Grants and and Governmental Expenses Services Contributions Contributions Activities S 14,852,600 S 99,638 S 4,098,320 S S (10,654,642) 2,346,748 32,259 799,305 (1,515,184) 2,678,270 200,963 1,865,820 W 1,487) 56,004 (56,004) 1,597,101 19,046 270,427 (1,307,628) 1,723,705 3,103 147,631 2,639,191 12066,220 619,446 306,743 (312,703) 1,264,104 (1,264,104) 404,179 (404,179) $ 25,542,157 $ 355,009 S 7,488,246 S 2,639,191 (15,059,711) General Revenues Property taxes levied for General purposes Debt service Other specific purposes Federal and State aid not restricted to specific purposes Interest and investment earnings Miscellaneous Total General Revenues and Special Items Change in net assets Net Assets - Beginning of Year Net Assets - End of Year See the accompanying notes to the financial statements. 2,682,521 1,134,908 7,566 14,622,919 552,653 821,984 19,822,551 4,762,840 6,869,555 S 11,632,395 -2- ROSEMEAD SCHOOL DISTRICT BALANCE SHEET- GOVERNMENTAL FUNDS June 30, 2005 Special Reserve Other Total General Building County School for Capital Governmental Governmental Fund Fund Facilities Fund Outlav Fund sir.---- Funds Funds Assets Cash in county treasury S 2,981,932 S 8,359,851 S 2,666,174 S 87,580 S 2,084,398 S 16,179,935 Cash on hand and in banks 60,000 60,000 Cash in revolving fund 23,000 - 700 23,700 Cash with fiscal agent 4,279,949 196,867 4,476,gi6 Investments 2,316,167 2,316,167 Accounts receivable: Federal and State governments 1,490,808 330,770 1,821,578 Miscellaneous 322,613 70,400 21,411 137,569 65,547 617,540 Due from other funds 110,000 100,000 Inventories 66,171 15,476 81,647 Total Assets $ 4,884,524 S 8,530,251 S 2,687,585 S 4,505,098 S 5,069,925 S 25,677,383 Liabilities and Fund Balance Liabilities - - Accounts payable S 1,220,577 S 677,919 S S 125,148 S 207,448 $ 2,231,092 Due to other funds 100,000 100,000 Deferred revenue 156,908 51,141 208,049 Total Liabilities 1,377,485 677,919 225,148 258,589 2,539,141 Fund Balance Restricted for debt service 3,113,205 3,113,205 Reserved for special purposes 89,171 16,176 105,347 Restricted forspecial purposes 759,859 759,859 Designated far special purposes 2,475,351 2,475,351 Undesignated 182,658 7,852,332 2,687,585 4,279,950 1,681,955 16,684,480 Total Fund Balance 3,507,039 7,852,332 2,687,585 4,279,950 4,811,336 23,138,242 Total Liabilities and Fund Balance $ 4,884,524 S 8,530,251 S 2,687,585 S 4,505,098 S 5,069,925 S 25,677,383 See the accompanying notes to the financial statements. -3- I ROSEMEAD SCHOOL DISTRICT RECONCILIATION OF THE GOVERNMENTAL FUNDS BALANCE SHEET TO THE STATEMENT OF NET ASSETS June 30, 2005 Total fund balance-governmental funds $ 23,138,242 Amounts reported for governmental activities in the statement of net assets are different because: Capital assets used for governmental activities are not financial resources and therefore are not reported as assets in governmental funds. These assets consist of: Land $ 958,706 Work in progress 2,387,463 Depreciable assets, net 11,736,567 Total capital assets 15,082,736 Long-term liabilities, including bonds payable, are not due and payable in the current period and therefore are not reported as liabilities in the funds. Long-term liabilities at year-end consist of: Certificates of participation $ 3,800,000 Qualified zone academy bond 5,000,000 General obligation bonds payable 17,405,000 Compensated absences 169,446 Retirees benefits 156.122 Total long-term liabilities (26,530,568) Interest expense related to certificates of participation and general obligation bonds payable was incurred but not accrued through June 30, 2005 (461,338) Issue costs and discounts associated with the issuance of debt are removed from expense in the governmental funds. These will be amortized over the life of the debt. 403,323 Total net assets - governmental activities $ 11.632.395 The notes to the financial statements are an integral part of this statement. -4- ROSEMEAD SCHOOL DISTRICT STATEMENT OF REVENUES, E.YPENDITURE& AND CHANGES IN FUND BALANCE-GOVERNMENTAL FUNDS For the Fiscal Year Ended June 30, 2005 Special Reserve Other Total General Building County School for Capital Governmental Governmental Fund Fund Facilities Fund Outlay Fund Funds Funds Revenues Revenue limit sources: State apportionments S 12,798,930 S S S S S 12,798,930 Local sources 2,682,520 2,682,520 Total revenue limit sources 15,481,450 - - - 15,481,450 Federal sources 2,824,151 1,136,587 3,960,738 Other State sources 3,139,639 2,639,191 928,949 6,707,779 Other local sources 1,654,168 212,361 48,394 66,529 1,951,137 3,932,589 Total Revenues 23,099,408 212,361 2,687,585 66,529 4,016,673 30,082,556 Expenditures Instruction 14,057,411 651,686 14,709,097 Instruction - related services 2,251,394 149,537 2,400,931 Pupil services 1,332,085 1,342,053 2,674,138 Enterprise 56,004 56,004 General administration 1,520,499 120,341 1,640,840 Plant services 1,881,656 2,568,783 137,568 22,709 4,610,716 Other outgo 619,446 619,446 Debt service 320,776 968,076 1,288,852 Total Expenditures 21,983,267 2,568,783 137,568 3,310,406 28,000,024 Excess (deficiency) ofrevenues over expenditures 1,116,141 (2,356,422) 2,687,585 (71,039) 706,267 2,082,532 Other Financing Sources (Uses) lnterfund transfers in 129,040 4,350,989 2,397,230 6,877,259 Interfund transfers out (269,213) (4,350,989) (2,257,057) (6,877,259) Total Other Financing Sources (l ses) (140,173) (4,350,989) 4,350,989 140,173 Net changes in fund balances 975,968 (6,707,411) 2,687,585 4,279,950 846,440 2,082,532 Fund Balance- Beginning of Year 2,531,071 14,559,743 3,964,896 21,055,710 Fund Balance - End of Year S 3,507,039 $ 7,852,332 S 2,687,585 S 4,279,950 $ 4,811,336 S 23,138,242 See the accompanying notes to the financial statements. -5- • • ROSEMEAD SCHOOL DISTRICT RECONCILIATION OF THE GOVERNMENTAL FUNDS STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE TO THE STATEMENT OF ACTIVITIES For the Fiscal Year Ended June 30, 2005 Net change in fund balances - Total government funds $ 2,082,532 Amounts reported for governmental activities in the statement of activities are different because: Governmental funds report capital outlay as expenditures. However, in the statement of activities, the cost of those assets is allocated over their useful lives as depreciation expense. Capital outlay $ 3,126,199 Depreciation expense 4( 04,179) Excess of capital outlay over depreciation expense 2,722,020 Repayment of long-term debt is reported as an expenditure in governmental funds, but the repayment reduces long-term liabilities in the statement of net assets. General obligation bond principal payments $ 135,000 Certificates of participation principal payments 135,000 Capital lease principal payments 100,927 370,927 Some items reported in the statement of activities do not require the use of current financial resources and therefore are not reported as expenditures in governmental funds. These activities consist of. Net increase in accrued interest $ (320,530) Net increase in compensated absences (9,163) Net increase in retiree benefits (47,875) Net decrease in bond issue costs and discount (35,071) (412,639) Change in net assets - governmental activities $ 4.762.840 See the accompanying notes to the financial statements. -6- ROSEMEAD SCHOOL DISTRICT STATEMENT OF FUND NET ASSETS - FIDUCIARY FUNDS June 30, 2005 Associated Student Body Funds Assets Cash on hand and in banks $ 31,864 Total Assets 31,864 Liabilities Funds held in trust 14,701 Total Liabilities 14,701 Net Assets Unrestricted 17,163 Total Net Assets 17,163 See the accompanying notes to the financial statements. 7- ROSEMEAD SCHOOL DISTRICT STATEMENT OF CHANGES IN FUND NET ASSETS - FIDUCIARY FUNDS For the Fiscal Year Ended June 30, 2005 Associated Student Body Funds Additions Revenue from local sources Total Additions Deductions Other expenses Total Deductions Changes in net assets Net Assets - Beginning of Year Net Assets - End of Year See the accompanying notes to the financial statements. $ 79,970 79,970 81,108 81,108 (1,138) 18,301 $ 17,163 -8- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE I - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: The District accounts for its financial transactions in accordance with the policies and procedures of the Department of Education's California School Accounting Manual, updated to conform to the most current financial and reporting requirements promulgated by the California Department of Education. The accounting policies of the District conform to generally accepted accounting principles as prescribed by the Governmental Accounting Standards Board and the American Institute of Certified Public Accountants. The significant accounting policies applicable to the District are described below. A. BASIS OF PRESENTATION: The accompanying financial statements have been prepared in conformity with generally accepted accounting principles as prescribed by the Governmental Accounting Standards Board (GASB), including Statement No. 34, Basic Financial Statements and Management Discussion and Analysis - for State and Local Governments and Audits of State and Local Governmental Units issued by the American Institute of Certified Public Accountants. The financial statement presentation required by GASB No. 34 provides a comprehensive, entity-wide perspective of the District's financial activities. The entity-wide perspective enhances the fund-group perspective previously required. Fiduciary activities are excluded from the basic financial statements. The School District's basic financial statements consist of government-wide statements, including a statement of net assets, a statement of activities, and fund financial statements. 1. Government-wide Financial Statements: The statement of net assets and the statement of activities display information about the District as a whole. These statements include the financial activities of the primary government. Fiduciary funds are excluded. -9- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) A. BASIS OF PRESENTATION: (continued) 1. Government-wide Financial Statements: (continued) The statement of net assets presents the financial condition of the governmental activities of the District at year-end. The statement of activities presents a comparison between direct expenses and program revenues for each program or function of the District's governmental activities. Direct expenses are those that are specifically associated with a service, program or department and therefore clearly identifiable to a particular function. Program revenues include charges paid by the recipient of the goods or services offered by the program, grants and contributions that are restricted to meeting the operational or capital requirements of a particular program and interest earned on grants that is required to be used to support a particular program. Revenues which are not classified as program revenues are presented as general revenues of the District. The comparison of direct expenses with program revenues identifies the extent to which each governmental function is self-financing or draws from the general revenues of the District. 2. Fund Financial Statements: During the year, the District segregates transactions related to certain District functions or activities in separate funds in order to aid financial management and to demonstrate legal compliance. Fund financial statements are designed to present financial information of the District at this more detailed level. The focus of governmental fund financial statements is on major funds. Each major fund is presented in a separate column. Non-major funds are aggregated and presented in a single column. The fiduciary funds are reported by type. -10- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) A. BASIS OF PRESENTATION: (continued) 2. Fund Financial Statements: (continued) The fund financial statement expenditures are presented in a function- oriented format. The following is a brief description of the functions: Instruction - includes the activities directly dealing with the interaction between teachers and students. Instruction-related services - includes supervision of instruction, instructional library, media and technology, and school site administration. Pupil services - includes home to school transportation, food services and other pupil services. Enterprise activities - includes activities that are financed and operated in a manner similar to private business enterprises, where the stated intent is that the costs are financed or recovered primarily through user charges. This function is used with self-insurance funds and retiree benefit funds. General administration - includes data processing services and all other general administration services. Plant services - includes activities of maintaining the physical plant. This also includes facilities acquisition and construction expenditures. Other outgo - includes transfers to other agencies. Debt service - includes principal and interest payments for long-term debt. The fiduciary fund expenditures are presented by natural classification. ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) B. FUND ACCOUNTING: To ensure compliance with the California Education Code, the financial resources of the District are divided into separate funds for which separate accounts are maintained for recording cash, other resources and all related liabilities, obligations and equities. The statements of revenue, expenditures and changes in fund balance are statements of financial activities of the particular fund related to the current reporting period. Expenditures of the various funds frequently include amounts for land, buildings, equipment, retirement of indebtedness, transfers to other funds, etc. Consequently, these statements do not purport to present the result of operations or the net income or loss for the period as would a statement of income for a profit- type organization. The modified accrual basis of accounting is used for all governmental funds. GOVERNMENTAL FUNDS - MAJOR General Fund (01) - the general operating fund of the District is used to account for all financial resources except those required to be accounted for in another fund. Building Fund (21) - used to account for repairs, construction and/or acquisition of major capital facilities; acquisition, retro-fitting, and operation of real property; proceeds of general obligation bonds, and certificates of participation and income from rental of unused sites. County School Facilities Fund (35) - used to account for modernization and new construction of various school sites. Special Reserve for Capital Outlay Fund (40) - used to account for capital outlay related to the qualified zone academy bonds program. -12- • . . 0 ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) B. FUND ACCOUNTING: (continued) GOVERNMENTAL FUNDS - NON-MAJOR Debt Service Funds - used to account for the accumulation of resources for, and the payment of, general long-term debt principal, interest, and re!ated costs. Bond Interest and Redemption Fund (51) - used to account for the payment of principal and interest on general long-term debt. The District maintains the Bond Interest and Redemption Fund to account for bond interest and redemption of bond principal. 2. Debt Service Fund (56) - used to account for the debt payments. Special Revenue Funds - used to account for the proceeds of specific revenue sources that are legally restricted to expenditures for specific purposes. Cafeteria Fund (13) - used to account for revenues received and expenditures made to operate the District's cafeterias. 2. Child Development Fund (12) - used to account for resources committed to child development programs maintained by the District. 3. Deferred Maintenance Fund (14) - used for the purpose of major repair or replacement of District property. 4. Special Reserve Fund Other Than Capital Outlay (17) - used to account for one-time expenditures as decided by the Board. 5. Retiree Benefits Fund (71) - used to account for future payments of health and welfare benefits and future payments of the exempt governmental deferred compensation plan. 13- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) C. FUND ACCOUNTING: (continued) GOVERNMENTAL FUNDS - NON-MAJOR (continued) Capital Projects Funds - used to account for the acquisition and/or construction of major governmental general fixed assets. Capital Facilities Fund (25) - used to account for resources received from residential and commercial developer impact fees. FIDUCIARY FUNDS Associated Student Body Funds - used to account for raising and expending money to promote the general welfare, morale and educational experiences of the student body. The District operates two Associated Student Body funds. The District operates one Student Aid Fund used to account for the use of local donations for needy students. AGENCY ACTIVITIES The District operates a Warrant Pass Through Fund as a holding account for amounts collected from employees for federal taxes, state taxes and other contributions. The District had cash in the County Treasury amounting to $195,086 on June 30, 2005, which represents withholdings payable. C. BASIS OF ACCOUNTING: Basis of accounting refers to when revenues and expenditures or expenses are recognized in the accounts and reported in the financial statements. Basis of accounting relates to the timing of measurement made, regardless of the measurement focus applied. Government-wide financial statements are prepared using the accrual basis of accounting. Governmental funds use the modified accrual basis of accounting. Fiduciary funds use the accrual basis of accounting. Differences in the accrual and the modified accrual basis of accounting arise in the recognition of revenue, the recording of deferred revenue, and in the presentation of expenses versus expenditures. 14- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) C. BASIS OF ACCOUNTING:- Cash and Cash Equivalents The District's cash and cash equivalents are considered to be cash on hand, demand deposits and short-term investments with original maturities of three months or less from the date of acquisition. Cash in the County treasury is recorded at cost, which approximates fair value, in accordance with the requirements of GASB Statement No. 31. 2. Receivables Receivables are generally recorded when the amount is earned and can be estimated. Per Education Code Section 33128.1, a local education agency may recognize for budgetary and financial reporting purposes any amount of state appropriations deferred from the current fiscal year and appropriated from the subsequent fiscal year for payment of current year costs as a receivable in the current year. The District has recognized receivables in accordance with this standard, the most notable being for the final P-2 apportionment. Inventory Inventories are presented at the lower of cost or market on an average basis and are expensed when used. Inventory consists of expendable supplies held for consumption. At June 30, 2005, the inventory for supplies is $66,171. The inventory for food is $15,476. 4. Prepaid Expenses Payments made to vendors for goods or services that will benefit periods beyond June 30, 2005, are recorded as prepaid items using the consumption method. A current asset for the prepaid amount is recorded at the time of the purchase and an expenditure/expense is reported in the year in which goods or services are consumed. -15- • i ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) C. BASIS OF ACCOUNTING: (continued) Capital Assets Generally, capital assets result from expenditures in the governmental funds. These assets are reported in the governmental activities column of the government-wide statement of net assets, but are not reported in the fund financial statements. Capital assets are capitalized at cost (or estimated historical cost) and updated for additions and retirements during the year. Donated fixed assets are recorded at their fair market values as of the date received. The District maintains a capitalization threshold of $5,000. The District does not own any infrastructure as defined in GASB No. 34. Improvements are capitalized; the costs of normal maintenance and repairs that do not add to the value of the asset or materially extend an asset's life are not capitalized. All reported capital assets except for land and construction in progress are depreciated. Improvements are depreciated over the remaining useful lives of the related capital assets. Depreciation is computed using the straight-line method over the following useful lives: Description Estimated Lives Buildings and Improvements 25-50 years Furniture and Equipment 10-15 years Vehicles 5-8 years 6. Deferred Revenue Cash received for federal and state special projects and programs is recognized as revenue to the extent that qualified expenditures have been incurred. Deferred revenue is recorded to the extent cash received on specific projects and programs exceeds qualified expenditures. -16- • . . 0 ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE I - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) C. BASIS OF ACCOUNTING: (continued) 7. Compensated Absences In accordance with GASB Statement No. 16, accumulated unpaid employee vacation benefits are recognized as a liability of the District. The current portion of the liability, if material, is recognized in the applicable fund at year-end. The entire compensated absences liability is reported on the government-wide financial statements. Sick leave benefits are accumulated without limit for each employee. The employees do not gain a vested right to accumulated sick leave. Accumulated employee sick leave benefits are not recognized as a liability of the District. The District's policy is to record sick leave as an operating expense in the period taken since such benefits do not vest nor is payment probable; however, unused sick leave is added to the creditable service period for calculation of retirement benefits when the employee retires. Long Term Obligations The District reports long-term debt of governmental funds at face value in the government-wide financial statements. Long-term debt and other obligations financed by proprietary funds are reported as liabilities in the appropriate funds. Fund Balance Reservations and Desi nag tions Reservations of the ending fund balance indicate the portions of the fund balance not appropriable for expenditure. Designations of the ending fund balance indicate tentative plans for financial resource utilization in a future period. -17- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) C. BASIS OF ACCOUNTING: (continued) 10. Net Assets Net assets represent the difference between assets and liabilities. Net assets invested in capital assets, net of related debt consists of capital assets, net of accumulated depreciation, reduced by the outstanding balances of any borrowings used for the acquisition, construction or improvements of those assets. Net assets are reported as restricted when there are limitations imposed on their use through external restrictions imposed by donors, grantors or laws or regulations of other governments. 11. State Apportionments Certain current year apportionments from the State are based upon various financial and statistical information of the previous year. Second period to annual corrections for revenue limits and other state apportionments (either positive or negative) are accrued at the end of the fiscal year. 12. Property Taxes Secured property taxes attach as an enforceable lien on property as of March 1. Taxes are payable in two installments on November 15 and March 15. Unsecured property taxes are payable in one installment on or before August 31. Real and personal property tax revenues are reported in the same manner in which the County auditor records and reports actual property tax receipts to the Department of Education. This is generally on a cash basis. A receivable has not been recognized in the General Fund for property taxes due to the fact that any receivable is offset by a payable to the State for revenue limit purposes. Property taxes receivable for debt service purposes are not material and have therefore not been accrued in the government-wide financial statements. -18- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) C. BASIS OF ACCOUNTING: (continued) 13. On-Behalf Payments GASB Statement No. 24 requires that direct on-behalf payments for fringe benefits and salaries made by one entity to a third party recipient for the employees of another, legally separate entity be recognized as-revenue and expenditures by the employer government. The State of California makes direct on-behalf payments for retirement benefits to the State Teachers and Public Employees Retirement Systems on behalf of all school districts in California. However, a fiscal advisory was issued by the California Department of Education instructing districts not to record revenue and expenditures for these on-behalf payments. The amount of on-behalf payments made for the District is estimated at $217,800 for STRS. 14. Estimates The preparation of the financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. Actual results may differ from those estimates. 15. Contributed Services Generally accepted accounting principles require that contributions of donated services that create or enhance non-financial assets or that require specialized skills, are provided by individuals possessing those skills, and would typically need to be purchased if not provided by donation, are to be recorded at fair value in the period received. Although the District receives numerous hours of volunteer time, it is not deemed necessary to record these hours on the books of the District based on the above guidelines. In addition, the District receives donations of immaterial equipment and supplies which are not recorded upon receipt. -19- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE I - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) D. REPORTING ENTITY: The District is the level of government primarily accountable for activities related to public education. The governing authority consists of elected officials who, together, constitute the Board of Education. The District considered its financial and operational relationships with potential component units under the reporting entity definition of GASB Statement No. 14, The Financial Reporting Entity. The basic, but not the only, criterion for including another organization in the District's reporting entity for financial reports is the ability of the District's elected officials to exercise oversight responsibility over such agencies. Oversight responsibility implies that one entity is dependent on another and that the dependent unit should be reported as part of the other. Oversight responsibility is derived from the District's power and includes, but is not limited to: financial interdependency; selection of governing authority; designation of management; ability to significantly influence operations; and accountability for fiscal matters. Based upon the requirements of GASB Statement No. 14, and as amended by GASB Statement No. 39, Determining Whether Certain Organizations are Component Units, certain organizations warrant inclusion as part of the financial reporting entity because of the nature and significance of their relationship with the District, including their ongoing financial support the District or its other component units. A legally separate, tax-exempt organization should be reported as a component unit of the District if all of the following criteria are met: The economic resources received or held by the separate organization are entirely or almost entirely for the direct benefit of the District, its component units, or its constituents. 2. The District, or its component units, is entitled to, or has the ability to otherwise access, a majority of the economic resources received or held by the separate organization. The economic resources received or held by an individual organization that the District, or its component units, is entitled to, or has the ability to otherwise access, are significant to the District. -20- t ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES: (continued) D. REPORTING ENTITY: (continued) Based upon the application of the criteria listed above, the following potential component unit have been excluded in the District's reporting entity: Rosemead School District Educational Facilities Financing Corporation - The Corporation is a legally separate entity formed for the purpose of acquiring equipment and capital outlay and then leasing such items to the Rosemead School District. Various PTA's and PTSA's - Each of these types of organizations at each of the school sites within the District were evaluated using the three criterion listed above. Each entity has been excluded as a component unit because the third criterion was not met in all cases; the economic resources received and held by the PTA's and PTSA's individually are not significant to the District. NOTE 2 - BUDGETS: The District has chosen to use the single budget adoption program that requires a July 1, using the Single Adoption Budget process budget adoption. A public hearing must be conducted to receive comments prior to adoption. The District's Governing Board satisfied these requirements. Budgets for all governmental funds were adopted on a basis consistent with generally accepted accounting principles (GAAP). These budgets are revised by the District's Governing Board and District Superintendent during the year to give consideration to unanticipated income and expenditures. The original and final revised budget is presented in a budgetary comparison schedule in the supplementary section. Formal budgetary integration was employed as a management control device during the year for all budgeted funds. Expenditures cannot legally exceed appropriations by major object account. -21- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 3 - DEPOSITS AND INVESTMENTS: A. Deposits Custodial Credit Risk - Deposits Custodial credit risk is the risk that in the event of a bank failure, the District's deposits may not be returned to it. The District does not have a deposit policy for custodial risk. As of June 30, 2005, $4,828,691 of the District's bank balance of $4,991,222 was exposed to credit risk as follows: Uninsured and collateral held by pledging bank's trust department not in the District's name $ 205,953 Uninsured and uncollateralized 4,622,738 Total $42 8=9 Cash in County Treasury In accordance with Education Code Section 41001, the District maintains substantially all of its cash in the Los Angeles County Treasury as part of the common investment pool. These pooled funds are carried at cost which approximates fair value. The fair market value of the District's deposits in this pool as of June 30, 2005, as provided by the pool sponsor, was $16,141,313. The County is authorized to deposit cash and invest excess funds by California Government Code Section 53648 et. seq. The county is restricted by Government Code Section 53635 pursuant to Section 53601 to invest in time deposits, U.S. government securities, state registered warrants, notes or bonds, State Treasurer's investment pool, bankers' acceptances, commercial paper, negotiable certificates of deposit, and repurchase or reverse repurchase agreements. The funds maintained by the County are either secured by federal depository insurance or are collateralized. Interest earned is deposited quarterly into participating funds, except for the Tax Override fund, in which case interest earned is credited to the general fund. Any investment losses are proportionately shared by all funds in the pool. -22- C • ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 3 - DEPOSITS AND INVESTMENTS: (continued) B. Investments As of June 30, 2005, the District had the following investments. All investments are in a Guaranteed Investment Contract: Investment Maturities Fair Value Guaranteed Investment Contract 12/17/2016 $ 2JU-6,16 7 Interest Rate Risk The District does not have a formal investment policy that limits investment maturities as a means of managing its exposure to fair value losses arising from increasing interest rates Credit Risk Government Code Section 16430 allows governmental entities to invest surplus moneys in certain eligible securities. The District has no investment policy that addresses investment credit risk. As of June 30, 2005, all of the District's investments were in a Guaranteed Investment Contract and not exposed to credit risk. -23- • • ROSEMEAD SCHOOL DISTRICT - NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 4 - INTERFUND TRANSACTIONS: Interfund activity has been eliminated in the Government-wide statements as required by GASB No. 34. Thifollowing balances and transactions are reported in the fund financial statements. A. Interfund Receivables/Pavables Individual interfund receivable and payable balances at June 30, 2005, are as follows: Interfund Interfund Fund Receivables Payables Building Fund $ 100,000 $ Special Reserve Fund for Capital Outlay Projects 100,000 Totals $ 1 D 0 $~1 0 QOQ B. Interfund Transfers Interfund transfers consist of operating transfers from funds receiving revenue to funds through which the resources are to be expended. Interfund transfers for the 2004-05 fiscal year are as follows: Transfer from the Special Reserve Fund Other Than Capital Outlay Fund to the Debt Service Fund to close out the Special Reserve Fund $2,128,017 Transfer from the General Fund to the Debt Service Fund to properly reflect the restrictions/use of these funds 194,213 Transfer from the Building Fund to the Special Reserve Capital Outlay Fund to record and track expenditures from Qualified Zone Academy Bonds proceeds 4,350,989 -24- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 4 - INTERFUND TRANSACTIONS: (continued) B. Interfund Transfers (continued) Transfer from the Special Reserve Fund Other Than Capital Outlay Fund to the General Fund to close out the Special Reserve Fund 129,040 Transfer from the General Fund to the Debt Service Fund to record deposit made to Qualified Academy Zone Bond sinking fund 75,000 Total $ 7.8 NOTE 5 - FUND BALANCES - RESERVEDIRESTRICTED/DESIGNATED: A. The following amounts were reserved by the Board of Education for the special purposes below: General Fund Revolving Cash Stores Inventory Total $ 23,000 66,741 $-a2,74-1 Cafeteria Fund $ 700 15,476 B. The restricted for special purposes fund balance is for special projects in the General Fund as stated below: Public School Library K-12 $ 5,494 English Language Acquisition Program 15,294 Lottery-Instructional Materials 74,767 Gifted and Talented Education 12,376 Instructional Materials Realignment 304,129 Peer Assistance Review 15,698 Economic Impact Aid 199,658 Carl Washington School Safety 25,161 Principals Training 1,500 Restricted Maintenance 105,782 Total Restricted Fund Balance $ -25- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 5 - FUND BALANCES - RESERVED/RESTRICTED/DESIGNATED: (continued) C. The following amounts were designated by the Board of Education for the special purposes below: Major Funds: General Fund: Economic Uncertainties $ 992,095 Certificates of Participation 35Q,000 Staff Development 50,000 Unbudgeted Teacher's Salaries 230,000 Unused Vacation 135,000 Qualified Zone Academy Bond Payment 75,000 Emergency and Safety Project 25,000 E-Rate 118,256 William's Settlement Compliance 100,000 Unfunded Retirees Liability 400,000 $ 2 4. 75.35 NOTE 6 - OPERATING LEASES: The District has entered into various operating leases for equipment with lease terms in excess of one year. None of these agreements contain purchase options. Future minimum lease payment under these agreements are as follows. Fiscal Year Lease Payment 2005-2006 $ 88,229 2006-2007 58,590 2007-2008 47,860 2008-2009 35,764 2009-2010 12,135 Total $ 242.578 Current year expenditures for operating leases is approximately $89,700. The District will receive no sublease rental revenues nor pay any contingent rentals for these leases. -26- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 7 - BONDED DEBT: On November 7, 2000, District voters approved general obligation bonds totaling $30,000,000. Proceeds from the sale of the bonds will be used to finance the repair and rehabilitation of schools and the construction and acquisition of new classrooms and school facilities. The outstanding bonded debt of Rosemead School District at June 30, 2005 is: Amount Date of Interest Maturity of Original Issue Rate % Date Issue 5/01/01 A 3.25-5.380% 2/12031 S 8,000,000 5/12/04 B 5.125-7.00% 8112033 10,00000 $ A. Series A: Redeemed Outstanding Current Outstanding July 1. 2004 Year June 30, 2005 S 7,540,000 5135,000 S 7,405,000 10.000.000 10.000.000 $11,5Q Sly S17 40 The annual requirements to amortize Series A bonds payable, outstanding as of June 30, 2005, are as follows: Year Ended June 30 Principal Interest Total 2006 $ --145,000 $ 385,175 $ 530,175 2007 155,000 377,925 532,925 2008 160,000 370,175 530,175 2009 170,000 361,375 531,375 2010 180,000 352,875 532,875 2011-2015 1,025,000 1,621,875 2,646,875 2016-2020 1,310,000 1,336,538 2,646,538 2021-2025 1,655,000 961,626 2,616,626 2026-2030 2,115,000 480,694 2,595,694 2031 490,000 26,338 516,338 Totals $ 7 405 $ 6.274.596 $13.67906 -27- • `-A ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 7 - BONDED DEBT: (continued) B. Series B: The annual requirements to amortize Series B bonds payable, outstanding as of June 30, 2005, are as follows: Year Ended June 30 Principal Interest Total 2006 $ 85,000 $ 517,869 $ 602,869 2007 185,000 508,419 693,419 2008 190,000 495,294 685,294 2009 190,000 481,994 671,994 2010 200,000 468,344 668,344 2011-2015 1,200,000 2,124,075 3,324,075 2016-2020 1,475,000 1,812,078 3,287,078 2021-2025 1,845,000 1,419,956 3,264,956 2026-2030 2,330,000 897,569 3,227,569 2031-2034 2,300,000 242,669 2,542,669 Totals $1 0 0 $ 8.968.267 $ 8.267 -28- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 8 - CERTIFICATES OF PARTICIPATION: Certificates of Participation (COPS) are long-term instruments which are tax exempt and therefore issued at interest rates below current market levels for taxable investments. The District has entered into long-term lease agreements to provide for the financing of equipment, relocatable structures, and building projects. The agreements are between the Rosemead School District as the "Lessee" and the Rosemead School District Educational Facilities Financing Corporation as the "Lessor", or "Corporation". The Rosemead School District Educational Facilities Financing Corporation is a legally separate entity which was formed for the sole purpose of acquiring equipment and capital outlay and then leasing such items to the Rosemead School District. A. 1996 Issue: On August 1, 1996, the District issued $2,600,000 in Certificates of Participation. The agreement is between the Rosemead School District and the Rosemead School District Educational Facilities Financing Corporation. The certificates were issued to (a) finance the acquisition, construction, installation and equipping of various capital improvements throughout the District, (b) fund a reserve fund, (c) refinance certain outstanding obligations of the District, and (d) pay certain costs in connection therewith. The District will repay the debt by making lease payments on February 1, and August 1, beginning February 1, 1997 and terminating on August 1, 2026. Interest rates range from 4.25% to 6.00% for the length of the issuance. -29- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 8 - CERTIFICATES OF PARTICIPATION: (continued) A. 1996 Issue: (continued) The remaining lease payments will be made as follows: Lease Payment Total Date Principal Interest Payments 2006 $ 50,000 $ 138,355 $ 188,355 2007 55,000 135,388 190,388 2008 60,000 132,080 192,080 2009 60,000 128,570 188,570 2010 65,000 124,850 189,850 2011-2015 390,000 557,775 947,775 2016-2020 530,000 417,390 947,390 2021-2025 710,000 226,625 936,625 2026-2027 350,000 22,188 372,188 Total $1 8 22 $4 15 B. 1997 Issue: On July 30, 1997, the District entered into a Certificates of Participation agreement with the Alameda-Contra Costa Schools Financing Authority. The Rosemead School District is one of eight entities in this pooled agreement. The total amount of the issuance is $26,590,000 with Rosemead's portion being $2,045,000. The proceeds of these certificates were used by the Rosemead School District to fund construction costs for a new district office, and a portion of the costs of the acquisition and installation of 21 modular classrooms. The District will repay the debt by making lease payments four times per year beginning October 1, 1997 and terminating on June 30, 2018. The interest rate for the length of the issuance is adjustable and has ranged from 2.2% to 7% as of the date of this report. -30- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 8 - CERTIFICATES OF PARTICIPATION: (continued) B. 1997 Issue: (continued) The remaining lease payments will be made as follows: Lease Payment Total Date Principal Interest Payments 2006 $ 90,000 $ 65,810 $ 155,810 2007 95,000 61,591 156,591 2008 95,000 57,432 152,432 2009 100,000 52,762 152,762 2010 105,000 48,203 153,203 2011-2015 605,000 162,946 767,946 2016-2018 440,000 25,421 465,421 Totals $ 0 $ 474,165 $ 2.004.165 NOTE 9 - QUALIFIED ACADEMY ZONE BOND (OZAB): The District obtained a Qualified Zone Academy Bond (QZAB) in December of 2002 for $5,000,000 for upgrading, equipping and improvements at Muscatel Middle School to create the Rosemead Technology/Literacy Academy at Muscatel Middle School. The District is required to make lease payments which will be invested in a Guaranteed Investment Contract (GIC) and are expected to produce an amount equal to the $5,000,000 cumulative lease payment on the maturity date. The fair market value of the GIC at June 30, 2005 is $2,261,555. The bonds mature on December 17, 2016 with the entire principal of $5,000,000 due on this date. There is no interest expense associated with this debt. In lieu of receiving periodic interest payments, eligible taxpayers who are bond holders will receive a Federal income tax credit. -31- • 9 ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCUL STATEMENTS June 30, 2005 NOTE 9 - QUALIFIED ACADEMY ZONE BOND (QZAB): (continued) The remaining lease payments are as follows: Annual Amount of Projected Lease Payment Annual Lease Interest Date Payment Earnings 12/17/05 $ 75,000 $ 117,592 12/17/06 -75,000 127,626 12/17/07 75,000 138,183 12/17/08 75,000 149,290 12/17/09 75,000 160,975 2010-2014 195,770 995,580 2015-2017 482,939 $ 70 _Q $ 721 The associated issue costs and discount are recorded as deferred charges on the statement of net assets and are amortized to interest expense over the life of the liability. Issue costs of $141,000 and a discount of $350,000 are amortized using the straight-line method. $35,071 was amortized during 2004-05 and $403,323 is the unamortized balance at June 30, 2005. NOTE 10 - CAPITAL ASSETS AND DEPRECIATION - SCHEDULE OF CHANGES: A schedule of changes in general fixed assets for the year ended June 30, 2005 is shown below: Balance Balance July 1, 2004 Additions Retirements June 30, 2005 Land $ 958,706 $ $ $ 958,706 Building and improvements 13,931,258 1,681,353 15,612,611 Machinery, equipment and vehicles 635,981 11,907 647,888 Construction in progress 954,524 2,085,260 652,321 2,387,463 Totals at historical cost 16,480,469 3,778,520 652,321 19,606,668 Less accumulated depreciation for: Building and improvements 3,810,884 320,591 4,131,475 Machinery, equipment and vehicles 308,869 83,588 392,457 Total accumulated depreciation 4,119,753 404,179 - 4,523,932 Governmental activities capital assets, net $ 0.716 $ 3.37441 $-5i5~ $1~ -32- 0 0 ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 11- LONG-TERM DEBT - SCHEDULE OF CHANGES: A schedule of changes in long-term debt for the year ended June 30, 2005, is shown below: Amount Due Balance Balance Within 2004 July 1 Additions Deductions June 30, 2005 One Year , Compensated absences $ 160,282 $ 9,164 $ $ 169,446 $ Early retirement 108,249 47;-873 156,122 46,708 Certificates of participation - 1996 2,320,000 50,000 2,270,000 50,000 Certificates of participation - 1997 1,615,000 85,000 1,530,000 90,000 Capital leases 100,927 100,927 - General obligation bonds 17,540,000 135,000 17,405,000 230,000 Qualified zone academy bonds 5,000,000 5,000,000 Totals $ 44.458 $___51jM $7 $41~Z9$ NOTE 12 - EMPLOYEE RETIREMENT PLANS: Qualified employees are covered under multiple-employer defined benefit pension plans maintained by agencies of the State of California. Certificated employees are members of the State Teachers' Retirement System (STRS) and classified employees are members of the Public Employees' Retirement System (PERS). State Teachers' Retirement System (STRS) Plan Description The District contributes to the State Teachers' Retirement System (STRS), a cost-sharing multiple-employer public employee retirement system defined benefit pension plan administered by STRS. The plan provides retirement, disability and survivor benefits to beneficiaries. Benefit provisions are established by State statutes, as legislatively amended, within the State Teachers' Retirement Law. STRS issues a separate comprehensive annual financial report that includes financial statements and required supplementary information. Copies of the STRS annual financial report may be obtained from STRS, 7667 Folsom Boulevard, Sacramento, CA 95826. -33- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 12 - EMPLOYEE RETIREMENT PLANS: (continued) State Teachers' Retirement System (STRS) (continued) Funding Policy Active plan members are required to contribute 8.0% of their salary and the District is required to contribute an actuarially determined rate. The actuarial methods-and assumptions used for determining the rate are those adopted by the STRS Teachers' Retirement Board. The-required employer contribution rate for fiscal year 2004-05 was 8.25% of annual payroll. The contribution requirements of the plan members are established and may be amended by State statute. Public Emplovees' Retirement System (PERS) Plan Description The District contributes to the School Employer Pool under the California Public Employees' Retirement System (CalPERS), a cost-sharing multiple-employer public employee retirement system defined benefit pension plan administered by CalPERS. The plan provides retirement and disability benefits, annual cost-of-living adjustments, and death benefits to plan members and beneficiaries. Benefit provisions are established by State statutes, as legislatively amended, within the Public Employees' Retirement Law. Ca1PERS issues a separate comprehensive annual financial report that includes required supplementary information. Copies of the CalPERS' annual financial report may be obtain from the Ca1PERS Executive Office, 400 P Street, Sacramento, CA 95814. Funding Policy Active plan members are required to contribute 7.0% of their salary and the District is required to contribute an actuarially determined rate. The actuarial methods and assumptions used for determining the rate are those adopted by the CalPERS Board of Administration. The required employer contribution rate for fiscal year 2004-05 was 9.952% of annual payroll. The contribution requirements of the plan members are established and may be amended by State statute. -34- • • ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 12 - EMPLOYEE RETIREMENT PLANS: (continued) Contributions to STRS and PERS The District's contributions to STRS and PERS for each of the last three fiscal years is as follows: STRS PERS Year Ended Required Percent Required Percent June 30, Contribution Contributed Contribution Contributed 2003 $933,480 100% $114,971 100% 2004 911,534 100% 425,355 100% 2005 890,766 100% 399,862 100% NOTE 13 - EMPLOYEE RETIREMENT AGREEMENTS: Retiree Health Benefits In 1993-94, the District offered to certain eligible employees meeting various years of service requirements the option of early retirement whereby the District will continue the retirees' health benefits for a mutually agreed upon period. Certificated retirees receive HMO medical benefits; classified retirees receive medical benefits not to exceed an agreed upon amount; management and confidential retirees receive medical, dental, and vision. The amount expended in 2004-05 was $56,004 and $60,000 is budgeted for 2005-06. Under these agreements, the District is obligated to continue to provide benefits without any additional performance from the retiree. The estimated future costs of these agreements is $156,122. Reserves to cover these liabilities will be set aside in the Retiree Benefits Fund, and the liability is reflected in the government-wide financial statements. -35- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 14 - JOINT POWERS AGREEMENTS: The Rosemead School District participates in three joint powers agreement (JPA) entities: MERGE Risk Management and the Los Angeles Regionalized Insurance Services Authority (LARISA) and Alliance of Schools for Cooperative Insurance Programs. MERGE arranges for and provides self-insurance of workers' compensation insurance claims and property and liability insurance for its member school districts. The District pays an annual premium which serves as a pool for payment of claims. LARISA provides the District with dental and vision insurance. Alliance of Schools for Cooperative Insurance Programs purchases property and liability insurance as well as participates in many safety and risk management control programs. Each JPA is independently accountable for its fiscal matters and is governed by a board consisting of representatives from each member District. Budgets are not subject to any approval other than that of the respective governing boards. Member districts share surpluses and deficits proportionately to their participation in the JPAs. The relationships between the Rosemead School District and the JPAs are such that none of the JPAs is a component unit of the Rosemead School District for financial reporting purposes. M Condensed financial information is as follows: LARISA Audited June 30. 2005 MERGE Audited June 30. 2004 ASCIP Unaudited June 30, 2005 Assets $ 16.378.631 Liabilities $ 1.186.071 Retained Earnings $ 15.192.560 Revenues $ 5,814,721 Expenditures 6,463,616 ) Net Income $--Q618,895 $ 16.352.275 $ 7.192.669 $ 9.159.606 $ 6,646,922 6,916,573 $ (269.651) $1QZJZL2B $ 73.460.323 $ 3.714.915 $ 59,456,571 48,864,188 $ 10,592.383 36- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 15 - COMMITMENTS AND CONTINGENCIES: A. State and Federal Allowances, Awards, and Grants The District has received State and Federal funds for specific purposes, including reimbursement of mandated costs, that are subject to review and audit by the grantor agencies. Although such audits could generate expenditure disallowances under terms of the grants, it is believed that any required reimbursement will not be material. B. Purchase Commitments As of June 30, 2005, the District was committed under various capital expenditure purchase agreements for construction and modernization projects totaling approximately $2,221,000. Projects will be funded through bond proceeds. C. Collective Bargaining Agreements The Board settled negotiations with the California School Employees Association in November 2005, and therefore, settlement costs are not part of these financial statements. The estimated cost for 2004-05 fiscal year is $10,400. D. County School Facilities Funds The District is currently involved in several construction and modernization projects funded through the State of California Proposition 47 general obligation bonds and reported in the County School Facilities Fund. These projects are subject to future audits by the State, which may result in other adjustments to the fund. -37- ROSEMEAD SCHOOL DISTRICT NOTES TO FINANCIAL STATEMENTS June 30, 2005 NOTE 16 - SUBSEQUENT EVENT: GASB Statement No. 45 The Governmental Accounting Standards Board (GASB) has recently issued Statement No. 45 outlining new accounting standards for governmental agencies regarding other post-employment benefits. The statement would be effective for phase two GASB Statement No. 34 implementers in fiscal year 2008-09. The statement requires governmental agencies to record and disclose the actuarially determined cost based on the benefits expected to be earned by employees in the future, as well as those benefits the employees have already earned. Annual required contributions shall include the employer's normal cost and a provision(s) for amortizing the total unfunded actuarial accrued liability for a period not to exceed 30 years. The statement also requires that an actuarial valuation be performed every two years for a plan with more than 200 members and every three years for plans with fewer than 200 members. -38- SUPPLEMENTARY INFORMATION SECTION ROSEMEAD SCHOOL DISTRICT HISTORY AND ORGANIZATION June 30, 2005 Rosemead School District was established May 4, 1859 under the name of Mission School District. On April 1, 1878, the District was renamed the Savannah School District. It became the present Rosemead School District on June 11, 1928. The District currently encompasses an area of approximately 3.13 square mile:,. situated in portions of the cities of El Monte, San Gabriel, Temple City and Rosemead, in the County of Los Angeles. The Board of Education and the District Administrators for the fiscal year ended June 30, 2005 were as -follows- BOARD OF EDUCATION Member Office Term Expires Mr. Fred Mascorro President December, 2005 Mrs. Linda Clark-Molina Clerk December, 2005 Mr. Ronald Esquivel Member December, 2007 Mr. Charles Lyons Member December, 2005 Mr. Randall Cantrell Member December, 2007 DISTRICT ADMINISTRATORS Dr. Amy Enomoto-Perez Superintendent Dr. Lila Bronson Director, Categorical/Technology Miss Armida Carreon Director, Personnel and Operations Mrs. Vera McNaught Business Manager Mrs. Diane Ezzo Director, Food Services Mrs. Julie Hoffman Director, Special Education Mrs. Barbara Richardson Director, Pupil Personnel/Educational Services 39- ROSEMEAD SCHOOL DISTRICT NON-MAJOR DEBT SERVICE FUNDS COMBINING BALANCE SHEET June 30, 2005 Bond Interest Total and Redemption Debt (Memorandum Fund Service Fund Only) Assets Cash in county treasury $ 600,171 $ $ 600,171 Cash with fiscal agent 196,867 196,867 Investments 2,316,167 2,316,167 Total Assets $ 600,171 $ 2,513,034 $ 3,113,205 Liabilities and Fund Balance Fund Balance Restricted for debt service Total Fund Balance Total Liabilities and Fund Balance $ 600,171 $ 2,513,034 $ 3,113,205 600,171 2,513,034 3,113,205 $ 600,171 $ 2,513,034 $ 3,113,205 See the accompanying notes to the supplementary information. -40- 0 • ROSEMEAD SCHOOL DISTRICT NON-MAJOR DEBT SERVICE FUNDS COMBINING STATEMENT OF REVENUES, EXPENDITURES AND CHANGES IN FUND BALANCE For the Fiscal Year Ended June 30, 2005 Revenues Other State sources Other local sources Total Revenues Expenditures Debt service Total Expenditures Excess (deficiency) of revenues over expenditures Other Financing Sources (Uses) Interfund transfer in Total Other Financing Sources (Uses) Net changes in fund balance Fund Balance - Beginning of Year Fund Balance - End of Year Bond Interest Total and Redemption Debt (Memorandum Fund Service Fund Only) $ 16,952 $ $ 16,952 1,124,099 115,804 1,239,903 1,141,051 115,804 1,256,855 883,076 883,076 883,076 883,076 257,975 115,804 373,779 257,975 342,196 342,196 $ 600,171 $ 2,513,034 $ 3,113,205 See the accompanying notes to the supplementary information. 2,397,230 2,397,230 2,397,230 2,397,230 2,513,034 2,771,009 -41- r m w c ~ z o ~ V 7 o a i_ LTJ Z C Q m 7 0 CA a a z ~ Z u n o $ 0 O 0 n -,r 'o V1 n y 00 - o, o N 00 n n E 00 n n v~ c M v -Uri i h cli 0 q 0 0 M ~O o M Q v; oo vi = O h oo wl c M L 00 O M 7 N N - C F E O Y v Vi HR H f/! M C4 N N N N N p O y j Vl I h » n - Q+ ~ ~ y a . 7 ~ M 1 f' M en f+ 1 L ` C 40 't Y fA V9 H V9 a p a w Gn w V+ N 0 O 00 OO 00 v - v $ M r C L a - . C L Y z w y e w b9 w H o a n a N M N ~O ~O ~D N to v~ r 'n ~O 6 C roe w U ~ D 6'! Gn (A My O o O o ~O U O, ~o V ~O r o0 o !f n a R r C ~O r - R M N O C M `D o r v v rn i ? o N M 00 V1 N O O M N V) v C a G. U 4A csq w 6'°+ _N C ~ u 0 V Y a C d r~ W a ~ u u a a m O V L 7 OO q V1 q 7 C d NO V p 4 Y u C a _ ' ' U cd C w an , ~ w u A C cd O t > ti t Q y Y y 4 'fl C ` O. y = y V . W -0 C a m Y « u u .a. Y _ C C C O V O Y N VI C u t o Z C M H C L a 7 w s U U s U o u ~ u y ~ ~ Q a Y or y 7 LT. Q 5 a fl e a ore o Q F ..7 F ~ F F 0 E c~ C C N a~ a a N N ~ O ~ v O C DQ C .T C R O u U R Z a> U E- a O 0 a W L z p Z Q &O ~ F a a h ~ y W r ~ Z n W w Q ~ d a w p Y Q ~ ~ W LL W z t U cz 'n F W ~ O W Z " Li. ~ w U Q L Z r, ~ Z ~ U Z Z m O U • E 7 7 F ° O E ~Y+ G y G f~ 00 w g 7 m 1 N 10 - Z I ~ M W a, h W N 64 I ~~pp I C, C. C O m m gl gl - Y ao a 'rr Y G u Y C C d c w' p 'm 2 C Y E r1 - C G t O ~ D Y C al W U 614 a t- a ni rn ~O I~ M ~2 M w 0o0 N O - t~ N - - D N U1 va ~ v oo ~ 1D ~o N %n F1 O N M w y 7 N 'S7 C~ yyy L.V. V E O W d ~ 3 7 U] ~ Y s ~ a aGi ~ O O ~ oC F • 10 n M .:r - a, O N P ~;z M 00 w m vn p v O M Co Y1 v1 Vl 00 N ~D v' O 8 V% n M "t C O r'1 rl~ v1 Q~r'n N N "T N V1 V1 M M Q~ ~O M M N N N O N N N N v M p GA S p 00 ~ O O R v~ h h 000 w N M W o C n r- N N r 1i N N N N w vNi VNl T v 00 00 N 00 00 W% vi r- ri N N IA oo^ n yr fn N h r ~O vMi eT N vii C. r- cri ~o ^ Vl ~ M M O Q a O h V1 00 M N M ? tT H y V 1.. r C ~ ^ N Y O j O L V y j Y Y j U U C ~ i ~ ~ p L >yG C > ~ QO V N y fr V O L •C 4 y CJ G y C O O G ° V C t C y ,C 'O V t.'. V C O ~ ~ t0 Y Y V V C y y O CV W y L L O ~C Oa C C y c a L•] 0 G. 07 X w- e) x V G C Cc7 a u7 t i F 0 F rs'. t°, 0 E L c~ .c c aU E -2 CL CL 0 N 0) ~ 0 Y 0 C oq c c ~a CL E O U U A N a~ rn ROSEMEAD SCHOOL DISTRICT NON-MAJOR CAPITAL PROJECTS FUND BALANCESHEET June 30, 2005 Capital Facilities Fund Assets Cash in county treasury $ 447,410 Accounts receivable: Miscellaneous 50,993 Total Assets $ 498,403 Liabilities and Fund Balance Fund Balance Undesignated $ 498,403 Total Fund Balance 498,403 Total Liabilities and Fund Balance $ 498,403 See the accompanying notes to the supplementary information. -44- ROSEMEAD SCHOOL DISTRICT NON-MAJOR CAPITAL PROJECTS FUND STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCE For the Fiscal Year Ended June 30, 2005 Capital Facilities Fund Revenues Other local sources $192,086 Total Revenues 192,086 Expenditures Debt service 85,000 Total Expenditures Excess (deficiency) of revenues over expenditures 107,086 Fund Balance - Beginning of Year 391,317 Fund Balance - End of Year $498,403 See the accompanying notes to the supplementary information. -45- • • ROSEMEAD SCHOOL DISTRICT FIDUCIARY FUND TYPES - TRUST AND AGENCY FUNDS COMBINING BALANCE SHEET June 30, 2005 Assets Cash on hand and in banks Total Assets Liabilities and Fund Balance Liabilities Funds held in trust Total Liabilities Fund Balance Undesignated Total Fund Balance Total Liabilities and Fund Balance Student Muscatel Encinita Total Aid Middle Elementary (Memorandum Fund School School Only) $ 1,335 $ 27,978 $ 2,551 $ 31,864 $ 1,335 $ 27,978 $ 2,551 $ 31,864 $ $ 14,701 $ $ 14,701 - 14,701 - 14,701 1,335 13,277 2,551 17,163 1,335 13,277 2,551 17,163 $ 1,335 $ 27,978 $ 2,551 $ 31,864 See the accompanying notes to the supplementary information. -46- • ROSEMEAD SCHOOL DISTRICT FIDUCIARY FUND TYPES - TRUST AND AGENCY FUNDS COMBINING STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCE For the Fiscal Year Ended June 30, 2005 Student Muscatel Encinita Total Aid Middle Elementary (Memorandum Fund School School Only) Revenues Yearbook $ $ 14,059 $ $ 14,059 Fundraising 40,425 40,425 Social activities 4,582 4,582 Special events 13,039 13,039 Other revenues 7,007 858 7,865 Total Revenues - 79,112 858 79,970 Expenditures Yearbook 16,365 16,365 Fundraising 25,635 25,635 Social activities 4,554 4,554 Special events 8,478 8,478 Other expenditures 1,358 23,043 1,675 26,076 Total Expenditures 1,358 78,075 1,675 81,108 Excess (deficiency) of revenues over expenditures (1,358) 1,037 (817) (1,138; Fund Balance - Beginning of Year 2,693 12,240 3,368 18,301 Fund Balance - End of Year $ 1,335 $ 13,277 $ 2,551 $ 17,163 See the accompanying notes to the supplementary information. -47- ROSEMEAD SCHOOL DISTRICT SCHEDULE OF BUDGETARY COMPARISON FOR THE GENERAL FUND For the Fiscal Year Ended June 30, 2005 Variance with Final Budget Favorable Budgeted Amounts (Unfavorable) Original Final Actual Final to Actual Revenues Revenue limit sources: State apportionments $ 10,783,307 $ 12,681,773 S 12,798,930 $ 117,157 Local sources 4,502,953 2,694,695 2,682,520 (12,175) Total revenue limit sources 15,286,260 15,376,468 15,481,450 104,982 Federal sources • 2,435,685 2,994,980 2,824,151 (170,829) Other State sources 2,923,054 3,063,471 3,139,639 76,168 Other local sources 1,458,025 1,682,705 1,654,168 (28,537) Total Revenues 22,103,024 23,117,624 23,099,408 (18,216) Expenditures Certificated salaries 11,568,998 11,508,142 11,296,547 211,595 Classified salaries 3,268,571 3,349,220 3,153,363 195,857 Employee benefits 3,926,007 3,992,654 3,866,642 126,012 Books and supplies 1,279,239 1,387,286 812,550 574,736 Services and other operating expenses 2,082,142 2,234,081 2,024,253 209,828 Capital outlay 20,500 10,031 (10,031) Tuition and other outgo 518,658 500,000 619,446 (119,446) Debt service 335,789 340,751 320,776 19,975 Direct support -indirect cost (102,720) (102,720) (120,341) 17,621 Total Expenditures 22,897,184 23,209,414 21,983,267 1,226,147 Excess (deficiency) of revenues over expenditures (794,160) (91,790) 1,116,141 1,207,931 Other Financing Sources (Uses) Interfund transfers in 129,040 129,040 - Interfund transfers out (320,102) (194,213) (269,213) (75,000) Total Other Financing Sources (Uses) (320,102) (65,173) (140,173) (75,000) Net change in fund balance $ (1,114,262) $ (156,963) 975,968 $ 1,132,931 Fund Balance - Beginning of Year Fund Balance - End of Year 2,531,071 $ 3,507,039 See the accompanying notes to the supplementary information. -48- ROSEMEAD SCHOOL DISTRICT SCHEDULE OF AVERAGE DAILY ATTENDANCE (ADA) For the Fiscal Year Ended June 30, 2005 The requirements governing ADA, admission of pupils, types of schools, recording and reporting of pupil attendance, and similar matters are controlled by provisions of the Education Code and by. regulations of the State Department of Education. ADA statistics reported to the State for the fiscal year ended June 30, 2005 are as follows: Second Period Annual Elementary: Kindergarten 278 280 First through third grade 1,066 1,067 Fourth through sixth grade 1,063 1,060 Seventh through eighth grade 720 717 Home and hospital 7 8 Special education master plan 65 65 Special education - extended year - special day class 11 11 Total elementary ADA 3.21-0 3 $ County Operated: Special education 14 14 ?2-4 1.2-22 Hourly Programs Hours of Attendance - Annual ~3 502 Elementary See the accompanying notes to the supplementary information. -49- • vI n. a. a. 0 U 0 U 0 U 0.0'o a o 00 0 00 Cl 00 J Z' O V F" N J O ~f1 V) v c) O C 41 7 to 00 N ~ ti N Q M N O R; ~ W Z y M N c Q C> 110 CD 00 00 ¢ r in W ~ u W W Gr, A ~ x 00 ) ° 0 0 o U w b Z U `0 o o 0 0 o M x bA Oq N cd GJ 4J U ~ 73 4 10 cad ` r~+ U L1 d 0 Q. a. 0 0 r. au c a 0 V U CCS N N U] a • ROSEMEAD SCHOOL DISTRICT 0 SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS For the Fiscal Year Ended June 30, 2005 Pass-Through Federal Entity Catalog Identifying Federal PROGRAM NAME Number Number Expenditures Federal Categorical Aid Programs: U.S. DEPARTMENT OF AGRICULTURE: National School Lunch Program 10.555 03396 $ 912,596 Especially Needy Breakfast Program 10.553 03526 156,123 Child Care Food Program 10.558 03393 62,238 U.S. DEPARTMENT OF EDUCATION: No Child Left Behind Act: Title I 84.010 13797 1,323,174 Title I Migrant Education 84.011 13174 212,334 Title 11 Enhancing Education Through Technology-Competitive 84.318 14368 54,769 Title II Enhancing Education Through Technology-Formula 84.318 14334 14,988 Title II Teacher Quality 84.367 14341 358,841 Title IH Limited English Proficient Program 84.365 10084 99,090 Title V Part A Innovative Education Strategies 84.298A 13340 28,839 Special Education: Local Assistance 84.027 13379 452,313 Preschool 84.173 13430 14,270 Safe and Drug Free Schools 84.184 10007 23,799 U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Child Nutrition: Nutrition Education 93.000 02151 68,966 Child Development Quality Improvement 93.575 13941 5,630 Community Services Block Grant 93.575 03676 12,563 Medi-Cal Administrative Activities Program 93.000 (1) 72,375 Medi-Cal Billing 93.773 I0013 89,160 Total Federal Programs $ 3,962,068 Reconciliation to Federal Revenue: Total Federal Program Expenditures $ 3,962,068 Expenditures in excess of Revenues related to Federal entitlement programs (1,330) Total Federal Revenue $ 3,960,738 (1) Pass-Through Entity Identifying Number was not available or applicable. See the accompanying notes to the supplementary information. -51- ROSEMEAD SCHOOL DISTRICT RECONCILIATION OF ANNUAL FINANCIAL AND BUDGET REPORT WITH AUDITED FINANCIAL STATEMENTS For the Fiscal Year Ended June 30, 2005 There were no differences between the District's Annual Financial and Budget Retort and the audited financial statements. See the accompanying notes to the supplementary information. -52- • SCHEDULE OF FINANCIAL TRENDS AND ANALYSIS For the Fiscal Year Ended June 30, 2005 ROSEMEAD SCHOOL DISTRICT GENERAL FUND: L J (Budget) 2006 2005 2004 2003 Amount % Amount % Amount % Amount % Revenue Revenue Limit Sources S 15,812,652 70.3 $ 15,481,450 69.6 $ 14.73U.434 63.9 S 15,083,366 66.1 Federal Sources 2,437,888 10.8 2,824,151 12.7 2,436,347 10.6 2,398,301 10.5 Other State Sources 2,938,924 13.1 3,139,639 14.1 4,522,907 19.6 4,494,445 19.7 Other Local Sources 1,296,638 5.8 1,654,168 7.4 225,144 1.0 160,905 0.7 Interfund Transfers In 129,040 4,181 0.0 Total Revenue 22,486,102 100.0 23,228,448 103.8 21,919,013 95.1 22,137,017 970 Expenditure s Certificated Salaries Classified Salaries Employee Benefits Books and Supplies Contracted Services Capital Outlay Debt Service Outgoing Tuition Other Transfers Out Interfund Transfers Out Indirect Costs Total Expenditures Change in Fund Balance Adjustment for Restatement Ending Fund Balance Available Reserve Recommended Reserve Percentage Average Daily Attendance (Second Period) Total Long-Tenn Debt IMPORTANT NOTES: 7 11,086,180 49.3 11,296,547 50.8 11,584,379 50.3 11,902,788 52.2 3,021,462 13.4 3,153,363 14.2 3,238,874 14.1 3,319,426 14.5 3,978,118 17.7 3,866,642 17.4 3,856,738 16.7 3,664,992 16.1 1,157,740 5.2 812,550 3.6 1,438,786 6.2 900,667 3.9 2,338,266 10.4 2,024,253 9.1 2,033,343 8.8 1,998,703 81 8,951 0.0 10,031 0.0 16,552 0.1 166,495 0.7 329,165 1.5 320,776 14 357,481 1.5 360,105 1.6 565,408 2.5 619,446 2.8 480,402 2.1 416,694 1.8 1,201 0.0 130,000 0.6 269,213 1.2 75,000 0.3 130,000 0.6 (131,472) (0.6) (120,341) (a.5) (32,611) (0.1) (38,291) 10.2) 22 483 818 100.0 22,252,480 100.0 23,048,944 100.0 22,822,780 100.0 , , S 2.284 0.0 5 v' .vn3 44 S (1.129,931) 14.9) S (685,763 13.0) S 3,509.323 15.6 $ 756,931 3.4 3.0 3,507,039 15.8 2,531,071 11.0 $ 1,174,753 5.3 S 1,129,687 4.9 3.0 3.0 3,661,002 16.0 S 2,405,998 10.5 3.0 3,210 S 26,113,860 3,210 3,287 S 26,530,568 S 26,844,458 The available reserves consist of those amounts designated for economic uncertainty in the General Fund. 2006 Budget is the original adopted budget All Percentages are of total expenditures. See the accompanying notes to the supplementary information. 3,267 $ 17,181,553 -53- ROSEMEAD SCHOOL DISTRICT SCHEDULE OF CHARTER SCHOOLS For the Fiscal Year Ended June 30, 2005 Rosemead School District is not the granting agency for any Charter Schools. See the accompanying notes to the supplementary information. -54- ROSEMEAD SCHOOL DISTRICT NOTES TO SUPPLEMENTARY INFORMATION For the Fiscal Year Ended June 30, 2005 NOTE 1 - PURPOSE OF SCHEDULES: A. Combining Financial Statements Combining balance sheets and statements of revenues, expenditures and changes in fund balance have been presented for the non-major funds to provide additional information to the users of these financial statements. These statements have been prepared using the basis of accounting described in the notes to financial statements. B. Schedules of Budgetary Comparison Schedules For The General Fund GASB Statement No. 34 requires a budgetary comparison be presented for the general fund and for any major special revenue fund that has a legally adopted annual budget. This schedule presents the budget as originally adopted, the revised budget as of the fiscal year end, actual amounts at fiscal year end and the variance between the final budget and actual amounts. C. Schedule of Average Daily Attendance (ADA) Average daily attendance is a measurement of the number of pupils attending classes of the District. The purpose of attendance accounting from a fiscal standpoint is to provide the basis on which apportionments of state funds are made to school districts. This schedule provides information regarding the attendance of students at various grade levels and in different programs. D. Schedule of Instructional Time The District has received incentive funding for increasing instructional time as provided by the Incentives for Longer Instructional Day. This schedule presents information on the amount of instructional time offered by the District and whether the District complied with the provisions of Education Code Sections 46200 through 46206. -55- ROSEMEAD SCHOOL DISTRICT NOTES TO SUPPLEMENTARY INFORMATION For the Fiscal Year Ended June 30, 2005 NOTE 1 - PURPOSE OF SCHEDULES: (continued) E. Reconciliation of Annual Financial and Budget Report with Audited Financial Statements This schedule provides the information necessary to reconcile the fund balances of all funds as reported on the Annual Financial and Budget Report to the audited financial statements. F. Schedule of Financial Trends and Analysis The State Controller's Office requires that this schedule be prepared showing financial trends of the General Fund over the past three fiscal years, as well as the current year budget. This schedule is intended to identify if the District has potential fiscal problems and if they have met the recommended available reserve percentages. G. Schedule of Charter Schools The State Controller's Office requires that this schedule list all charter schools chartered by the District and inform the users whether or not the charter school information is included in the District's financial statements. 56- ROSEMEAD SCHOOL DISTRICT NOTES TO SUPPLEMENTARY INFORMATION For the Fiscal Year Ended June 30, 2005 NOTE 2 - EXCESS OF EXPENDITURES OVER APPROPRIATIONS: Excesses of expenditures over appropriations, by major object accounts, occurred in the following funds: Major Funds: General Fund: Capital Outlay $ 10,031 Tuition 119,446 Interfund Transfers Out 75,000 Building Fund: Books and Supplies 374 Non-Major Funds: Child Development Fund: Books and Supplies 47,558 Services and Other Operating Expenditures 5,811 Direct Support/Indirect Costs 17,405 Cafeteria Fund: Books and Supplies 44,225 Services and Other Operating Expenditures 12,114 -57- VICEATI + LLOYD *tTUTZMAN LLP VF B U S I N E S S C O N S U L T A N T S A N_ D C P A s Chairman ROYCE A. STUTZMAN Partners PETER F. GAUTREAU RENEE S. GRAVES WADE N. MCMULLEN KARIN HECKMAN NELSON REPORT ON INTERNAL CONTROL OVER FINANCIAL CARL PON GEMA M. PTASINSKI REPORTING AND ON COMPLIANCE AND OTHER MARY ANN QUAY MATTERS BASED ON AN AUDIT OF FINANCIAL LNDA M. SADDLEMIRE STATEMENTS PERFORMED IN ACCORDANCE Principal WITH GOVERNMENT AUDITING STANDARDS JERI A. WENGER Sedar Maaepers JANETTE CAMPS CLAUDETTE ELIAS DAIN TIMOTHY D. EVANS PRISCIL.LA OSBORNE FLORES Board of Education PHEBE M. MCCUTCHEON Rosemead School District SHARI PROSSER 3907 N. Rosemead Blvd. COLLEEN K. TAYLOR Rosemead, California 91770 We have audited the financial statements of the governmental activities, each major fund, and the aggregate remaining fund information of Rosemead School District (the District) as of and for the year ended June 30, 2005 which collectively comprise the District's basic financial statements, and have issued our report thereon dated November 9, 2005. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Internal Control Over Financial Reporting In planning and performing our audit, we considered Rosemead School District's internal control over financial reporting in order to determine our auditing procedures for the purpose of expressing our opinions on the financial statements and not to provide an opinion on the internal control over financial reporting. However, we noted a certain matter involving the internal control over financial reporting and its operation that we consider to be a reportable condition. Reportable conditions involve matters coming to our attention relating to significant deficiencies in the design or operation of the internal control over financial reporting that, in our judgment, could adversely affect Rosemead School District's ability to record, process, summarize and report financial data consistent with the assertions of management in the financial statements. A reportable condition is described in the accompanying schedule of findings and questioned. costs. 2210 E. ROUTE 66, GLENDORA, CA 91740 -58- Tel 626.857.7300 Fax 626.857.7302 Web WWW.VLSLLP.COM E-Mal INFO@VLSLLP.COM u • REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT OF FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS A material weakness is a reportable condition in which the design or operation of one or more of the internal control components does not reduce to a relatively low level the risk that misstatements caused by error or fraud in amounts that would be material in relation to the financial statements being audited may occur and not be detected within a timely period by employees in the normal course of performing their assigned functions. Our consideration of the internal control over financial reporting would not necessarily disclose all matters in the internal control that might be reportable conditions and, accordingly, would not necessarily disclose all reportable conditions that are also considered to be material weaknesses. However, we believe the reportable condition described above is not a material weakness. Compliance and Other Matters As part of obtaining reasonable assurance about whether Rosemead School District's financial statements are free of material misstatement, we performed tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements, noncompliance with which could have a direct and material effect on the determination of financial statement amounts. However, providing an opinion on compliance with those provisions was not an objective of our audit and, accordingly, we do not express such an opinion. The results of our tests disclosed instances of non-compliance or other matters that are required to be reported under Government Auditing Standards which are described in the accompanying schedule of findings and questioned costs. This report is intended solely for the information and use of the Board, management, the California Department of Education, the State Controller's Office and federal awarding agencies and pass-through entities and is not intended to be and should not be used by anyone other than these specified parties. VICENTI, LLOYD & STUTZMAN LLP November 9, 2005 -59- TI • LLOYD ♦ ITUTZMANLLP S S C O N S U L TA N T S A N D C P A s Chairman ROYCE A. STUTZMAN Partner: PETER F. GAUTREAU RENEE S. GRAVES WADE N. MCMULLEN KARIN HECKMAN NELSON REPORT ON COMPLIANCE WITH REQUIREMENTS CARL PON GEMA M. PTASINSKI APPLICABLE TO EACH MAJOR PROGRAM AND ON MARY ANN QUAY INTERNAL CONTROL OVER COMPLIANCE IN LINDA M. SAODLEMIRE ACCORDANCE WITH OMB CIRCULAR A-133 Priadpai .JERI A. WENGER Senior Managers JANETTE CAMPS CLAUDETTE ELIAS RAIN Board of Education TIMOTHY D. EVANS PRISCILLA O FLORES Rosemead School District PHEBE M. . MCC MCCUTCHEON 3907 N. Rosemead Blvd. SHARI PROSSER Rosemead, California 91770 COLLEEN K. TAYLOR Compliance We have audited the compliance of Rosemead School District (the District) with the types of compliance requirements described in the U.S. Office of Management and Budget (OMB) Circular A-133 Compliance Supplement that are applicable to each of its major federal programs for the year ended June 30, 2005. Rosemead School District's major federal programs are identified in the summary of auditor's results section of the accompanying schedule of findings and questioned costs. Compliance with the requirements of laws, regulations, contracts and grants applicable to each of its major federal programs is the responsibility of Rosemead School District's management. Our responsibility is to express an opinion on Rosemead School District's compliance based on our audit. We conducted our audit of compliance in accordance with auditing standards generally accepted in the United States of America; the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States; and OMB Circular A-133, Audits of States Local Governments and Non-Profit Organizations. Those standards and OMB Circular A-133 require that we plan and perform the audit to obtain reasonable assurance about whether noncompliance with the types of compliance requirements referred to above that could have a direct and material effect on a major federal program occurred. An audit includes examining, on a test basis, evidence about Rosemead School District's compliance with those requirements and performing such other procedures as we considered necessary in the circumstances. We believe that our audit provides a reasonable basis for our opinion. Our audit does not provide a legal determination on Rosemead School District's compliance with those requirements. In our opinion, Rosemead School District complied, in all material respects, with the requirements referred to above that are applicable to each of its major federal programs for the year ended June 30, 2005. 2210 E. ROUTE 66, GLENDORA, CA 91740 -60- Tel 626.857.7300 Fax 626.857.7302 Web WWW.VLSLLP.COM E-Mail INFO@VLSLLP.COM I 0 REPORT ON COMPLIANCE WITH REQUIREMENTS APPLICABLE TO EACH MAJOR PROGRAM AND ON INTERNAL CONTROL OVER COMPLIANCE IN ACCORDANCE WITH OMB CIRCULAR A-133 Internal Control Over Compliance The management of Rosemead School District is responsible for establishing and maintaining effective internal control over compliance with requirements of laws, regulations, contracts and grants applicable to federal programs. In planning and performing our audit, we considered Rosemead School District's internal control over compliance with requirements that could have a direct and material effect on a major federal program in order to determine our auditing procedures for the purpose of expressing our opinion on compliance and to test and report on the internal control over compliance in accordance with OMB Circular A-133. Our consideration of the internal control over compliance would not necessarily disclose all matters in the internal control that might be material weaknesses. A material weakness is a reportable condition in which the design or operation of one or more of the internal control components does not reduce to a relatively low level the risk that noncompliance with the applicable requirements of laws, regulations, contracts and grants caused by error or fraud that would be material in relation to a major federal program being audited may occur and not be detected within a timely period by employees in the normal course of performing their assigned functions. We noted no matters involving the internal control over compliance and its operation that we consider to be material weaknesses. This report is intended solely for the information and use of the Board, management, the California Department of Education, the State Controller's Office and federal awarding agencies and pass-through entities and is not intended to be and should not be used by anyone other than these specified parties. November 9, 2005 VICENTI, LLOYD & STUTZMAN LLP -61- VICENTI • LLOYD ♦ STUTZMANLLP VF B U S I N E S S C O N S U L T A N T S A N D C P A s chairman ROYCE A. STUTZMAN PETER F. GAUTREAU RENEE S. GRAVES WADE N. MCMULLEN KARIN HECKMAN NELSON CARL PON GEMA M. PTASINSKI REPORT ON STATE COMPLIANCE MARY ANN QUAY LINDA M. SADDLEMIRE Mn*al JERI A. WENGER Senior Manager Board of Education JANETTE CAMPS Rosemead School District DAIS CLAU ELIAS D D. OTHY EVANS M TIMOTHY D. 3(1 707 N. Rosemead Blvd. PRISCILLA OSBORNE FLORES Rosemead,-C,allfomia 91~7 170 PHEBE M. MCCUTCHEON _ SHARI PROSSER COLLEEN K. TAYLOR We have audited the basic financial statements of the Rosemead School District, as of and for the year ended June 30, 2005, and have issued our report thereon dated November 9, 2005. Our audit was made in accordance with auditing standards generally accepted in the United States of America, the standards for financial and compliance audits contained in Government Auditing Standards, issued by the Comptroller General of the United States, and the State Controller's Standards and Procedures for Audits of California K-12 Local Educational Agencies. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. The District's management is responsible for the District's compliance with laws and regulations. In connection with the audit referred to above, we selected and tested transactions and records to determine the District's compliance with the laws and regulations applicable to the following items: Description Attendance accounting: Attendance reporting Kindergarten continuation Independent study Continuation education Adult education Regional occupational center/programs Procedures in Controller's Audit Guide Procedures Performed 8 Yes 3 Yes 22 No (see below) 10 Not applicable 9 Not applicable 6 Not applicable 2210 E. ROUTE 66, GLENDORA, CA 91740 -62- Tai 626.857.7300 Fax 626.857.7302 Web WWW.VLSLLP.COM E-Mail ISFOl7aVLSLLP.COM • 0 REPORT ON STATE COMPLIANCE Description Instructional time and staff development reform program Instructional time: School Districts County Offices of Education Community day schools Class size reduction program: General requirements Option 1 Option 2 One school serving K-3 Instructional materials: General requirements Grades K-8 only Grades 9-12 only Ratios of administrative employees to teachers Early retirement incentive program GANN limit calculation School Construction Funds: School District Bonds State School Facilities Funds Alternative Pension Plans Proposition 20 Lottery Funds (Cardenas Textbook Act of 2000) State Lottery Funds (California State Lottery Act of 1984) California School Age Families Education (Cal-Safe) Program School Accountability Report Card Office of Criminal Justice Planning 12 Procedures Performed Yes Yes Not applicable Not applicable Yes Yes Yes Not applicable Yes Yes Not applicable Yes Not applicable Yes Yes Yes Not applicable Yes Yes No Yes (see below) Not applicable We did not perform testing for independent study because the independent study ADA was under the level which requires testing. The District did not participate in the Early Retirement Incentive Program in 2004- 05; therefore, the compliance procedures are not applicable. For the School Accountability Report Card, we did not perform tests on the quarterly complaint information or the interim evaluation instruments because this information was not available at the time the 2003-04 School Accountability Report Card was issued. As this information was not in the 2003-04 School Accountability Report Card, it could not be audited. Procedures in Controller's Audit Guide -63- REPORT ON STATE COMPLIANCE Based on our audit, we found that, for the items tested, the Rosemead School District complied with the laws and regulations of the state programs referred to above, except as described in the sdhedule of findings and questioned costs. Further, based on our examination, for items not tested, nothing came to our attention to indicate that the Rosemead School District had not complied with the laws and regulations of state programs and requirements. This report is intended solely for the information and use of the Board, management, the California Department of Education, and the State Controller's Office and is not intended to be and should not be used by anyone other than these specified parties. 'AY i S"&Jzt4 wo VICENTI, LLO D & STUTZMAN LLP November 9, 2005 -64- E • ROSEMEAD SCHOOL DISTRICT SCHEDULE OF FINDINGS AND QUESTIONED COSTS SUMMARY OF AUDITOR RESULTS June 30, 2005 Financial Statements Type of auditor's report issued: Internal control over financial reporting: Material weakness(es) identified? Reporting condition(s) identified not considered to be material weaknesses? Noncompliance material to financial statements noted? Federal Awards Internal control over major programs: Material weakness(es) identified? Reporting condition(s) identified not considered to be material weaknesses? Type of auditor's report issued on compliance for major programs: Unqualified Yes X No X Yes None reported Yes X No Yes X No Yes X None reported Unqualfd Any audit findings disclosed that are required to be Reported in accordance with Circular A-133, Section .510(a) Yes X No Identification of major programs CFDA Number(s) Name of Federal Program or Cluster 10.553 and 10.555 National School Lunch Program 84.367 Title II Teacher Quality Dollar threshold used to distinguish between Type A and Type B programs: $ 300,000 Auditee qualified as low-risk auditee? X Yes No -65- • 0 ROSEMEAD SCHOOL DISTRICT SCHEDULE OF FINDINGS AND QUESTIONED COSTS RELATED TO THE FINANCIAL STATEMENTS June 30, 2005 Per Assembly Bill 3627, all audit findings must be identified as one or more of the following six categories: Five Digit Code AB 3627 Finding Types 10000 Attendance 20000 Inventory of Equipment 30000 Internal Control 40000 - State Compliance 50000 Federal Compliance 60000 Miscellaneous FINDING 05-1 - STATE COMPLIANCE - TEACHER CREDENTIALS 40000 Finding: In accordance with Education Code Section 44253.3, all teachers who are assigned to teach a class in which more than 20 percent of the pupils are English learners are required to hold a certificate that authorizes the holder to provide services to limited-English-proficient pupils. We noted one teacher who did not hold such a certificate. Questioned Costs: Not applicable Recommendation: Ensure that all teachers assigned to teach a class in which more than 20 percent of the pupils are English learners hold a valid certificate. District Response: The Rosemead School District has twelve teachers, district wide, who do not possess English Learner authorization (CLAD, BCLAD, BBC, LDS authorization, or SB1969, 395, or 2913 certification) who currently are teaching classes with 20% or more English Language learners. The District has offered those teachers who qualify for certification through SB 2913 training (with 9 or more years of full-time teaching experience in California public schools) that is being offered through Los Angeles County Office of Education. The cost per teacher is $1,175 ($490 registration fee, $75 materials fee, $110 substitute teacher pay, and $500 stipend for English Learner materials upon completion of training). An eight-day training is scheduled for January 2006. Those teachers who do not qualify for SB2913 may obtain certification through a local college or university. -66- • `J ROSEMEAD SCHOOL DISTRICT SCHEDULE OF FINDINGS AND QUESTIONED COSTS RELATED TO THE FINANCIAL STATEMENTS June 30, 2005 _ FINDING 05-2 - ANTI-FRAUD PROGRAM 30000 Finding: Auditing requirements applicable to the 2005 audit included the review of the District's anti-fraud programs and controls. Inadequate programs could lead to more opportunity and or motive to commit fraud within the organization. Questioned Costs: Not applicable Recommendation: We believe the District should consider the following: 1) As the District continues to develop new policies and procedures, we recommend that the District implement a formal code of ethics and conduct for the Board and Employees. Employees and the Board should receive training on the District's values and codes of conduct/ethics as part of their initial orientation and periodically thereafter. 2) Employees should understand their responsibility to communicate matters of actual or suspected fraud and how to communicate such matters. To this end, a mechanism should be in place to provide employees with a formal way to communicate suspected/actual known fraud. Employees should complete a confirmation of this understanding annually. As part of its oversight responsibilities, the Board should encourage management to provide a mechanism for employees to report concerns and the Board should receive periodic reports describing the nature, status, and disposition of any fraud or unethical conduct. District Response: As a result of the new SAS 99, the auditors annually interview selected positions for anti-fraud control requirements. The auditor and Superintendent discussed a number of ideas for fraud prevention and presented a sample of Glendale Unified School District's Code of Ethics brochure that is distributed to employees upon their initial employment in the district. The Board gave direction to proceed in the research and development of a code of ethics or policies appropriate for the Board to review at a future meeting. -67- ROSEMEAD SCHOOL DISTRICT SCHEDULE OF FINDINGS AND QUESTIONED COSTS RELATED TO FEDERAL AWARDS June 30, 2005 There were no findings and questioned costs related to Federal Awards for fiscal year 2004-05. -68- i V- - - w - STATISTICAL SECTION ROSEMEAD SCHOOL DISTRICT SELECTED STATISTICAL INFORMATION (UNAUDITED) June 30, 2005 Secured tax levies for fiscal year 2004-05 $ 1,124,095 (1) Secured tax delinquencies for fiscal year 2004-05 $ 58,821 (1) Secured tax collections for fiscal year 2004-05 $ 1,065,274 (1) Assessed valuation for fiscal year 2004-05 $1,702,462,679 (2) 2004-05 LARGEST LOCAL SECURED TAXPAYERS ROSEMEAD SCHOOL DISTRICT (2) Property 2004-05 % of Name Description Assessed Valuation Total 1. Aespace America Inc. Shopping Center $ 39,617,799 2.63% 2. Wells Fargo Bank Commercial 32,117,535 2.13 3. Multi Investment Associates 11 Office Building 20,436,195 1.35 4. Crown Telstar LLC Industrial 15,865,661 1.05 5. FR Acquisition Inc. Industrial 7,969,418 0.53 6. Merwyn C. Gill/Gill Properties Office Building 7,922,028 0.53 7. Thrifty Payless Inc. Commercial 7,218,540 0.48 8. Ban V. and Phuong H. Nguyen Commercial 6,734,221 0.45 9. Chippewa Enterprises Inc. Office Building 6,575,096 0.44 10. Clayton Land Holding Co. Industrial 6,365,873 0.42 11. James Jones Co. Industrial 6,342,869 0.42 12. Alan Li Apartments 5,758,569 0.38 13. Hsiu 1. Shen and Chin L. Su Office Building 5,246,149 0.35 14. ABC Management Co. Office Building 5,028,487 0.33 15. BHC Alhambra Hospital Inc. Hospital 4,800,704 0.32 16. 8920 Glendon Way Associates LLC Commercial 4,767,500 0.32 17. Rosalinde and Arthur Gilbert Industrial 4,680,000 0.31 18. Vans Investment Group Inc. Hotel 4,655,128 0.31 19. Huo and Elizabeth Chen Commercial 4,366,872 0.29 20. Eddy Tan Industrial 4,100,000 0.27 $200,568,644 13.30% 2004-05 Local Secured Assessed Valuation: $1,508,518,366 (1) Information obtained from the Los Angeles County Auditor-Controller's Office. (2) Information obtained from California Municipal Statistics, Inc. -70- • w • CDBG FUNDING APPLICATION AGENCY INFORMATION Agency Name: West San Gabriel Valley YMCA Agency Address: Number Street City Zip Code Administrator Telephone No 626 / 576-0226 Fax 626 1576-1351 Project Site Address: Number Street City Zip Code Project Manager Name: Mike Mogensen Title: General Director & CEO Project Manager's Telephone No.626 / 576-0226 Fax: 626/ 576-1351 Project Manager's Email Address: Mike@wsgvymca.orq Describe Agency's overall function or purpose. Include history and experience in providing this service. (If more room is needed, please use additional paper and attach to the back of the application with a reference number). The YMCA is an organization providing programs that build strong kids, strong families, and strong communities. For over 80 years, the YMCA has provided affordable programs that teach values and model healthy lifestyles for all ages. Programs include: after school care, wellness, fitness, and nutrition, swim lessons and aquatic exercise, mountain resident camping, summer & sport programs and activities designed for seniors. Has the Agency previously received funding from the City of Rosemead? [X] YES NO If yes, please identify the years and amounts funded: Year Amount 2005-2006 $ 2004-2005 $5,753 2003-2004 $ 2002-2003 $ 20,000 6 2. PROJECT PROPOSAL AND DESCRIPTION In this section, briefly describe the project proposal, including cost estimates. Grant amount Requested: $36,160 Briefly describe your proposed Project;/Program goals. Your response must describe the scope of services for the project, proposed solutions to problems identified in Priority Needs: below but in a more casual situation. teachers and administrators. In each case these opportunities would be unlikely the students would have this unique Briefly describe and include resources dedicated to the program such as money, staff, equipment and supplies: In 2007 the project will provide three hundred sixty qualified low-income 6th grade participants, and assistance with activities and events - program provided by the Camp Ta Ta Pochon staff team. • 11 Briefly describe your proposed program Activities. Your response must describe the strategies and techniques that comprise service and outreach methodology Briefly describe the direct product of the program activities. Include the volume if work accomplished such as number of: low-income households served, youth, elderly, disabled or number of loan applications processed. Goals must include numeric goals for service that will be achieved during the program year: Minimum of 400 qualified low-income students. Can this Project /Program proceed on July 1, 2006? [ X ] YES [ ] NO 8 < mmo 00Om~ o =r o z C o <r» O n O m 7 3 x 3°° m cD a v D O T =m, I Qa O O 0~cCDrn Y' ° C OOM ° c CD r« O I a3 CD Z OD 0) =T o -0 _ W Ohl ~ (D (p (=D T CD <D (A 3 cD 0) cD O CD 0 n C $ C d U (D 0 CD CL w a~'a o c C C CD c~D c 00 :1 OL = CD = 3 CD a c Cl) w cD tS NcyD o3iB`c CD O (D a ~ w O fD CD 01 Oi m ? m ~ to CD 0 C S7 to C =r m O c 3 ? -u .0 a CD 0 U) c c c o 3q Smz' tD j O o co a8 0 m mo 03tn .a ° ? O O ai N o 9 o c ~ m v► m tQ Q°p to O CL o N o M 0 C H ~ o m c d 3-0 N 0 CA 7 v ~ 3• a~ 7 n ~ o c~ N CD N CD m a a` • 11 o' Iz z x0 o xm 3 xr o xo 3 00 xd~ 3 OA ~ c t~ c 0 c n > tog D tog 3 tog ~ . D ID'7 o » too m a D Z $ a M ff! n' 7 A p ~p to n 7 m to t~D ~D q fD O as c 3 fl C O. C d O O O O m 3 7 ~ r- 7 tp N w 0 90 0 N 7 S 0 ~ A(A :r (n0 M. p cc o 3 ~a S u m o A Q v S ~.8 3 CL a a c 7 o to cn Q to < c 0 S O O o o m m = m o 0 (n d MD d + A ~ y~ 7 a c tD 0 ~ x x m m Z o ~ y S o 0 + < 0 N_ d x O~ '9 ni t) t0 D' O O A d rTS c tp to r 3 3 10 3 c~ to fA O 7 s as C i 3 cco ?,c 01 tQ q t~ c 6t FL rXA. ? 3 19 7 0 Q0 7 C f C A d ~ A A ~ to to 1 ri °A 0 A c<m ~ to O m?3%oc a 0 - a O ~ • ► to -w y~ o ro 57 - O ' tD S c tD C Q a 3 mot ~ ~ ~w~t1 3 o N r O CL ty x 7 S2 CL ~L*< 7 O o c n 3 3 °1'0 c ° -4 t9' CL Oaf O C A. <~< m g S f tD M 3 3 a Ce a A mn rP 'ory 3 d 3 3 3 0 o ~A co 3 »3_ ato m m to A - 3 CL :3 ..a0 ~ CL a 10 Oi~n mOC CL 8 G O a < n p S x m%- a= ' r c 3 r y OL < ? to m " rn c m c g A nnn rrr ~ 10'A ~ A n y c ~ ~ ~ 3 O O 3 > > a 1 ~ > O > 3 - m c o 3 (n •t3 "a Q g c ~ C %CC c c < q 10 C a~ o ~ cr K A O C a 3 a C A ~3 a - ~ ' ` a w 7 - 3 O fP S ~ cr Ali M O n 3 • . . • 3. PROJECT PROPOSAL AND DESCRIPTION (continued) If your proposal is for an existing Project/Program that is currently funded through the City of Rosemead's General Fund, this request will: PLEASE CHECK ONLY ONE: 1. [ ] Increase Service. If so, how? 2. [ ] Continue the existing funded program at currently funded service levels. 3. [ ] Replace a previous source of funding. If so, list source and reason 4. [ X ] New program for FY 2006-2007 5. [ ] New request (not currently funded) 4. CLIENT INTAKE INFORMATION - FOR PUBLIC SERVICE ACTIVITIES The U.S. Department of Housing and Urban Development (HUD) requires that agencies obtain intake data from each client/family served. Does your agency obtain this information? [ X ] YES [ ] NO If yes, does your intake sheet obtain the following: • Name Yes[ X ] No[ ] ■ Address Yes[ X ] No[ ] • City in which client last resided Yes[ X ] No[ ] ■ Number of Family members Yes[ X ] No[ ] • Total family (household) income Yes[ X ] No[ ] ■ Race/Ethnicity Yes[X ] No[ ] • Female head of household Yes[ X ] No[ ] ■ Disability Yes[ X ] No[ ] Describe any special characteristics of your client population. 10 0 • 5. CLIENT INTAKE INFORMATION - CLIENT INTAKE AND PERFORMANCE Provide the actual numbers of your total clients in the categories listed below: (for new, non-city of Rosemead funded agencies, please provide projected data for upcoming fiscal year.) Estimates. TIME PERIOD AGENCY ROSEMEAD YOUTH WOMEN AT-RISK YOUTH AT-RISK SENIORS DISABLED HOMELESS 7/ 1 /04 to 6/30/05 7/1/05 to 3300 400 400 12/31/05 Provide the actual numbers of persons served in the following age categories: (for new, non-city of Rosemead agencies, please provide projected data for upcoming fiscal year): Estimates 11 • • 6. CLIENT INTAKE INFORMATION - CLIENTS SERVED BY INCOME LEVEL Report the actual number of unduplicated number of clients your agency served from July 1, 2005 through December 31, 2005. One person can only be counted one time, even though the client may have been served many times during the reporting period. Calculate the totals and percentages for each category: Projections Household CDBG Eligible # Served by # Of # Served # Of Rosemead Size Based on Income Agency below Rosemead by Project residents served by Limits the Income residents below the project below the Limit served by the Income Income Limit Agency below Limit the Income *NEW *NEW Limit PROJECT PROJECT 1 $36,700 2 $41,900 31 3 $47,150 46 4 $52,400 58 5 $56,600 21 6 $60,800 16 Subtotal of CDBG 172 400 400 400 Eligible Households Total Households Served 321 750 750 750 Percentage of CDBG Income 53 53 53 53 Eligible Families Served 7. CLIENT INTAKE INFORMATION - CLIENT OR PROJECT INFORMATION The source of funding for Public Service Grants comes from a Community Development Block Grant (CDBG) received through the U.S. Department of Housing and Urban Development (HUD). CDBG funds are for the specific purpose of benefiting low/moderate income households. In order to be eligible for these funds, your organization must provide a service for the residents of the City of Rosemead and be able to document that at least 51 percent of the clientele served by the project/program earn less than the following income limits: 12 • • Income Limits are based on HUD Section 8 Income Guidelines: HOUSEHOLD SIZE ANNUAL INCOME LIMIT 1 $36,700 2 $41,900 3 $47,150 4 $52,400 5 $56,600 6 $60,800 7 $65,000 8 $69,150 Please check the corresponding letter, which further describes the activity you are proposing: ■ Public Service Projects will most likely be (c), or in some cases (a), per CDBG Eligibility Requirements. a) The project will benefit a clientele that is generally presumed by HUD to be below the eligible income limits. The following groups are presumed to meet this criterion: abused children, battered spouses, elderly persons, and illiterate persons and persons with acquired Immune Deficiency Syndrome (AIDS) b)_X_ The project information on family size and income shows that it is evident that at least 51 percent of the clientele are persons whose family income does not exceed the CDBG eligible income limit (i.e. mapping service area and demonstrating that more than 51 % of persons in the service area are low-moderate income). C) The project has income limits that limit the activity exclusively to CDBG eligible income persons. 13 0 8. ADDITIONAL APPLICATION DISCLOSURE STATEMENT All organizations that submit this application must provide accurate data concerning the number and income levels of clients and/or location and nature of projects/services, as well as demonstrated site control. Estimates are unacceptable except for previously non-CDBG funded agencies. This stipulation shall apply to all organizations that are subsequently awarded funding. Any organization that falsifies information, either accidentally or intentionally, shall be required to reimburse the City for any funds paid out and shall not be permitted to apply for funding in the future. The applicant hereby proposes to provide the services or projects for the City of Rosemead as stated in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state and local regulations and other assurances, as required by the City of Rosemead, will be adhered to. As the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal. DATE: Z- )L-0(- SIGNED: TITLE: G tip vt 0'.4g C. f e 6-0 ORGANIZATION: We4+S1#4 6941 v • I I~ ye" c.T 14 T 71 c 11 N~ m n 0 O G o w a p ; iv cn (D a n Cr o 0 U g :3 -1 =r - O CO a C/) CD (D C ~ !v a ~ - 3 ( D (D W n (D (n , (D to . (D m 0 !J? :3 0 CL F ' 3 =c(n (D a) D .0 ~ N 71'a O (D =i CL 3 `n N (D O O O n o 0 9L CD ~ 0) a) o c 0- O (D c a 0 (D 0 co 0 o ~ o Q a) c a O m (D C7 r: C7 co n X 2 00 C ^O 0 m i X 0 0 Cl) n r i E -1 C7 o o ~ C a O O O D 0 CD c D CD - (D CD CD O D 5 n m cfl (D 0 o O N a cn c cn c o :3 m n m x (D D CD :z (fl co m O m m c (D 0 _0x O n 0 0 m v cn m m cn n o a G) 'D (D m n c CD 3 z G7 cn (D W (D 3 O ca c m cn r c CA (D :3 - z c _ CA m 0 C) co 0 = c v 0 0 --1 n D r- 40 o m z = m M D 0 0 v a~ O A ~p O ~ 3~6 D rn rn r o O w D 000 N -109 (7) O M X 0 N) N) K) 0 S Q N O O O O M v ao (A w c i 0) -4 v CO N O Q O O O O n_ I 169 0 64 p c ° c 0 3 a 3 n CF) CY) 3 o 3 v o0 0 0 0 ( D ` ° G7 m X 2 --I I 'D Z 00 C rn • • EXHIBIT B -BOARD OF DIRECTORS AFFIDAVIT All applicant Agencies must complete this affidavit listing the members of the Board of Directors and all other officers. If there are changes in the Board membership after the request is submitted, the City of Rosemead must be notified in writing. In submitting this funding request, I, Designee) Art Narvaez depose and say that I am President of the West San Gabriel Valley YMCA The other members and officers of the Board of Directors of this Agency are: (Please list names of current Board Members and attach an additional sheet, if necessary: Please see attached DATE: FEBRUARY 16, 2006 AT: Alhambra California (CITY & STATE) THE APPROPRIATE AGENCY DESIGNEE MUST SIGN AND AFFIX THE SEAL (Corporate Seal) certify and declare under penalty of perjury that the foregoing is true and correct. J ~l ✓L i/'" " Le 9k' rHiLFL n/~lk'yA)f r Print Name Signature and Title' corn, 990 ReOl of Organization Exempt from Intme Tax Under section 501(c), 527, or 4947(axl) of the Internal Revenue Code (except black lung benefit trust or private foundation) Department of the Treasury Internal Revenue Service ► The organization may have to use a copy of this return to satisfy state reporting requirements. A For the 2004 calendar year, or tax year beginning 2004, and B Check d applicable: Address Grange AIRS labels YOUNG MEN'S CHRISTIAN ASSOCIATION OF °f rint WEST SAN GABRIEL VALLEY Name change or Pipe. 401 EAST CORTO STREET See Initial return i~c ALHAMBRA, CA 91801 Final return Lions. Amended return Application pending a Section 501(cx3) organizations and 4947(axl) nonexempt charitable trusts must attach a completed Schedule A (Form 990 or 990-En. J Organization ty e (check only one X❑ 501(c) 3 4 (insert no.) 04947(a)(1) J 4g47(a)(1) or n I 1527 K Check here 0, [j if the organization's gross receipts are normally not more than $25,000. The organization need not file a return with the IRS; but if the organization received a Form 990 Package in the mail, it should file a return without financial data. Some states require a complete return. Add lines 6b. 8b. 9b. and 1 Ob to line 12... 'a' Revenue, Expenses, and Chanqes in Net Assets or OMB No. 1545-OG47 2004 Open to Public Inspection U Employer Identification Number 95-1644051 G Telephone number 626-576-0226 F Accounting method: 11 Cash Accrual Other (soecdy) 11- H and I are not applicaUe to section 527 organizations H (a) Is this a group return for affiliates?.... 11 Yes a No H (b) If 'Yes.' enter number of affiliates a" H (C) Are all affiliates included?.......... F]Yes No (If 'No,' attach a list. See instructions.) H (d) Is this a separate return filed by an organization covered by a group ruling? I I Yes No Group Exemption Number.. M Check ► U if the organization is not required to attach Schedule 8 (Form 990, 99012, or 990.PF). (see instructions) 1 Contributions, gifts, grants, and similar amounts received: a Direct public support 1 a 94,377. b Indirect public support 1 b c Government contributions (grants) . 1 c d Total a throughlIc) (cash $ 94, 377 , noncash $ Id 99, 377. 2 Program service revenue including government fees and contracts (from Part VII, line 93) 2 709, 796. 3 Membership dues and assessments . 3 4 Interest on savings and temporary cash investments 4 422,282. 5 Dividends and interest from securities. . . 5 439. 6a Gross rents 6a b Less: rental expenses 6b c Net rental income or (loss) (subtract line 6b from line 6a) 6c R 7 Other investment income (describe........ ► ) 7 v 8a Gross amount from sales of assets other (A) Securities (B) Other E N than inventor Y 8a u b Less: cost or other basis and sales expenses 8b c Gain or (loss) (attach schedule) 8c d Net gain or (loss) (combine line 8c, columns (A) and (B)) . 9 Special events and activities (attach schedule). If any amount is from gaming, check here..... a Gross revenue (not including $ of contributions reported on line 1 a) 9a b Less: direct expenses other than fundraising expenses 9b c Net income or (loss) from special events (subtract line 9b from line 9a) 9c 10a Gross sales of inventory, less returns and allowances 10a b Less: cost of goods sold 10 b e Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) 10c 11 Other revenue (from Part VII, line 103) 11 12 Total revenue (add lines Id, 2, 3, 4, 5, 6c, 7, 8d, 9c, 1Oc, and 11) 12 1, 226, 894. E 13 Program services (from line 44, column (B)) 13 1, 191, 902. z F 14 Management and general (from line 44, column (C))......... 14 254, 606. E N 15 Fundraising (from line 44, column (D))............................................................... 15 E s 16 Payments to affiliates (attach schedule) 16 S 17 Total expenses (add lines 16 and 44, column (A)).... . . . 17 1, 446, 508. 18 Excess or deficit for the year subtract line 17 from line 12 . 18 -219, 614. s 19 Net assets or fund balances at beginning of year (from line 73, column (A)) . . 19 1,337, 345 . E T T 20 Other changes in net assets or fund balances (attach explanation) . See. -Statement. 20 33,153 . S 21 Net assets or fund balances at end of year (combine lines 18, 19, and 20). 21 1,150, 884. BAA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. TEEAD107L 01107105 Form 990 (2004) Form,990 (2004) YOUNG MEN'S 96STIAN ASSOCIATION OF • 95-1644051 Page 2 Part II Statement of Functions x enses All organizations must complete column (A). Columns (B), (C), and (D) are required for section 501(c)(3) and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others. Do not include amounts reported on fine 6b, 8b, 9b, 10b, or 16 of Part 1. (A) Total (B) Program services (C) Management and general (D) Fundraising 22 Grants and allocations (aft sch) (cash $ non-cash $ 22 23 Specific assistance to individuals (aft sch)..... . 23 24 Benefits paid to or for members (aft sch) 24 25 Compensation of officers, directors, etc..... 25 67,500. 33,750. 33,750. 26 Other salaries and wages..... . 26 592, 041. 503, 235. 88,806. 27 Pension plan contributions.... 27 28 Other employee benefits 28 66,025. 56,121. 9,904. 29 Payroll taxes 29 56,401. 45,910. 10,491. 30 Professional fundraising fees . 30 31 Accounting fees 31 22,526. 22,526. 32 Legalfees 32 33 Supplies . 33 10,875. 9, 244. 1 631. 34 Telephone 34 14,874. 51 950. 8, 924. 35 Postage and shipping 35 3,200. 3,200. 36 Occupancy. 36 121, 714. 100, 779. 20,935. 37 Equipment rental and maintenance.. 37 41,468. 41,468, 38 Printing and publications 38 2,943. 2, 943. 39 Travel 39 10,680. 9,078. 1,602. 40 Conferences, conventions, and meetings 40 1, 489. 1,489. 41 Interest . 41 6,662. 6,662. 42 Depreciation, depletion, etc (attach schedule).... 42 100, 936. 93,870. 7,066. 43 Other expenses not covered above (itemize): a See Statement 2 43a 327,174. 288,065. 39,109. b - - 43b c 43c d 43d e 43e 44 Total functional expenses (add lines 22 - 43 . ccarrrynthesietotalstollines s13columns 1s, (Di, 44 1, 446, 508. 1,191, 902. 254, 606. 0. Joint Costs. Check. 11- if you are following SOP 98.2. Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services?.... Yes Xa No If 'Yes,' enter the aggregate amount of these joint costs $ ; (Ii) the amount allocated to Program services $ ; (ii) the amount allocated to Management and general $ ; and (iv) the amount allocated to Fundraising $ Part III Statement of Program Service Accomplishments What is the organization's primary exempt purpose? ► _SPIRIT, _S_OC_I_AL_ PHYSICAL _D_E_VEL_OP_ME_NT_ All organizations must describe their exempt purpose achievements in a clear and concise manner. State the number of lients served, publications issued, etc. Discuss achievements that are not measurable- (Section 501 (c) 3) & (4) organ• izations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of rants & allocations to others.) Program Service Expenses red I(x 501 (c) (Re organizations tions (3) and (44) ) org orgam a ut 4947( )(1) vUSfs, but ooi oaa 10(,tnei5 a THE YMCA OF WEST SAN GABRIEL VALLEY PROVIDES VARIOUS PROGRAM ACTIVITIES FOR THE SPIRITUAL, SOCIAL, MENTAL AND PHYSICAL DEVELOPMENT AND IMPROVEMENT FOR YOUTHS AND ADULTS IN THE COMMUNITY. (Grants and allocations $ ) ,191,902. b (Grants and allocations $ ) c (Grants and allocations $ ) d (Grants and allocations $ } e Other program services (Grants and allocations $ ) If Total of Program Service Expenses (should equal line 44, column (B), Program services)... ► 1,191, 902. BAA TEEAOron 01107/05 Form 990 (2004) • Form 44 Part IV Balance Sheets (See Instructions) Note: Where required, attached schedules and amounts within the description (A) (B) column should be for end-of-year amounts only. Beginning of year End of year 45 Cash - non-Interest-bearing 14,302. 45 3,739. 46 Savings and temporary cash investments 46 47a Accounts receivable 47a 10,044. b Less: allowance for doubtful accounts 47b 9,157. 47c 10,044. 48a Pledges receivable 48a 935. b Less: allowance for doubtful accounts 48b 12, 318. 48c 935. 49 Grants receivable 49 A 50 Receivables from officers, directors, trustees, and key s employees (attach schedule) 50 s E 51 a Other notes & loans receivable (attach sch) 51 a T S b Less: allowance for doubtful accounts 51 b 51 c 52 Inventories for sale or use 52 53 Prepaid expenses and deferred charges -9, 628. 53 54 Investments - securities (attach schedule)... ~11 Cost El FMV 10, 600. 54 36,891. 55a Investments - land, buildings, & equipment: basis 55a b Less: accumulated depreciation (attach schedule)... 55b 55c 56 Investments - other (attach schedule) 56 57a Land, buildings, and equipment: basis............ 57a 3,372,574. b Less: accumulated depreciation (attach schedule)............ Sta.tement.3 57b 1, 680, 131. 1, 793, 379. 57c 1, 692, 443. 58 Other assets (describe P- } . 15,431. 58 59 Total assets (add lines 45 through 58) (must equal line 74) 1, 845, 559. 59 1,744,052. 60 Accounts payable and accrued expenses . . 248, 724. 60 204, 166. L 61 Grants payable 61 1 A e 62 Deferred revenue 62 1 L 63 Loans from officers, director, trustees, and key employees (attach schedule) 63 I 64a Tax-exempt bond liabilities (attach schedule) 64a T I b Mortgages and other notes payable (attach schedule) 240, 566. 64b 252,087, E s 65 Other liabilities (describe See Statement 4 } . 18,924. 65 136,915. 66 Total liabilities (add lines 60 through 65) . 508, 214. 66 593, 168. Organizations that follow SFAS 117, check here X and complete lines 67 N f through 69 and lines 73 and 74. A 67 Unrestricted _ 1, 286, 992. 67 1,145,284. 68 Temporarily restricted 50,353. 68 5,600. 69 Permanently restricted... 69 R Organizations that do not follow SFAS 117, check here and complete lines F 70 through 74. N 70 Capital stock, trust principal, or current funds 70 0 e 71 Paid-in or capital surplus, or land, building, and equipment fund 71 A 72 Retained earnings, endowment, accumulated income, or other funds 72 A 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72; column (A) must equal line 19; column (B) must equal line 21)............ 1, 337, 345. 73 1,150, 884. 74 Total liabilities and net assets/fund balances (add lines 66 and 73)........... 1, 845, 559. 74 1,744,052. Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization. How the public perceives an organization in such cases may be determined by the information presented on its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments. BAA TEEF0103L 01107105 Foirn 990 (2004) YOUNG MEN'S CHRISTIAN ASSOCIATION OF 95-1644051 Page 4 Part IV-A Reconciliation of Revenue per Audited Part IV-B Reconciliation of Expenses per Audited Financial Statements with Revenue Financial Statements with Expenses per Return (See instructions.) per Return a Total revenue, gains, and other support a Total expenses and losses per audited per audited financial statements....... ► a 1, 232, 265. financial statements ► a 1,446, 508. b Amounts included on line a but b Amounts included on line a but not not on line 12, Form 990: on line 17, Form 990: (1) Net unrealized (1) Donated serv- gains on ices and use investments.... $ 5,371. of facilities $ (2) Donated serv• (2) Prior year adjust- ices and use of facilities $ ments reported on line 20, Form 990.... $ (3) Recoveries of prior (3) Losses reported on year grants $ line 20, Form 990.... $ (4) Other (specify): (4) Other (specify): $ $ Add amounts on lines (1) through (4) ► b 5,371. Add amounts on lines (1) through (4) ► b c Line a minus line b ► c 1, 226, 894. c Line a minus line b ► c 1,446, 508. d Amounts included on line 12, d Amounts included on line 17, Form 990 but not on line a: Form 990 but not on line a: (1) Investment expenses (1) Investment expenses - not included on line not included on line 3 6b, Form 990...... $ 6b, Form 990..... . $ (2) Other (specify): (2) Other (specify): Add amounts on lines (1) and (2).. ► d Add amounts on lines (1) and (2)... ► d Total revenue per line 12, Form a Total expenses per line 17, Form 990 (line c plus line d). ► e 1, 226, 894. 990 (line c plus line d).... ► e 1, 446, 508. Part V List of Officers. Directors. Trustees. and Kev EmDlovees (List each one even if not cmmnen~aterl cap inctrurt nn, ) (A) Name and address (B) Title and average hours per week devoted to position (C) Compensation (f not paid, enter -0-) (D) Contributions to employee benefit plans and deferred (E) Expense account and other allowances compensation ARTHUR-NAVAREZ - - - - - - - - - - President 0. 0. 0. None DAVID-WONG - Secretary 0. 0. 0. None JOE PAVON Vice President 0. 0. 0. 905 WESTMINSTER AVE None ALHAMBRA, CA 91803 75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations? . ► Yes l No If 'Yes,' attach schedule - see instructions. BAA Form 990 (2004) TEE-A01041- 0;/07M • • 76 Did the organization engage in any activity not previously reported to the IRS? If 'Yes,' attach a detailed description of each activity 77 Were any changes made in the organizing or governing documents but not reported to the IRS? 77 X If 'Yes,' attach a conformed copy of the changes. 78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return?. 78a X b If 'Yes,' has it filed a tax return on Form 990-T for this year? 78b N 'A 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If 'Yes,' attach a statement 79 X 80a Is the organization related (other than by association with a statewide or nationwide organization) through common membership, governing bodies, trustees, officers, etc, to any other exempt or nonexempt organization? 80a X b If 'Yes,' enter the name of the organization N/A _ and check whether it is exempt or nonexempt. 81 a Enter direct and indirect political expenditures. See line 81 instructions. . .................81 a 0. b Did the organization file Form 1120-POL for this year? 81 b X 82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? 82, b If 'Yes,' you may indicate the value of these items here. Do not include this amount as revenue in Part I or as an expense in Part 11. (See instructions in Part III.) 182bl N/) 83a Did the organization comply with the public inspection requirements for returns and exemption applications? b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? . 84a Did the organization solicit any contributions or gifts that were not tax deductible? . b If 'Yes,' did the oranization include with every solicitation an express statement that such contributions or gifts were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84b N A 85 501(c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members?- . 85a N A b Did the organization make only in-house lobbying expenditures of $2,000 or less? 85b N A If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year, c Dues, assessments, and similar amounts from members 85c NIT d Section 162(e) lobbying and political expenditures . . 85d NIP e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e NIP. If Taxable amount of lobbying and political expenditures (line 85d less 85e) 85f N/P. g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f? . h If section 6033(e)(IXA) dues notices were sent, does the organization agree to add the amount on line 85f to its r easonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? . 86 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 12 . . I 86al N/A b Gross receipts, included on line 12, for public use of club facilities 87 501(c)(12) organizations. Enter: a Gross income from members or shareholders......... . bGross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301.7701.2 and 301.7701.3? If 'Yes,' complete Part IX 88 89a 501(c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under: section 4911 ► 0 . ; section 4912 ► 0 . : section 4955 ► 0. b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year or did it =aware of an excess benefit transaction from a prior year? If 'Yes,' attach a statement explaining each transaction 89 c Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 0. d Enter: Amount of tax on line 89c, above, reimbursed by the organization . 0. 90 a List the states with which a copy of this return is filed ► None b Number of employees employed in the pay period that includes March 12, 2004 (See instructions.) 90b 0 91 The books are in care of ► MIKE MOGENSON Telephone number ► 626-576-0226 Locatedat► 4 01 E. CORTO STREET, ALHAMBRA, CA ZIP+4► 91801 92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1x741- Check here N/A. ~ and enter the amount of tax-exempt interest received or accrued during the tax year ►192 I N/A BAA Form 990 (2004) TEEA0105L 01)07105 L1 Form 990 (2004) YOUNG MEN'S CHRISTIAN ASSOCIATION OF 95-1644051 Page 6 Part VII Analysis of Income-Producing Activities :See instructions.) Note: other) 93 f 94 95 96 97 a 98 99 100 101 102 103 b c d e 104 Unrelate d business income Excluded by s ection 512, 513, or 514 (E) Enter gross amounts unless vise indicated. (A) Business code (B) Amount (C) Exclusion code (D) Amount Related or exempt function income Program service revenue: tOTHER INCOME 2,605. )PROGRAM FEES 707,191. Medicare/Medicaid payments Fees & contracts from government agencies Membership dues and assessments. Interest on savings & temporary cash invmnts.. 422,282. Dividends & interest from securities.. 439. Net rental income or (loss) from real estate: debt-financed property . . not debt-financed property.......... . Net rental income or (loss) from pers prop Other investment income........... . Gain or (loss) from sales of assets other than inventory Net income or (loss) from special events.... . Gross profit or (loss) from sales of inventory . Other revenue: a ubtotal (add columns (B), (D), and (E)) > d e g b 1,132,517. 105 Total (add line 104, columns (B), (D), and (E)) 1,132, 517. ote: Line 105 plus line l d, Part 1, should eoual the amount on line 12. Part 1. Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes). (See instructions.) (A) Name, address, and EIN of corporation, partnership, or disregarded entity (B) Percentage of ownership interest (C) Nature of activities (D) Total income (E) End-of-year assets N/A % °s % rar & n rrrrvrrrlauUrr nW arum r IarrSrCrn MbbU9.lar.CU vnUI rrrsunal oenefn wrRrdLth twee instructions.) a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? Yes X No b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . Yes X No Note: If 'Yes' to (b), file Form 8870 and Form 4720 (see instructions). Under penalties of pequrX_ I declare that I have examined this return. including accompanying schedules and statements. and, to the best of my knowledge and belief, if is Please 101- Sign Here 1111111- or print name Date Paid Pre- Preparer's signature X 110i Date Check if self. employed . X Peneralr Instruction or PN (See eneralstructron W)) G N/A arer's Fum'sname(or James F. Hundshamer, C.P.A. se yours if self- employed). ► 525 South Myrtle Avenue, Suite 210 EIN ► N/A Only ZIPdre545. and Monrovia, CA 91016 Phone no. (626) 359-7103 BAA TEEA0106L 10/03/03 Form 990 (2004) SCHEDULE A (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Sernce • Organization Exempt Under• OMB No 1545-0( Section 501(cx3) (Except Private Foundation) and Section 501(e), 501(f), 501(k), 2~~4 501(n), or Section 4947(axl) Nonexempt Charitable Trust Supplementary Information - (See separate instructions.) MUST be completed by the above organizations and attached to their Form 990 or 990-EZ. Name of the organization YOUNG MEN'S CHRISTIAN (See instructions. List each one. If there are none, enter OF (a) Name and address of each employee paid more than $50,000 (b) Title and average hours per week devoted to position (c) Compensation (d) Contributions to employee benefit plans and deferred compensation (e) Expense account and other allowances None Part II Compensation of the Five Highest Paid Independent Contractors for Professional Services (See Instructions. List each one (whether individuals or firms). If there are none, enter 'None.') (a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation None Total number of others receiving over $50,000 for professional services.......... 0 BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ. Schedule A (Form 990 or990•EZ) 2004 TEEAD401L 07122c4 Schedule A (Form 990 or 990-EZ) 2004 YOUNG MEN'S CHRISTIAN ASSOCIATION OF 95-1644051 Page 2 Part III Statements About Activities (see instructions.) Yes No 1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If 'Yes,' enter the total expenses paid or incurred in connection with the lobbying activities . 0' $ N/A (Must equal amounts on line 38, Part VI-A, or line i of Part VI-B.) . 1 X Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A. Other organizations checking 'Yes' must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities. 2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? (If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions.) a Sale, exchange, or leasing of property? 2a X b Lending of money or other extension of credit? . . . . 2b X c Furnishing of goods, services, or facilities? 2c X d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)? 2d X e Transfer of any part of its income or assets? 2e X 3a Do you make grants for scholarships, fellowships, student loans, etc? (If 'Yes,' attach an explanation of how you determine that recipients qualify to receive payments.) 3a X b Do you have a section 403(b) annuity plan for your employees? . 4a Did you maintain any separate account for participating donors where donors have the right to provide advice on the use or distribution of funds? . . . 4a X b Do you provide credit counseling, debt rncjnaaement, credit repair, or debt negcl ahon sarwces? 4 bl X Part IV Reason for Non-Private Foundation Status (See instructions.) The organization is not a private foundation because it is: (Please check only ONE applicable box.) 5 A church, convention of churches, or association of churches. Section 170(b)(1)(A)(i). 6 A school. Section 170(b)(1)(A)(ii). (Also complete Part V.) 7 A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(iii). 8 A Federal, state, or local government or governmental unit. Section 170(b)(1)(A)(v). 9 A medical research organization operated in conjunction with a hospital. Section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state w 10 F] An organization operated for the benefit of a college or university owned or operated by a governmental unit. Section 170(b)(1)(A)(iv). (Also complete the Support Schedule in Part IV-A.) 11a X❑ An organization that normally receives a substantial part of its support from a governmental unit or from the general public. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.) 11b ❑ A community trust. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.) 12 ❑ An organization that normally receives: (1) more than 33.113% of its support from contributions, membership fees, and gross receipts from activities related to its charitable, etc, functions - subject to certain exceptions, and (2) no more than 33-113% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Also complete the Support Schedule in Part IV-A.) 13 ❑ An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in: (1 lines 5 through 12 above; or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2). (See section 509(a)(3).) (a) Name(s) of supported organization(s) (b) Line number from above Provide the following information about the supported organizations. (See instructions.) 14 n An organization organized and operated to test for public safety. Section 509(a)(4). (See instructions.) BAA TEEA0402L 07127104 Schedule A (Form 990 or Form 990-EZ) 2004 Schedule A (Form 990 or 990-EZ) 2004 YOUNG MEN'S CHRISTIAN ASSOCIATION OF 95-1644051 Page 3 Part IV-A Support Schedule (Complete only if you checked a box on line 10, 11, or 12.) Use cash method of accounting. Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting. Calendar year (or fiscal year (a) (b) (c) (d) (e) beginning in) . . 2003 2002 2001 2000 Total 15 Gifts, grants, and contributions received. (Do not include unusual grants. See line 28.)... 168, 542. 238, 445. 165, 927. 187, 971. 760, 885. 16 Membership fees received...... 455, 644. 466, 935. 454, 451. 455, 050. 1, 832, 080. 17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's charitable, etc, purpose 578, 711. 752, 008. 889, 940. 879, 744. 3,100,403. 18 Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organ. izationafter June 30,1975........... 278. 588. 2,518. 5,020. 8,404. 19 Net income from unrelated business activities not included in line 18...... . 20 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf 21 The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to the public without charge 22 Other income. Attach a schedule. Do not include gain or (loss) from sale of capital assets . 23 Total of lines 15 through 22..... 1, 203, 175. 1,457, 976. 1, 512, 836. 1, 527, 785. 5,701,772. 24 Line 23 minus line 17.......... 624, 464. 705, 968. 622, 896. 648, 041. 2, 601, 369. 25 Enter 1 % of line 23 12, 032. 14,580. 15, 128. 15,278. 26 Organizations described on lines 10 or 11: a Enter 2% of amount in column (e), line 24 ► 26a 52,027. b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly supported organization) whose total gifts for 2000 through 2003 exceeded the amount shown in line 26a. Do not file this list with your return. Enter the total of all these excess amounts 26b c Total support for section 509(a)(1) test: Enter line 24, column (e) . 26c 2, 601, 369. d Add: Amounts from column (e) for lines: 18 8,404. 19 22 26b 26d 8,404. e Public support pine 26c minus line 26d total). 01 26e 2,592, 965. f Public support percentage (fine 26e (numerator) divided b line 26c (denominator)) 0, 26f 99.68 % 27 Organizations described on line 12: N/A a For amounts included in lines 15, 16, and 17 that were received from a 'disqualified person,' prepare a list for your records to show the name of, and total amounts received in each year from, each 'disqualified person.' Do not file this list with your return. Enter the sum of such amounts for each year: (2003) (2002) (2001) (2000) Vor any amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000. (Include in the list organizations described in lines 5 through 11, as well as individuals.) Do not file this list with your return. Amer computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year: (2003) (2002) (2001) (2000) c Add: Amounts from column (e) for lines: 15 16 17 d Add: Line 27a total.... . 20 21 and line 27b total.......... . e Public support (line 27c total minus line 27d total) . f Total support for section 509(a)(2) test: Enter amount from line 23, column (e) "I 27f g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) . In Investment income uercentaae (line 18, column (e) (numerator) divided by line 27f (denominator))........ . 28 Unusual Grants: SAA described in line 10, 11, or 12 vear. the name of the contribi. TEEA0403L 07123/04 s during 2000 through 2003, prepare a grant, and a brief description of the Schedule A (Form 990 or 990-EZ) 2004 • • 4 1Part y I Private School westionnalre (See instructions ) (To be completed ONLY by schools that checked the box on line 6 in Part IV) N/A 29 Does the organization have a racially nondiscriminatory policy toward students by statement in is charter, bylaws, other governing instrument, or in a resolution of its governing body? 29 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, L and scholarshipsZ 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves? 31 If 'Yes,' please describe; if 'No,' please explain. (If you need more space, attach a separate statement.) 32 Does the organization maintain the following: a Records indicating the racial composition of the student body, faculty, and administrative staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships? d Copies of all material used by the organization or on its behalf to solicit contributions? If you answered 'No' to any of the above, please explain. (If you need more space, attach a separate statement.) 33 Does the organization discriminate by race in any way with respect to: a Students' rights or privileges? b Admissions policies? c Employment of faculty or administrative staff?. . d Scholarships or other financial assistance? e Educational policies? f Use of facilities? g Athletic programs?.. . . . . . . . . . . . . . . . . . . . . . . . . . . . h Other extracurricular activities? . 33f If you answered 'Yes' to any of the above, please explain. (If you need more space, attach a separate statement.) 34a Does the organization receive any financial aid or assistance from a governmental agency? 134a b Has the organization's right to such aid ever been revoked or suspended? . . If you answered 'Yes' to either 34a or b, please explain using an attached statement. 35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev Proc 75.50, 1975.2 C.B. 587, covering racial nondiscrimination? If 'No.' attach an explanation... BAA TEEAO404L 07/23104 or No or 990-EZ) 2004 YOUNG MEN'S CHRISTIAN ASSOCIATION OF 95-1644051 Part WA Lobbying Expenditures by Electing Public Charities (See instructions.) (To be completed ONLY by an eligible organization that filed Form 5768) N/A Check ~ a if the organization belongs to an affiliated group. Check w b if you checked 'a' and 'limited control' provisions apply. Limits on Lobbying Expenditures (a) Affiliated group (b) To be completed (The term 'expenditures' means amounts paid or incurred.) totals for ALL electing organizations 36 Total lobbying expenditures to influence public opinion (grassroots lobbying). 36 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37 38 Total lobbying expenditures (add lines 36 and 37) 38 39 Other exempt purpose expenditures 39 40 Total exempt purpose expenditures (add lines 38 and 39) 40 41 Lobbying nontaxable amount. Enter the amount from the following table - If the amount on line 40 is - The lobbying nontaxable amount is - Not over $500,000 . 20% of the amount on line 40 Over $500,000 but not over $1,000,000 . $100,000 plus 15% of the excess over $500,000 Over $1,000,000 but not over $1,500,000.......... $175,000 plus 10% of the excess over $1,000,000 41 Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000 Over $17,000,000 $1,000,000....................... 42 Grassroots nontaxable amount (enter 25% of line 41) 42 43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36 43 44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38 44 Caution: If there is an amount on either line 43 or line 44, you must file Form 4720. 4 -Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 45 through 50.) Lobbying Expenditures During 4 -Year Averaging Period Calendar year (a) (b) (c) (d) (e) (or fiscal year 2004 2003 2002 2001 Total beginning in) 45 Lobbying nontaxable amount.... 46 Lobbying ceiling amount (150% of line 45(e)). . . 47 Total lobbying expenditures 48 Grassroots non- taxable amount...... . 49 Grassroots ceiling amount (150% of line 48(e)) 50 Grassroots lobbying expenditures . (Part W U Lobbying Activity by Nonelectinq Public Charities (For reporting only by organizations that aid not complete Part VI-A) (See instructions.) N/A During the year, did the organization attempt to influence national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of; Yes No Amount a Volunteers b Paid staff or management (Include compensation in expenses reported on lines c through h.)......... c Media advertisements.... . d Mailings to members, legislators, or the public . e Publications, or published or broadcast statements . I Grants to other organizations for lobbying purposes g Direct contact with legislators, their staffs, government officials, or a legislative body . In Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means . i Total lobbying expenditures (add lines c through h.) . If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities. BAA Schedule A (Form 990 or 990-EZ) 2004 TEEA0405L 07/23,04 A (Form 990 or 990-EZ) 2004 YOUNG MEN'S CHRISTIAN ASSOCIATION 0 95-1 Information Reaardina Transfers To and Transactions and Relationships With Noncl 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a nonchantable exempt organization of: Yes No (i)Cash (i)Other assets b Other transactions: (i)Sales or exchanges of assets with a noncharitable exempt organization . (i)Purchases of assets from a noncharitable exempt organization . . (iii)Rental of facilities, equipment, or other assets . (v) Reimbursement arrangements (v)Loans or loan guarantees (vi)Performance of services or membership or fundraising solicitations c Sharing of facilities, equipment, mailing lists, other assets, or paid employees . d If the answer to any of the above is 'Yes,' complete the following schedule. Column (b) should alwa s show the fair r the goods, other assets, or services given by the reporting organization. If the organization receivedyless than fair m~ anv transaction or sharino arranoement. show in column d) the value of the ooods, other assets, or services receive Line no . I Amount involved I Name of noncharitable exempt organization I Description of transfers, transactions, and sharing arrangements 52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? 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W a a a S Lt a L~ F- ~ Li a U li Q x ti U ° Fa- ono m m m m m °aQ m$ o 0 0$ o `8 0 0 0°^ V N N tD N Cl O 0 O O tD Q c E v a a) c L m F- 2004 Federal Statements Page 1 YOU NG MEN'S CHRISTIAN ASSOCIATION OF Client 120 WEST SAN GABRIEL VALLEY 95-1644051 10/17/05 1 1 :03AM Statement 1 Form 990, Part I, Line 20 Other Changes in Net Assets or Fund Balances PRIOR YEAR INCOME DIFFERENCE $ 27,781. UNREALIZED NET GAINS...... 5,372. Total $ 33,153. Statement 2 Form 990, Part Il, Line 43 Other Expenses (A) (B) (C) (D) Program Management Total Services & General Fundraisina ADVERTISING 651. 651. BANK CHARGES 10,693. 10,693. GARDENING SVC 3,835. 3,835. INSURANCE 78,342. 71,291. 7,051. NATIONAL SUPPORT DUES 10,551. 10,551. ORGANIZATIONAL DUES 857. 857. OTHER 700. 700. OUTSIDE SVC 13,510. 13,510. PERMITS AND TAXES 5,372. 5,372. RETURNED CHECKS -55. -55. SPECIAL ACTIVITIES 113,569. 113,569. UTILITIES 89,149. Total $ 327,174. 87,366. $ 288,065. 1,783. $ 39,109. $ 01 Statement 3 Form 990, Part IV, Line 57 Land, Buildings, and Equipment Accum. Book Category Basis Deprec. Value Automobiles / Transportation Equipment $ 43,027. $ 42,577. $ 450. Furniture and Fixtures 40,080. 39,975. 105. Machinery and Equipment 245,688. 219,731. 25,957. Buildings 2,730,386. 1,138,897. 1,591,489. Improvements 286,973. 238,951. 48,022. Land 26,420. Total $ 3,372,574. $ 26,420. 1,680,131. 1,692,443. Statement 4 Form 990, Part IV, Line 65 Other Liabilities ACCRUED VACATION. . $ 18,730. ACCRUED WAGES . 7,859. RETIREMENT ACCRUAL... . 91,978. Rounding 1. TRUST ACCOUNTS . . . . 347. 18 Total $ , 136 915. , 0 A • CDBG FUNDING APPLICATION AGENCY INFORMATION Agency Name: YWCA of San Gabriel Valley (WINGS Domestic Violence Program) Agency Address: P.O. Box 1464, West Covina, CA 91793 Number Street City Zip Code Administrator Telephone No._626-915-5191_Fax:_626-858-5140 Project Site Address: Number Project Manager Name: Marilyn Zimmerman Title: Director, Domestic Violence Prog. Project Manager's Telephone No. 626-915-5191 Fax: 626-858-5140 Project Manager's Email Address: _mzim@ywcawings.org Has the Agency previously received funding from the City of Rosemead? [X] YES NO If yes, please identify the years and amounts funded: Year Amount 2005-2006 $ 8500. 2004-2005 $ 8500. 2003-2004 $ 8500. 2002-2003 $ 6 Describe Agency's overall function or purpose. Include history and experience in providing this service. (If more room is needed, please use additional paper and attach to the back of the application with a reference number). • 4 . 0 2. PROJECT PROPOSAL AND DESCRIPTION In this section, briefly describe the project proposal, including cost estimates. Grant amount Requested: $_8,500. Briefly describe your proposed program Activities. Your response must describe the strategies and techniques that comprise service and outreach methodology: necessary to free themselves from situations of domestic violence. Briefly describe the direct product of the program activities. Include the volume if work accomplished such as number of: low-income households served, youth, elderly, disabled or number of loan applications processed. Goals must include numeric goals for service that will be achieved during the program year: Can this Project /Program proceed on July 1, 2006? [X] YES [ ] NO 7 Briefly describe your proposed Project/Program goals. Your response must describe the scope of services for the project, proposed solutions to problems identified in Priority Needs: Briefly describe and include resources dedicated to the program such as money, staff, equipment and supplies: • • o's c `2 c c `2S C r ~E la p ~E !a rp ~E R ap Q C :E oo? 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C ~w :5 E m C C ~ C l0 a a) E E ova m C ~atw C t0 0o m 9)•°- m C ~w l6 0 m c-a m 1 c c m > T3 c ac,lR~ c;6 ° a c- o c~~ °•a c m c Z> 5 4~v> c c~> d~ E t la E v O 0 sa > m > ° a to p a 7 2 0 C ° 0'& m a C 0 = ° aro °i 7 0 m Q 0 ~ -N 10 CMV a N o aft d o ma c m a E m E E c a~ o- 9° ME tom C an ~ ~ JR m 0. $ o~ ~ ;E o !4 I C09.. 0 0 € 0 3 ~0 m3 m cc . 0 mo > 2 7 2o Cc 0 01a$ m c CL O _V t O 0 'A 'o € u mm Via' m m ~ 0 S U 0 Q o y a+ ° r m w M V Z Ao ~ a M EVE Z> o- C 0 0 C e m m J° o s G a N Nrfn - 4 G 0- 21 3 E "o- Q 2 c> a~ o 0 o uZ Zc ~ o E2 E c LU aac aa0> aE m ~=OVE q fA M O N of > z as 0 ~ > t O a'~ v aa ~ c~n 0 E 2~ = Z E m= IL O v av> O V r av°O>> w ,^V` A W W E / Y W A' WW C w Oa T U N ~ C a c o o(D m aE U y O C Oo 0 C) t r D> m tU/) N fn 2 a a) C O O M " CD O o C 41 3 o & O :E a;EU N co C O 0 O p) o 2a' E O c ) 3 E 0~3 0c oU) 00m m a aO~E av~i fpEd~ N S N O O Nj ow am m 0 6= o 0 -0 or M m m 'Q N >w 0 :3 E E8 0(D ~0 `p m 0) O O T ~_"cam 00) m 3 N _ 0 O .rs•C O a> O 34) ~E C os NE m CD m v,Omc,u,r~ Mm0 CD 4) 0 ~ c E c m wmm ~co.E~ EL- 00 C ~ a cr p O t!~ .c cl U U) w CD :3 CD U I O C cl: 0 O Q O D N Z so- (OD E 1-- E O ` U a>i O Za:c0m~ O0 0 Q u0 U! CL n co • • 3. PROJECT PROPOSAL AND DESCRIPTION (continued) If your proposal is for an existing Project/Program that is currently funded through the City of Rosemead's General Fund, this request will: PLEASE CHECK ONLY ONE: 1. [ ] Increase Service. If so, how? 2. [ X ] Continue the existing funded program at currently funded service levels. 3. [ ] Replace a previous source of funding. If so, list source and reason 4. [ ] New program for FY 2006-2007 5. [ ] New request (not currently funded) 4. CLIENT INTAKE INFORMATION - FOR PUBLIC SERVICE ACTIVITIES The U.S. Department of Housing and Urban Development (HUD) requires that agencies obtain intake data from each client/family served. Does your agency obtain this information? [ X ] YES [ ] NO If yes, does your intake sheet obtain the following: ■ Name Yes[X ] No[ ] ■ Address Yes[ X ] No[ ] ■ City in which client last resided Yes[X ] No[ ] ■ Number of Family members Yes[ X ] No[ ] ■ Total family (household) income Yes[X ] No[ ] ■ Race/Ethnicity Yes[X ] No[ ] • Female head of household Yes[X ] No[ ] ■ Disability Yes[X ] No[ ] 9 0 • Describe any special characteristics of your client population. 5. CLIENT INTAKE INFORMATION - CLIENT INTAKE AND PERFORMANCE Provide the actual numbers of your total clients in the categories listed below: (for new, non-city of Rosemead funded agencies, please provide projected data for upcoming fiscal year.) TIME PERIOD AGENCY ROSEMEAD YOUTH WOMEN AT-RISK YOUTH AT-RISK SENIORS DISABLED HOMELESS 7/1/04 2104 24 441 1501 305 107 47 31 to 6/30/05 7/1105 832 6 153 262 99 40 8 19 to 12/31/05 Provide the actual numbers of persons served in the following age categories: (for new, non-city of Rosemead agencies, please provide projected data for upcoming fiscal year): PERFORMANCE CHILDREN YOUTH ADULT ELDERLY PERIOD 0-12 13-17 18-54 55 & OVER Rosemead Agency Rosemead Agency Rosemead Agency Rosemead Agency 7/1/04 7 408 2 86 9 1485 2 105 to 6/30/05 7/1/05 0 191 1 24 3 571 2 40 to 12/31/05 _ 10 • • 6. CLIENT INTAKE INFORMATION - CLIENTS SERVED BY INCOME LEVEL Report the actual number of unduplicated number of clients your agency served from July 1, 2005 through December 31, 2005. One person can only be counted one time, even though the client may have been served many times during the reporting period. Calculate the totals and percentages for each category: Household CDBG Eligible # Served by # Of # Served # Of Rosemead Size Based on Income Agency below Rosemead by Project residents served by Limits the Income residents below the project below the Limit served by the Income Income Limit Agency below Limit the Income Limit 1 $36,700 314 0 314 0 2 $41,900 31 0 31 0 3 $47,150 220 0 220 0 4 $52,400 147 1 147 1 5 $56,600 75 1 75 1 6 $60,800 39 4 39 4 Subtotal of CDBG 826 6 826 6 Eli ible Households Total Households Served 832 6 832 6 Percentage of CDBG Income 99% 100% 99% 100% Eligible Families Served 7. CLIENT INTAKE INFORMATION - CLIENT OR PROJECT INFORMATION The source of funding for Public Service Grants comes from a Community Development Block Grant (CDBG) received through the U.S. Department of Housing and Urban Development (HUD). CDBG funds are for the specific purpose of benefiting low/moderate income households. In order to be eligible for these funds, your organization must provide a service for the residents of the City of Rosemead and be able to document that at least 51 percent of the clientele served by the project/program earn less than the following income limits: 11 Income Limits are based on HUD Section 8 Income Guidelines: HOUSEHOLD SIZE ANNUAL INCOME LIMIT 1 $36,700 2 $41,900 3 $47,150 4 $52,400 5 $56,600 6 $60,800 7 $65,000 8 $69,150 Please check the corresponding letter, which further describes the activity you are proposing: ■ Public Service Projects will most likely be (c), or in some cases (a), per CDBG Eligibility Requirements. a) X_ The project will benefit a clientele that is generally presumed by HUD to be below the eligible income limits. The following groups are presumed to meet this criterion: abused children, battered spouses, elderly persons, and illiterate persons and persons with acquired Immune Deficiency Syndrome (AIDS) b) The project information on family size and income shows that it is evident that at least 51 percent of the clientele are persons whose family income does not exceed the CDBG eligible income limit (i.e. mapping service area and demonstrating that more than 51 % of persons in the service area are low-moderate income). C) The project has income limits that limit the activity exclusively to CDBG eligible income persons. 12 • 8. ADDITIONAL APPLICATION DISCLOSURE STATEMENT All organizations that submit this application must provide accurate data concerning the number and income levels of clients and/or location and nature of projects/services, as well as demonstrated site control. Estimates are unacceptable except for previously non-CDBG funded agencies. This stipulation shall apply to all organizations that are subsequently awarded funding. Any organization that falsifies information, either accidentally or intentionally, shall be required to reimburse the City for any funds paid out and shall not be permitted to apply for funding in the future. The applicant hereby proposes to provide the services or projects for the City of Rosemead as stated in this proposal. If this proposal is approved and funded, it is agreed that relevant federal, state and local regulations and other assurances, as required by the City of Rosemead, will be adhered to. As the duly authorized representative of the applicant organization, I certify that the applicant is fully capable of fulfilling its obligation under this proposal. DATE: 2/1106 SIGNED: TITLE: Chief Executive Officer ORGANIZATION: YWCA of San Gabriel Valley 13 9 ATTACHMENT A BUDGET PROPOSAL 10 Salaries and Benefits Operating Bud et Current Year Pro Bud et 1. 5alaries:ust w Positions and Identify full/art time or contract b title #FT # #C Total $ Other City CDBG Total $ Other city CDBG A. Director, Domestic Violence Pr . 1 $ 50,000 $ 50,000 $ 51,650 $ 51,650 B. Comm Outreach 8 Development M 1 $ 32,000 $ 32,000 $ 33,056 $ 33,056 C_ Fiscal Coordinator 1 $ 36,000 $ 36,000 $ 37,188 $ 37,188 D. Administrative Coordinator 1 $ 19,591 $ 19,591 E. Data En /Admin. Assistant 1 $ 22,170 $ 22,170 $ 22,902 $ 22,902 F. Case managers 5 $ 119,727 $ 113,550 $ 6,177 $ 123,678 $ 117,297 $ 6,198 G. Famit Counselor/Children's P re 1 $ 32,000 $ 32,000 $ 33,056 $ 33,056 H. Outreach Services Manager 1 $ 36,848 $ 36,848 $ 38,064 $ 38,064 1. Legal Assistance Coordinator 1 $ 27,450 $ 27,450 $ 28,356 $ 28,356 J. Children's Program Assistants 2 1 $ 51,977 $ 51,977 $ 53,692 $ 53,692 K. Housing Assistance Coordinator 1 $ 16,200 $ 16,200 $ 16,735 $ 16,735 L. Commun' Outreach Assistant 1 $ 12,304 $ 12,304 $ 12,710 $ 12,710 M. Children's Program Coordinator 1 $ 29,630 $ 29,630 $ 30,608 $ 30,608 N. Hel IineAssistanceCoordinator 1 $ 15,674 $ 15,674 $ 16,191 $ 16,191 0. Residential Family Svcs Manager 1 $ 36,682 $ 36,682 $ 37,893 $ 37,893 P. Residential Facilities Coordinator 1 $ 22,330 $ 22,330 $ 23,067 $ 23,067 Q. Su rtive Services Coordinator 1 $ 28,320 $ 28,320 $ 29,255 $ 29,255 R. Su rtive Services Assistants 4 4 $ 120,936 $ 120,936 $ 124,927 $ 124,927 TOTAL SALARIES $ 709,839 $ 703,662 $ 6,177 $ 713,026 $ 706,645 $ 6,198 2. Benefits: List each Payroll Taxes FICA/SUI $ 59,332 $ 58,816 $ 516 $ 58,546 $ 57,932 $ 614 Worker's Comp $ 40,088 $ 39,973 $ 115 $ 41,295 $ 41,180 $ 115 Retirement/medical/dental $ 45,480 $ 44,523 $ 957 $ 46.850 $ 45,890 $ 960 3. Total Salaries and Benefits $ 854.739 $ 846,974 $ 7.765 5 859,717 $ 851,647 $ 7,887 J Q U) 1- O z a W Q = a a w a 11 ao 9 0 O Il- O CD r O m O U r r V- V- (D O CD ~ U 'v O m O O a O O w O N CD O O O O O sT N r 0 O O O O O 0 O O w O O O O O O O O N O O O i• m v Co " p o w t N d N (O N M CD CA CA T O 0 i° O t r M N O L. r CL O W) CD O O O O O O O O O O O O co O q O O O O O O CD O O O Q v N O O O O O It t. w r MD. ,r O CD (O N v r Cp k lq~ r cO M CD CA Cn CD O 0) 16 co ILA N a 40 O f- r O N L r Q O N O CIP) O O m r { A N CO m U } U t U O L) O (D O N O O O O O t- r O O O O O O O O ►n O Cv N M N N O m Co ° O N O O O M O O r Co sj O CO (D O O O O T" CIS (D O 0) ~ O N p t ( D c C D r M N m O r C v d II O O D O O CD O O N O O O O O O O CD r O CD O O tf) O O CO p O O O O CA p O N CO D M CO) 1 N 1- . O C O V r C - et CO O N N s- O O V r (D O CA (O O O r ~ M N ~ r C d l) N d _ CL N V O C) N U) N CIL _ Z J (v J C (D OL CL 3 fn (D w c 0) 0 O x w 'a ~ O (D p 4) co W C O C m v (D :3 G) m C = N C O C O m m st Ll) co 1~ CD Cn O r r r N r M r 'i r O r cD r Fes- • • EXHIBIT B -BOARD OF DIRECTORS AFFIDAVIT All applicant Agencies must complete this affidavit listing the members of the Board of Directors and all other officers. If there are changes in the Board membership after the request is submitted, the City of Rosemead must be notified in writing. In submitting this funding request, I, Designee)_Marty Trisler depose and say that I am President [insert title, President, Vice President, etc.] of YWCA of San Gabriel Valley, 961 S. Glendora Ave, West Covina, CA 91790 [Insert name and address of Agency] The other members and officers of the Board of Directors of this Agency are: (Please list names of current Board Members and attach an additional sheet, if necessary): wee 5. DATE: JANUARY 31, 2006 AT:-West Covina, CA (CITY & STATE) THE APPROPRIATE AGENCY DESIGNEE MUST SIGN AND AFFIX THE SEAL (Corporate Seal) I certify and declare under penalty of perjury that the foregoing is true and correct. -Marty Trisler ~(1 President Print Name Signature and Title 0 0 V w LL 0 0 I.L a 0 m w J J a J w 2 m a c~ z /ate 4- 0 Q 0 0 N C 7 O Returk Organization Exempt Frotincome Tax Form 9 9 0 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung Departrnent of the Treasury benefit trust or private foundation) Internal Revenue service ► The organization may have to use a copy of this return to satisty state reportino requirements. or tax vear beolnnlna JUL 1. 2003 and B cheek If applicable: Plena C Name of organization 0 Employer Identification number use IRS Address Qchan°e - labia pdntor WCA OF SAN GABRIEL VALLEY -1641967 95 1cha° range F type- Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Telephone number ~returrn spwflc 961 SOUTH GLENDORA AVENUE (626)960-2995 ED RAW return eons. City or town, state or country, and ZIP +4 F Accauntln°metllo¢ cash X Al x,u ~"returnd"' ST COVINA CA 91790 ~ NPOther od 0. ap -lion • Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts ending H and I are not applicable to section 527 organizations. must attach a completed Schedule A (Form 990 or 990-E2). H(a) is this a group return for affiliates? Yes ® No G website: ►YWCASGV . ORG H(b) If Yes; enter number of affiliates ► J Organization type (&wk"one)► X~ 501(c)( 3 ensertno.) = 4947(a)(1) or 527 H(c) Are all affiliates included? N/A =Yes =No (IT -NO ; attach a list.) K Check here 10- Q ff the organization's gross receipts are normally not more than $25,000. The H(d) Is s this,- a separate return filed b an or- y organization need not file a return with the IRS; but if the organization received a Form 990 Package anization covered b a group ruling? 0 Yes © No in the mail, it should file a return without financial data. Some states require a complete return. I Group Exemption Number ► M Check ► LJ If the organization is not required to attach L Gross receipts: Add lines 6b, 8b, 9b, and 10b to line 12 ► 4,819,365. Sch. 8 (Form 990, 990-EZ, or 990-PF). Revenue Expenses, and Changes in Net Assets or Fund Balances 1 Contributions, gifts, grants, and similar amounts received: a Direct public support b Indirect public support c Government contributions (grants) 1 c 2 574,303. d Total (add lines to through 1c) (cash $ 3,854,510. noncash $ ) td 3,854,510. 2 Program service revenue including govemment fees and contracts (from Part VII, line 93) z 300 887. 3 Membership dues and assessments 3 28 671. 4 Interest on savings and temporary cash Investments 5 Dividends and interest from securities 5 5,218. 8 a Gross rents b Less: rental expenses 8b c Net rental Income or (loss) (subtract line 6b from line 6a) 6c m 7 Other investment income (describe ► FMV INCREASE-SECURITIES 7 6,604. C 8 a Gross amount from sales of assets other A Securities B Other 1 than inventory 497,669. ea b Less: cost or other basis and sales expenses 328f523. 8b c Gain or (loss) (attach schedule) 169,146. 8c d Net gain or (loss) (combine fine 8c, columns (A) and (8)) ........STMT ..,1 8d 169,146. 9 Special events and activities (attach schedule). If any amount Is from gaming, check here ► Q a Gross revenue (not Including $ 0 . of contributions reported on line la) 9a 125,698. b Less: direct expenses other than fundraising expenses Ob 9b 26,702. , c Net income or (loss) from special events (subtract line 9b from line 9a) EE STATEMENT ....2'.. 1 9c 98r996. 10 a Gross sales of inventory, less retums and allowances 10a b Less: cost of goods sold 10b c Gross profit or (lass) from sales of inventory (attach schedule) (subtract line 10b from line 10a) loci 11 Other revenue (from Part VII, line 103) 11 12 Total revenue add lines 1d 2 3 4 5 6c 7 8d 9c 10c and 11 12 4f464, 140. 13 Program services (from line 44, column (B)) 13 3,501,442. 14 Management and general (from line 44, column (C)) , 14 280 932. 15 fundraising (from line 44, column (0)) 15 16 Payments to affiliates (attach schedule) SEE... STATEMENT...3.... 16 26,230. 17 Total expenses add lines 16 and 44, column A 17 3 808, 604. 18 Excess or (deficit) for the year (subtract line 17 from line 12) . 18 655,536. Z 19 Net assets or fund balances at beginning of year (from line 73, column (A)) 19 5 7 4 , 217 . 20 Other changes in net assets or fund balances (attach ex lanation) p 20 0 . 21 Net assets or fund balances at end of year combine lines 18, 19, and 20 21 1 2 2 9 7 5 3. iz=ii-ar LHA For Paperwork Reduction Act Notice, see the separate Instructions. Form 990 (2003) 1 112431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 26502 1 If statement oT 'Wil organizations must complete column (A). GOlumns (8),M-and (D) are required Tor section 501(4)(3) Page 2 FP8R Functional Expenses and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others. Do not include amounts reported on line 6b 8b 9b 10b or 16 of Part 1. (A) Total (8) Program services (C) Management and general (D) Fundraising 22 Grants and allocations (attach schedule) cash S noncesh S 22 23 Specific assistance to individuals (attach schedule) 23 24 Benefits paid to or for members (attach schedule) 24 25 Compensation of officers, directors, etc 25 0. 0. 0 . 0. 26 Other salaries and wages 26 1 765 100. 1,629,347. 135t 753 . 27 Pension plan contributions 27 28 Other employee benefits 28 232r150. 213,089. 19 061 . 29 Payroll taxes 29 14 9 6 0 3. 138,350. 11, 253 . 30 Professional fundraising fees 30 31 Accounting fees 31 32 Legal fees 32 33 Supplies 33 35 280 . 33, 232 . 2 048 . 34 Telephone 34 27 912 . 26, 204 . 1 708 . 35 Postage and shipping 35 8 195. 5 863. 2 332. 36 Occupancy 36 246 711. 222 405 . 24, 306 . 37 Equipment rental and maintenance 37 32 527 . 28, 386 . 4 141. 38 Printing and publications 38 20,922. 15,956. 4,966. 39 Travel 39 51 787 . 51 431 . 356 . 40 Conferences, conventions, and meetings 40 10,645 . 8,446. 2 199. 41 Interest 41 42 Depreciation, depletion, etc. (attach schedule) 42 58,996 . 48r742 . 10r254 . 43 Other expenses not covered above (itemize): & PROFESSIONAL FEES 43a 91,306. 62,123. 29,183. bINSURANCE 43b 46,872. 43f863. 3,009. cF00D AND HYGIENE 43c 967 678. 967 678. 0. dMISCELLANEOUS 43d 36,690. 6r327. 30,363. e 43e (ad II 44 cdu~mts( °Dm22 ythee" mlines1315 44 3,782,374.1 3150 1 442. 2-8-0-r932.1 0. Joint Costs. Check ► M If you are following SOP 98-2. Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services? ► = Yes © No If 'Yes,' enter (1) the aggregate amount of these Jolntcosts $ ; (II) the amount allocated to Program services $ iii the amount allocated to Mana ement and general $ and Ir the amount allocated to Fundraisin ,.part III Statement of Program Service Accomplishments What is the organization's primary exempt purpose? ► PROVIDING VOLUNTARY HEALTH AND WELFARE SERVICES Prourn Service _E All organizations must describe their exempt purpose achievements In a dear and concise manner. State the number of clients served, publications Issued, etc. Olaass achiovement3 that are not measurable. (Section 501(4x() and (4) organizatlons and 4947(a)(1) nonexempt charitable busts must also enter the amount of grants and allocations to others.) penieS (Required for and 4944)(() and busts; bu of ption aal9for(othe ) a SENIOR PERSONS MEAL PROGRAMS Grants and allocations 1,920,503. b DOMESTIC VIOLENCE INTERVENTION & PREVENTION Grants and allocations 1 2 5 3 611. c CHILDCARE DAY CAMP CLASSES AND OTHER ACTIVITIES Grants and allocations 327,328. d Grants and allocations $ e Other program services attach schedule (Grants and allocations $ f Total of Program Service Expenses (should equal line 44, column (B), Program services) ► 3,501,442. 12301 o3 Form 990 (2003) 2 12431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 26502 Form 990 Fa1'{f Balance Sheets • Note: Where required, attached schedules and amounts within the descrfpdon column should be for end-of-year amounts only. (A) Beginning of year (B) End of year 45 Cash - non-interest-bearing 36 ,249. 45 34 ,510. 46 Savings and temporary cash investments 60 ,437. 46 34 ,337. 47 a b Accounts receivable 471 Less: allowance for doubtful accounts 47b ::'1,Zz 47c 46 a Pledges receivable 48a 1 0 b Less: allowance for doubtful accounts 48b 21 ,535. 48c 21 ,047. 49 Grants receivable 276 ,174. 49 313 ,466. 50 Receivables from officers, directors, trustees, and key employees 50 51 a Other notes and loans receivable 51a b Less: allowance for doubtful accounts 51b . 51e 52 Inventories for sale or use 53 Prepaid expenses and deferred charges 22, 178. 53 33 ,427. 54 Investments -securities STMT .,,4 ► Cost ® FMV 4 109. 54 756 ,388. 55 a b Investments - land, buildings, and equipment: basis 553 Less: accumulated depreciation 55b 5c 55 Investments - other 55 57 a Land, buildings, and equipment: basis 57a 1,535,907. b Less: accumulated depreciation TMT 57b 834r285. 817, 08T . 57e 701, 622. 58 Other assets (describe ► 58 59 Total asset: add lines 45 through 58 must equal line 74 1,237, 769. 59 1,894, 797. 60 Accounts payable and accrued expenses 285, 102. 60 260, 059. 61 Grants payable 61 62 Deferred revenue 108, 605. 62 94, 010. 63 Loans from officers, directors, trustees, and key employees 63 64 a Tax-exempt bond liabilities 54a j b mortgages and other notes payable STMT.... 6.................................. 269, 845. 64b 310, 975. 65 Other liabilities (describe ► ) 65 56 Total liabilities add lines 60 throw h 65 663, 552. 66 665, 044. y~ Organizations that follow SFAS 117, check here ► and complete lines 67 through 69 and lines 73 and 74. 67 Unrestricted 526, 287. 67 863 498. 58 Temporarily restricted 47, 930. 68 366r 255. 69 Permanently restricted 69 ° Organizations that do not follow SFAS 117, check here ► El and complete lines 70 through 74. 70 Capital stock, trust principal, or current funds y 71 Paid-in or capital surplus, or land, building, and equipment fund 71 72 Retained earnings, endowment, accumulated income, or other funds 72 Z 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72; column (A) must equal line 19; column (B) must aqual lino 21) 574, 217. ' 73 1,229, 753. 74 Total liabilities and net assets/ fund balances (add lines 66 and 73) 1,237, 769. 74 1,894, 797. Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization. How the public perceives an organization in such cases may be determined by the Information presented on its return. Therefore, please make sure the return Is complete and accurate and fully describes, in Part Ili, the organization's programs and accomplishments. 323021 12-17-03 3 12431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 26502 VAT.T,FY 0 a Total revenue, gains, and other support per audited financial statements ► b Amounts Included on line a but not on line 12, Form 990: (1) Net unrealized gains on Investments S (2) Donated services and use of facilities $ 7 9 7 , 0 7 3 . (3) Recoveries of prior year grants $ (4) Other (specify): STMT 7 $ 26, 702. Add amounts on lines (1) through (4)... ► c Line a minus line b ► d Amounts Included on line 12, Form 990 but not on line o: (1) Investment expenses not included on line 6b, Form 990 ...i (2) Other (specify): S Add amounts on lines (1) and (2) ► e Total revenue per line 12, Form 990 audited financial statements ► b Amounts included an line a but not on line 17, Form 990: (1) Donated services and use of facilities... $ 7 9 7 , 0 7 3 . (2) Prior year adjustments reported on line 20, Form 990 $ (3) Losses reported on line 20, Form 990 $ (4) Other (specify): STMT $ $ 26, 702. Add amounts on lines (1) through (4) ► e Line a minus line b ► d Amounts Included on line 17, Form 990 but not on line a: (1) Investment expenses not included on line 6b, Form 990 S (2) Other (specify): S Add amounts on lines (1) and (2) ► e Total expenses per line 17, Form 990 per 5. List of Officers, Directors, T rustees, and Key E mployees (List each one even It not compensated.) (A) Name and address (0) Title and average hours per week devoted to position IC) Compensation It not p I , enter . (D)Contribueone to ePy,,; a d °efr,,reefit d m ansation (E) Expense account and other allowances ANGELA CHANG TREASURER 44 0 FE RARA C T. #304 - PHILLIPS- -RA-NCH CA 91766 0. 0. 0. L A V ER N E FORD ICE PRESIDE _ _ _ _ _ _ 475 EAST BADILLO STREET - COVINA CA 91723 1 0. 0. 0. PATRICIA FOSTER ICE PRESIDE 1$03 SEATTLE AVENUE WEST COVINA CA 91790 1 0. 0. 0. SUE HAMMETT RESIDENT ----E-AS--TSAN -----B-E---RNA-R O DI---N--RO--A-D 22 1 COVINA, CA 91723 3 0. 0. 0. - ROAD . BARRANCA AVENUE, #10-0 75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related 323031 12-17-03 112431112 739445 26502 per Audited Revenue per Form 990 4 2003.06010 YWCA OF SAN GABRIEL VALLEY 265021 0 76 Did the organization engage in any activity not previously reported to the IRS? If 'Yes; attach a detailed description of each activity 77 Were any changes made in the organizing or governing documents but not reported to the IRS? If 'Yes,' attach a conformed copy of the changes. 78 a Did the organization have unrelated business gross Income of $1,000 or more during the year covered by this return? b It 'Yes,* has it flied a tax return on Form 990-T for this year? N/A 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If'Yes ; attach a statement 80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? b If 'Yes; enter the name of the organization ► and check whether it is exempt or 0 nonexempt. 81 a Enter direct or indirect political expenditures. See line 81 instructions 181 all I 0. b Did the organization file Farm 1120-POL for this year? 82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? b If'Yes ; you may Indicate the value of these items here. Do not include this amount as revenue in Part I or as an expense in Part II. (See Instructions in Part III.) I8 82b 1 7 9 7 , 0 7 3 . 83 a Did the organization comply with the public Inspection requirements for returns and exemption applications? ~T b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 84 a Did the organization solicit any contributions or gifts that were not tax deductible? b If Yes; did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? N/A..... . 85 501(c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members? N /A b Did the organization make only in-house lobbying expenditures of $2,000 or less? .............N(A If *Yes* was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year. c Dues, assessments, and similar amounts from members 55c N/A d Section 162(e) lobbying and political expenditures 85d N/A e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e N/A I Taxable amount of lobbying and political expenditures (line 85d less 85e) 85f N/A g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f? N/A......... h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? N /A......... 88 501(c)(7) organizations. Enter: a Initiation fees and capital contributions Included on line 12 86a N/A b Gross receipts, Included on line 12, for public use of club facilities 86b N/A 87 501(c)(12) organizations. Enter: a Gross income from members or shareholders 87a N/A b Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) 87b N/A 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If 'Yes,' complete Part IX 89 a 90 a 91 501(c)(3) organizations. Enter. Amount of tax imposed on the organization during the year under: section 491110, 0 - ; section 4912 ► 0 . ;section 4955 ► 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year or did I become aware of an excess benefit transaction from a prior year? If 'Yes,* attach a statement explaining each transaction Enter. Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 Enter. Amount of tax on line 89c, above, reimbursed by the organization List the states with which a copy of this return Is filed ► CALIFORNIA Number of employees employed in the pay period that includes March 12, 2003 L The books are in care of ► EVELYN BROWN Telephone no. X ► 0. ► 0. Locatedat► 961 S. GLENDORA AVE., WEST COVINA, CA ZIP+4►91790 92 Section 49470(1) nonexempt charitable trusts filing Form 9901n lieu of Form 1041- Check here and enter the amount of tax-exempt interest received or accrued during the tax year ► 192 323041 12. 17-03 5 12431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 0. X ► = Form 990 (2003) 265021 Form 990 2003 ( ) YWCA SAN GABRIEL 'VALLEY 10 95-1641967 PageB . Part Vi Analysis of Income-Producina Activities (See nape 33 of the instnirtinnc 1 Note: indi 93 a b C d e f 9 94 95 1 98 97 a b 98 99 100 101 102 103 a b c d e 104 Enter gross amounts unless otherwise ated. Program service revenue: Unrela Bus Hess code ted business income (B) Amount Exclu ExCu ,Ion Dods dad section 512, 513, or 514 (D) Amount (E Related or exempt function Income CLASSES AND ACTIVITIES 173 676 CHILDCARE AND DAY CAMP . 127 211 . Medicare/Wicaid payments Fees and contracts from government agencies Membership dues and assessments 28f671. nterest on savings and temporary cash investments 108. Dividends and Interest from securities Net rental income or (loss) from real estate: ebt-financed property 5 218. ot debt-financed property et rental Income or (loss) from personal property ther investment income 6,604. ain or (loss) from sales of assets ther than inventory 169,146. et income or (loss) from special events 98t996. ross proftit or (loss) from sales of inventory ther revenue: ubtotal (add columns (B), (D), and (E)} 0 . ? 0 . G d n N D G o N D O S 6 0 9 6 3 0 . 105 Total (add line 104, columns (8), (D), and (E)) ► 609,630. Note: Line 105 plus line 1d, Part i, should equal the amount on line 12, Part 1. Park>V[11.1 Relationship of Activities to the Accomplishment of Exempt Purposes (Seepage 34 of the instructions.) Line No. I Explain how each activity for which Income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's '>tX Information Regardi ng Taxable Subsidiaries and Disregarded Entities (See page 34 of the Instructions.) Name, address, and EIN of corporation, partnership, or disregarded ent Percentage of ownershl interest Nature of )activities Total income End-or? year assets N/A % % % f: cu: a-„ -:,s:j 111urrnaluvn riegarging If ranszers Assoctazea wtzn Personal benefit Contracts (See page 34 of the Instructions.) (a) Did the organization, during the year, receive any funds, directly or Indirectly, to pay premiums on a personal benefit contract? L] Yes ® No (b) Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? 0 Yes ® No Nola: If "Yes' to (b). file Form 8870 and Form 4720 see Instructions). Please Unaair ties of perjury, l declare that I has ned this return Including accompanying scnedul•s and statements, and to the best of my knowledge and belief, it is true, co and complete. eclaratlon of p fllce~ Is bred on all In do of which pneparer has any knowledge Sign Q OF 16UE Aj ?hW4 C, ii EYt~ r0 0111 r,t Here , S gna ure of offic r Date Type or pant name and tit e. Paid Preparer's Date Check I Preperses ssN or PTIN 20% 1 signature 1 d*-~Ov 2 e ployed ► P O 017 7 0 8 4 Preparers Flmisno"(or ARKE, GUP ILL 0., LLP EIN ► 95-3378831 Use Only you', If self-employed), KST 2 6 E . GAR EY AVE . 12-fiat z'di13.4 "'d COVINA, CA 91791-2198 of ► 99 F-11Q-71d1 6 Form 990 (2003) 12431112 739445 26502 2nni-nAn1n vwr a n>: CANT r_aPT?TT."T. 17ATTVV 1) 4Z rn1) 1 SCHEDULE A Orglnization Exempt Under Sect 501 (c)(3) OMeNo.1545-0047 (Form 990 or 990-E2) (Except Private Foundation) and Section 501(9), 501(0, 501(k), 501(n), or Section 4947(a)(1) Nonexempt Charitable Trust O O~ DeparbTwt of Owe Treasury Supplementary Information-(See separate instructions.) Internal Revenue Service ► MUST be completed by the above organizations and attached to their Form 990 or 990-EZ Name of the organization Employer Identification number YWCA OF SAN GABRIEL VALLEY 195::1641967 >Pk Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions. List each one. If there are none, enter 'None!) (a) Name and address of each employee paid more than $50,000 (b Title and average hours per week devoted to position (c) Compensation (d) contnbutione to aI nis 6 tl bwali compensation a Expense account and other allowances EVELYN BROWN______________________ 1975 PASEO GABRIELA SAN DIMAS CA. .E.0. 0.0 71 331. 4,488. DONALD -------E-.--H-ER-R-I-N-G 14195 STANISLAUS COURT FONTANA CA ROG'M DIRECT 40.0 4,600. ,095. Total number of other employees paid c,:er 550.000 ► I Q l PwO Compensation of the Five Highest Paid Independent Contractors for Professional Services (a) Name and address of each independent contractor paid more than $50,000 NONE (b) Type of service (c) Compensation Total number of others receiving over $50,000 for professional services ► 0 323101/12-05-03 LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990•EZ. Schedule A (Form 990 or 990-EZ) 2003 7 12431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 265021 Schedule A (Form 990 or 990-EZ) 2003 YWO OF SAN GABRIEL VALLEY • 95-1641967 Page 2 Pa k IV Reason for Non-Private Foundation Status (Seepages 3 through 6 of the Instructions.) The organization is not a private foundation because it is: (Please check only ONE applicable box.) 5 0 A church, convention of churches, or association of churches. Section 170(b)(1)(A)(1). 8 0 A school. Section 170(b)(1)(A)(11). (Also complete Part V.) 7 A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(iii). 8 0 A Federal, state, or local government or governmental unit. Section 170(b)(1)(A)(v). 9 A medical research organization operated In conjunction with a hospital. Section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state 00, 10 a 11a 11b 12 An organization operated for the benefit of a college or university owned or operated by a governmental unit. Section 170(b)(1)(A)(Iv). (Also complete the Support Schedule in Part IV-A.) An organization that normally receives a substantial part of its support from a governmental unit or from the general public. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.) A community trust. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule In Part IV-A.) An organization that normally receives: (1) more than 331/3"/0 of its support from contributions, membership fees, and gross receipts from activities related to its charitable, etc., functions - subject to certain exceptions, and (2) no more than 331/3% of its support from gross Investment Income and unrelated business taxable Income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Also complete the Support Schedule In Part IV-A.) Schedule A (Form 990 or 990-EZ) 2003 323111 12-05-03 Statements About Activities (See page 2 of the instructions.) Yes No 1 During the year, has the organization attempted to Influence national, state, or local legislation, Including any attempt to influence public opinion on a legislative matter or referendum? If 'Yes' enter the total expenses paid or incurred in connection with the lobbying activities 10, $ $ (Must equal amounts on line 38, Part VI-A, or line I of Part VI-8.) 1 X Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A. Other organizations checking 'Yes; must complete Part VI-8 AND attach a statement giving a detailed description of the lobbying activities. 2 During the year, has the organization, either directly or indirectly, engaged In any of the following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person Is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? Of the answer to any question is 'Yes," I attach a detailed statement explaining the transactions.) a Sale, exchange, or leasing of property? 2a X b Lending of money or other extension of credit? 2b X c Fumishing of goods, services, or facilities? 2c X d Payment of compensation (or payment or reimbursement of expenses If more than $1,000)? 2d X e Transfer of any part of its Income or assets? 2e X 3 a Do you make grants for scholarships, fellowships, student loans, etc.? (if Yes; attach an explanation of how you determine that recipients qualify to receive payments.) 3a X b Do you have a section 403(b) annuity plan for your employees? S Did you maintain any separate account for participating donors where donors have the right to provide advice on the use or distribution of funds? . 4 X 8 12431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 26502 13 EJ An organization that Is not controlled by any disqualified persons (other than foundation managers) and supports organizations described In: Schedule A (Form 990 or 990-EZ) 2003 • Support Schedule (Complete only if you checked a box on line 10, 11, or 12.) Use cash method of accounting. Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting. Calendar year (or fiscal year be innln In ► (a) 2002 (b) 2001 c) 2000 (d) 1999 (e) Total 15 Gifts, grants, and contributions t i l d d receive . (Do no nclu e unusua rants. See line 28.) 3,391,077. 3,636,809. 31498,680. 3,141,224. 13 667 790. 16 Membership fees received 30,609. 39,450. 31,269. 27,615. 128,943. 17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities In any activity that is related to the organization's charitable, etc., purpose 510,558. 623,831. 813f837. 862,147. 2,810,373. 18 Gross income from Interest, dividends, amounts received from payments on securities loans (sec- tlon 512(a)(5)), rents, royalties, and unrelated business taxable Income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975 98. 8 3 0. 1r899. 1 2 2 3. 4,050. 19 Net Income from unrelated business activities not Included In line 18 _ 20 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf 21 The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally fumished to the public without charge 22 Other Income. Attach a schedule. Do not include gain or (loss) from sale of capital assets 23 Total of lines 15 through 22 3,932,342. 4r300, 920. 4,345,685. 4 032 209. 16 611 156. 24 Line 23 minus line 17 3 421 784. 3 677 089. 3 531 848. 3,170,062. 13 800 783. 25 Enter 1 % of line 23 39 323. 43 009. 43 457. 40 322. 25 Organizations described on lines 10 or 11: a Enter 2% of amount in column (e), line 24 ► 26a N / A b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly supported organization) whose total gifts for 1999 through 2002 exceeded the amount shown In line 26a. Do not ilia this list with your return. Enter the total of all these excess amounts ► 26b NA A c Total support for section 509(a)(1) test: Enter line 24, column (e) ► 28c N/A d Add: Amounts from column (e) for lines: 16 19 ....A.,.,..,,.. ~ 22 26b ► 25d N/A e Public support (line 26c mirus line 26d total) ► 26e N/A f Public support percentage (line 26e (numerator) divided by line 26c denominator ► 26f N/A % 27 Organizations described on line 12: a For amounts Included In lines 15, 16, and 17 that were recetved from a *disqualified person' prepare a list for your records to show the name of, and total amounts received In each year from, each 'disqualified person' Do not file this list with your return. Enter the sum of such amounts for each year: (2002) .............................0.~. (2001) ...................................0... (2000) ................................0.A. (1999) b For any amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (1) the amount online 25 for the year or (2) $5,000. (Include in the list organizations described in lines 5 through 11, as well as individuals.) Do not file this list with your return. After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year: (2002) 7.6.,.5.7.6. (2001) 1.91 r..4 5 6 i. (2000) ...............1.5.1.,.9.Q.9. (1999) c Add: Amounts from column (e) for lines: 15 13,667,790. 16 128,943. 17 2, 810, 373. 20 21 ► 27c 16 607 1i d Add: Line 27a total 0. and line 27b total 4 21, 9 41. ► 27d 421,9- a Public support (line 27c total minus line 27d total) ► 27e 16 185 11 f Total support for section 509(a)(2) test: Enter amount on line 23, column (e) ► 27f g Public support percentage (line 27e (numeratod divided by line 271 (denominator)) 0... 0. 28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 1999 through 2002, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant. Do not ilia this list with your return. Do not Include these grants in line 15. 12431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 265021 • (See page 7 of the N/A 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing instrument, or in a resolution of its governing body? 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships? 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, In a way that makes the policy known to all parts of the general community it serves? 11 'Yes,* please describe; If'No; please explain. (If you need more space, attach a separate statement.) 32 Does the organization maintain the following: a Records Indicating the racial composition of the student body, faculty, and administrative staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships? d Copies of all material used by the organization or on its behalf to solicit contributions? If you answered 'No' to any of the above, please explain. (If you need more space, attach a separate statement.) 33 Does the organization discriminate by race in any way with respect to: a Students' rights or privileges? Ill Admissions policies? c Employment of faculty or administrative staff? d Scholarships or otherfinancial assistance? e Educational policies? i Use of facilities? g Athletic programs? h Other extracurricular activities? If you answered 'Yes' to any of the above, please explain. (If you need more space, attach a separate statement.) 34 a Does the organization receive any financial aid or assistance from a governmental agency? b Has the organization's right to such aid ever been revoked or suspended? If you answered 'Yes' to either 34a or b, please explain using an attached statement. 35 Does the organization certify that 4 has complied with the applicable requirements of sections 4.01 through 4.05 of Rev. Proc. 75-50, 1975-2 C.B. 587, covering racial nondiscrimination? It *No' attach an explanation 4 No Schedule A (Form 990 or 990-EZ) 2003 323131 12-05.03 10 12431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 265021 990 or 990-EZ) 2003 0 t -rt>YFA: Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions.) N/A (To be completed ONLY by an eligible organization that filed Form 5768) Check lllll~ a EJ if the oraanizat,cn :@;onas to an affiliated orouo. Check ► b if you checked "a'and'limited control' provisions aoolv. (a) ( Limits on Lobbying Expenditures Affiliated group To be completed for ALL (The term 'expenditures* means amounts paid or incurred.) totals electing organizations N/A 38 Total lobbying expenditures to Influence public opinion (grassroots lobbying) 36 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37 38 Total lobbying expenditures (add lines 36 and 37) 38 39 Other exempt purpose expenditures 39 40 Total exempt purpose expenditures (add lines 38 and 39) 40 41 Lobbying nontaxable amount. Enter the amount from the following table - If the amount on line 40 Is - The lobbying nontaxable amount Is - Not over $500,000 20% of the amount on line 40 g. Over $500.000 but not over $1,000,000 $100,000 plus 15% of the excess over M,000 ~ I Over $1,000,000 but not over $1,5oo,000 , $175,000 plus 10% of the excess over $1,000,000 41 Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000 0ver517,000,000 $1,000,000............................... 42 Grass roots nontaxable amount (enter 25% of line 41 ) 42 43 Subtract line 42 from line 36. Enter- if line 42 Is more than line 36 43 44 Subtract line 41 from line 38. Enter -0- if line 41 Is more than line 38 44 Caution: If there is an amount on either line 43 or line 44, you must file Form 4720. 4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 45 through 50 on page 11 of the instructions.) Lobbying Expenditures During 4-YearAveraping Period N/A Calendar year (or (a) (b) (e) (d) (e) fiscal year beginning In) ► 2003 2002 2001 2000 Total 45 Lobbying nontaxable amount 0. 40 Lobbying ceiling amount 16,61 a a 150% of line 45(e)) 0 . 47 Total lobbying expenditures 0. 48 Grassroots nontaxable amount 0. 49 Grassroots ceiling amount > 150% of line 48(e)) 0. 50 Grassroots lobbying ex en0ures 0. `lfl'(3 Lobbying Activity by Nonelecting Public Charities (For reporting only by organizations that did not complete Part VI-A) (See page 12 of the Instructions.) During the year, did the organization attempt to Influence national, state or local legislation, Including any attempt to Yes No influence public opinion on a legislative matter or referendum, through the use of: a Volunteers b Paid staff or management (Include compensation in expenses reported on lines c through h.).................................... Media advertisements Mailings to members, legislators, or the public Publications, or published or broadcast statements Grants to other organizations for lobbying purposes Direct contact with legislators, their staffs, government officials, or a legislative body Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means Total lobbying expenditures (Add linesc through h.) It 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities. Amount A Schedule A (Form 990 or 990-EZ) 2003 112431112 739445 26502 11 2003.06010 YWCA OF SAN GABRIEL VALLEY 26502 iedule A (Form 990 or 990-EZ) 2003 YWOOF SAN GABRIEL VALLEY Is Exempt Organizations (See page 12 of the instructions.) 51 Did the reporting organization directly or indirectly engage In any of the following with any other organization described In section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No (1) Cash 51a(1) X (11) Otherassets &(II) X b Other transactions: (1) Sales or exchanges of assets with a noncharitable exempt organization b(I) X (11) Purchases of assets from a noncharitable exempt organization b(II) X (111) Rental of facilities, equipment, or other assets b(III) X iv Reimbursement arrangements b(iv) X (v) Loans or loan guarantees b(v) X (vl) Performance of services or membership or fundraising solicitations b(vl) X Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X If the answer to any of the above Is "Yes; complete the following schedule. Column (b) should always show the fair market value of the goods, other assets, or services given by the reporting organization. If the organization received less than fair market value In any Name of organization I Type of organization I Description of relationship 12431112 739445 26502 Schedule A (Form 990 or 990-EZ) 2003 12 2003.06010 YWCA OF SAN GABRIEL VALLEY 265021 52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? ► =yes ® No Schedule B 10 Schedule of Contributot OMB No. 1545-0047 (Form 990, 990-EZ, or 990-PF) Supplementary Information for 2003 Departrnent of the Treasury line 1 of Form 990, 990-EZ, and 990-PF (see instructions) Intemal Revenue Servlce Name of organization Employer Identification number YWCA OF SAN GABRIEL VALLEY 95-1641967 Organization type (check one): Filers of: Section: Form 990 or 990-EZ © 501(c)( 3 ) (enter number) organization 4947(a)(1) nonexempt charitable trust not treated as a private foundation 527 political organization Form 990-PF 501(c)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated as a private foundation 0 501(c)(3) taxable private foundation Check if your organization is covered by the General Rule or a Special Rule. (Note: Only a section 501(c)(7), (8), or (10) organization can check box(es) for both the General Rule and a Special Rule-see instructions.) General Rule- For organizations filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more On money or property) from anyone contributor. (Complete Parts I and 11.) Special Rules- For a section 501(c)(3) organization filing Form 990, or Form 990-EZ, that met the 331/3% support test of the regulations under sections 509(a)(1 Y170(b)(1)(A)(vD and received from any one contributor, during the year, a contribution of the greater of $5,000 or 2% of the amount on line 1 of these forms. (Complete Parts I and II.) For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from anyone contributor, during the year, aggregate contributions or bequests of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. (Complete Parts I, II, and 111.) a For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from any one contributor, during the year, some contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not aggregate to more than $1,000. Of this box Is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the Parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more during the year.) ► $ Caution: Organizations that are not covered by the General Rule and/or the Special Rules do not file Schedule B (Form 990, 990-EZ, or 990-P17, but they must check the box in the heading of their Form 990, Form 990-EZ, or on line 1 of their Form 990-PF, to certify that they do not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PP). LHA For Paperwork Reduction Act Notice, seethe Instructions Schedule B (Form 990, 990-EZ, or 990-PF) (2003) for Form 990 and Form 990-EZ 323451 12-05-03 13 12431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 265021 • Name of organization 0 Employer Identification number p8t: !i Contributors (See Specific Instructions.) (a) No. (b) Name, address, and ZIP + 4 (c) Aggregate contributions (Co Type of contribution 1 Z ICKERMAN TRUST Person 0 2125 E. MARDINA STREET $ 344, 202. Payroll 0 Noncash WEST COVINA, CA 91791 (Complete Part II if there Is a noncash contribution.) (a) No. (b) Name, address, and ZIP + 4 Aggre (c) gate contributions (d) Type of contribution 2 Z ICKERMAN TRUST Person 0 2125 E. MARDINA STREET $ 328, 471. Payroll 0 Noncash WEST COVINA, CA 91791 (Complete Part II if there Is a noncash contribution.) (a) No. (b) Name, address, and ZIP + 4 Aggre (c) gate contributions (d1 Type of contribution Person $ Payroll 0 Noncash 0 (Complete Part II If there Is a noncash contribution.) (a) No. (b) Name, address, and ZIP + 4 Aggre (c) gate contributions (d) Type of contribution Person $ Payroll 0 Noncash 0 (Complete Part II if there Is a noncash contribution.) (a) No. (b) Name, address, and ZIP + 4 Aggr (c) to contributions (d) Type of contribution Person $ Payroll 0 Noncash 0 (Complete Part II if there Is a noncash contribution.) (a) No. (b) Name, address, and ZIP + 4 Aggre (c) gate contributions (d) Type of contribution Person $ Payroll 0 Noncash 0 (Complete Part II if there Is a noncash contribution.) 323452 12-05-03 Schedule B (Form 9 90. 990-EZ. or 990-PFI (20031 14 12431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 26502 • F-1 (a) No. from Part I Description of noncash property given (c1 FMV i(or nstructions) (see ins) Date received REAL PROPERTY 1 $ 344,202. 08/ /03 No. from Part I Description of noncash property given (c) FMV I(or nstructions) (see ins) Date received SECURITIES (STOCKS) 2 $ 328,471. 08/ /03 No. from Part I Description of noncash property given (c) FMV I(or nstructions) (see ins) (CQ Date received (a) No. from Part I Description of noncash property given (c) FMV I(or nstructions) (see ins) Date received (a) No. from Part I Description of noncash property given (c1 FMV n(or s estimate) (sae instructions) Date received (a) No. from Part 1 (b) Description of noncash property given (c) FMV (or estimate) (see instructions) (d) Date received s 323453 12-05-03 Schedule B (Form 990, 990-EZ, or 990-PF) (2003) 15 12431112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 26502 Noncash Property (See Specific Instructions.) a rn c, N W a 0 m ON G4 W Q Z O QF N F O ZO Q Z O F a V W m a W D S 04 N 0 pit YWCA OF SAN GABRIEL V4EY • 95-1641967 FORM 990 GAIN (LOSS) FROM PUBLICLY TRADED SECURITIES STATEMENT 1 DESCRIPTION STOCKS - 15207SH RELIANCE STEEL TO FORM 990, PART I, LINE 8 497,669. 328,523. 0. 497,669. 328,523. 0. 169,146. 169,146. I FORM 990 SPECIAL EVENTS AND ACTIVITIES STATEMENT 2 GROSS DESCRIPTION OF EVENT RECEIPTS SPORTS CLASSIC 61,984. WOMEN OF ACHIEVEMENT 62,509. MISCELLANEOUS 1,205. TO FM 990, PART I, LINE 9 125,698. GROSS COST OR EXPENSE NET GAIN SALES PRICE OTHER BASIS OF SALE OR (LOSS) CONTRIBUT. GROSS DIRECT NET INCLUDED REVENUE EXPENSES INCOME 61,984. 1,686. 60,298. 62,509. 25,016. 37,493. 1,205. 1,205. 125,698. 26,702. 98,996. 17 STATEMENT(S) 1, 2 12411112 739445 26502 2003.06010 YWCA OF SAN GABRIEL VALLEY 26502 1 YWCA OF SAN GABRIEL VAEY 95-1641967 FORM 990 PAYMENTS TO AFFILIATES STATEMENT 3 AFFILIATE'S NAME AFFILIATE'S ADDRESS YWCA OF THE U.S.A.-PACIFIC REGION 2600 BANCROFT WAY, BER KELEY, CA 94704 PURPOSE OF PAYMENT AMOUNT SHARED MEMBERSHIP DUES 26,230. TOTAL TO FORM 990, PART I, LINE 16 26,230. FORM 990 NON-GOVERNMENT SECURITIES STATEMENT 4 OTHER PUBLICLY TOTAL CORPORATE CORPORATE TRADED OTHER NON-GOV'T SECURITY DESCRIPTION STOCKS BONDS SECURITIES SECURITIES SECURITIES SECURITIES 756,388. 756,388. TO 990, LN 54 COL B 756,388. 756,388. FORM 990 DEPRECIATION OF ASSETS NOT HELD FOR INVESTMENT STATEMENT 5 COST OR ACCUMULATED DESCRIPTION OTHER BASIS DEPRECIATION BOOK VALUE BUILDING AND IMPROVEMENTS 851,387. 416,781. 434,606. FURNITURE AND EQUIPMENT 264,247. 203,893. 60,354. VEHICLES 34,623. 32,271. 2,352. LAND 146,177. 0. 146,177. NONEXPENDABLE EQUIPMENT 239,473. 181,340. 58,133. TOTAL TO FORM 990, PART IV, LN 57 1,535,907. 834,285. 701,622. 18 STATEMENT(S) 3, 4, 5 17AZ1111 1'A0AAF A9; n) gnni .nAnin VWrA nP SAN rARRTF.T, VAT,T,F.V 96909 1 YWCA OF SAN GABRIEL VOEY 0 95-1641967 FORM 990 MORTGAGES PAYABLE STATEMENT 6 DESCRIPTION BALANCE DUE LOW INCOME HOUSING FUND 124,477. PACIFIC WESTERN NAT'L BANK 186,498. TOTAL INCLUDED ON FORM 990, PART IV, LINE 64B, COLUMN B 310,975. FORM 990 OTHER REVENUE NOT INCLUDED ON FORM 990 STATEMENT 7 DESCRIPTION AMOUNT SPECIAL EVENTS 26,702. TOTAL TO FORM 990, PART IV-A 26,702. FORM 990 OTHER EXPENSES NOT INCLUDED ON FORM 990 STATEMENT 8 DESCRIPTION SPECIAL EVENTS TOTAL TO FORM 990, PART IV-B 1 ')All 1 l) '7 7 0 A A r, 7 dZS n 7 AMOUNT 26,702. 26,702. 19 STATEMENT(S) 6, 7, 8 7nn7 n4n1 n VT.T/'P nV CHAT t!AnDTT.T 17TTT VV 79z rn7 1 0 • ' , . 0 UMtl NO IJ9YV1/ For„4562 L Depreciation and Amortization 99 2 0 3 Department of the Treasury (Including Information on Listed Property) internal Revenue Service Attachment lip- See separate Instructions. Ill Attach to your tax return. Sequence No. 87 Name(s) shown on return Business or activity to which this form relates Identifying number YWCA OF SAN GABRIEL VALLEY ORM 990 PAGE 2 95-1641967 Pan't4. Election To Expense Certain Tangible Property Under Section 179 Note: If you have an listed property, complete Part V before you complete Part I. 1 Maximum amount. See instructions for a higher limit for certain businesses 1 10 0 0 0 0 . . 2 Total cost of section 179 property placed in service (see instructions) 2 3 Threshold cost of section 179 property before reduction In limitation 3 400,000. 4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0 . 4 use only) I (c) Elected cost 7 Usted property. Enter the amount from line 29 1 7 1 8 Total elected cost of section 179 property. Add amounts In column (c), lines 6 and 7 9 Tentative deduction. Enter the smaller of line 5 or line 8 10 Carryover of disallowed deduction from line 13 of your 2002 Form 4562 11 Business Income limitation. Enter the smaller of business Income (not less than zero) or line 5 12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 13 Carryover of disallowed deduction to 2004. Add lines 9 and 10, less line 12 ► F13 Note: Do not use Part 11 or Part III below for listed property. Instead, use Part V. 14 Special depredation allowance for qualified property (other than listed property) placed in service during the tax year (see Instructions) 15 Property subject to sectlon 168(f)(1) election (see Instructions) 17 MACRS deductions for assets placed in service in tax years beginning before 2003 18 If you are electing under section 1680(4) to group any assets placed in service during the tax 3eCilan - ASSe[S rracea ur .per srce+ a+unn wv.a , aw ■ War aia... (b) Month and (d Basis for depredation (a) Convention M Method (g) Depreciation deduction (a) classification of property yew placed (businewnyestment use Recovery In sepia only - see Instructions) h Residential rental property I Nonresidential real property Rnretinn r _ Ocaet4 Placad In Service Durina 2003 Tax Year Usina the Alternative DeDreciation System 20a Class life S/L b 12 ear 12 yrs. S/L c 40-year / 40 yrs. MM S/L 21 Usted property. Enter amount from line 28 22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnershlps and S corporations - see Instr . 23 For assets shown above and placed In service during the current year, enter the If -I LHA For Paperwork Reduction Act Notice, see separate instructions. Form 4562 (2003) 20 'r10A n r. 749n7 1 nn7 n A n 1 n Vwra OV PAM r_IIRRTVT. VnT.T.FV 9 FSn~ 1 2 deducting lease expense, complete only 24a, 24b, columns (a) z4a uu uu nave 11VIMICU to su On 11111 O1.1511111551Hiv113Un111I1 ua11 wa1111eu r (_J Tes u 1140 4410 IT - T es - is Tne evice nce wmTen r u Yes u rvo (a) (b) (c) (co ce) M ce) (h) c► Type of properrtyry Date placed In Business/ investment Cost or anisfordeprW I n (busI'w arn.sanau Recovery Method/ Depreciation Elected section 179 (list vehicles tirst) service use percentage other basis use only) Period Convention deduction cost 25 Special depreciation allowance for qualified listed property placed In service during the tax ear and used more than 50% in a qualified business use 27 28 Add amounts In column (h), lines 25 through 27. Enter here and on line 21, page 1 Section B - Information on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other 'more than 5% owner,' or related person. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. 30 Total businessAnvestment miles driven during the (a) Vehicle (b) Vehicle (c) Vehicle (CO Vehicle (e) Vehicle M Vehicle year (do not Include commuting miles) 31 Total commuting miles driven during the year 32 Total other personal (noncommuting) miles driven 33 Total miles driven during the year. Add lines 30 through 32 34 Was the vehicle available for personal use Yes No Yes No Yes No Yes No Yes No Yes No during off-duty hours? 35 Was the vehicle used primarily by a more than 5% owner or related person? 36 Is another vehicle available for personal use? Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you meet an exception to completing Section 8 for vehicles used by employees who are not more than 5% 37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your Yes No employees? 38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See Instructions for vehicles used by corporate officers, directors, or 1 % or more owners 39 Do you treat all use of vehicles by employees as personal use? 40 Do you provide more than five vehicles to your employees, obtain Information from your employees about the use of the vehicles, and retain the Information received? „ . . 41 Do you meet the requirements concerning qualified automobile demonstration use? Note: if your answer to 37, 38, 39, 40, or 41 Is "Yes," do not complete Section B for the covered vehicles. 43 Amortization of costs that began before your 2003 tax year 31625WO-21-03 Form 4562 (2003) 21 11 1 1 1 '710AAC 19 Sn7 onni nrn1n VTAIr•a f)r Carl r_1%UVTrT. ITAT.T.T`.V 1) r% C;n~ 1