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Item 8.1 Teen Esteem Exh 16
oa a —axws + ,r. .nY H +an _,... r�nn�- ctFxYfi�*.:3'�F i'cM3,v %•Wa9E1�Wf9x', �A+YkRXdMnYFXC we�rlP�h!M R,.:e�+aAi}fYA+mP8d354nmMwaBSM T ! °T S CITE OF DUBLINRECEIVED CITY OF DUBLIN JAN 2 9 2009 COMMUNITY GROUP /ORGANIZATIONAWY MANAGER'S OFFICE FUNDING REQUEST APPLICATION PACKET Fiscal Year 2009 -2010 Section 2: Application for Community Group /Organizational Funding SECTION 2 Page 1 of 22 EXHIBIT )�" I COMMUNITY GROUP /ORGANIZATION APPLICATION FOR FUNDS COVER PAGE AGENCY NAME: TEEN ESTEEM PROPOSED PROJECTIPROGRAM NAME: EQUIPPING YOUTH TO MAKE HEALTHY CHOICES FUNDING AMOUNT REQUESTED: $6,000 SECTION 2 Page 2 of 22 d CITY OF DUBLIN Fiscal Year 2009 -2010 Board President (if Please list the Primary Project Contact Per! project/program during the funding period. Linda Turnbull Director Contact Person for Project/Program Job Title 925 - 855 -9941 lnda@teenesteem.com Work Phone Email SECTION 2 Page 3 of 20 Fax about this application and 9" Federal Tax Identification No. (required) 20- 1598494 City of Dublin Business License No. (required) SECTION 2 Page 4 of 20 City of Dublin Fiscal Year 2009-2010 Application for Funds 3. Proposed Project/Program Information (Do not describe Organization.) Agency ""is 00% disbursement at the bead a, of the Fiscal Year. 9 nnm � if x Agency is not requesting 100% disbursement at the beginning of the Fiscal Please vrb'✓ide the frequencv, that reimbursements will be submitted t, e.g., monthly, quarterly, at project completion, etc. SECTION 2 Page 5 of 20 9 Cr 12 V City of Dublin Fiscal Year 2009 -2010 Application for Funds a. How would the requested funds be used? ■ Describe, in detail, the PROPOSE] ■ B 11 d AlLf u ate te ac xt is cepta , e. ■ Identify if the proposed project/program is a new ■ An vailable through for` Fallon Middy W. Young, ener+, y as well as a li Id be scheduled t would-be in ad, The importance of making Media influences - Consequences of choices /PROGRAM (not the Agency). extension of an ow Teen Esteem to provide school le School, Dublin High School and speakers would incorporate multi - idents in an assembly format. The iroughout the school year. ; The classroom presentations) alreadv Local professionals would provide parent education events for prior to the scheduled school assembly . covering the identified - Influences of the media and the Internet - Types of choices youth in the Dublin School District are m risk adolescent behavior - Body Image, eating disorders and'cutting - Understanding daughters /sons' - Development of the teen brain - Parenting and how to better communicate with your child - Today's culture of drugs, alcohol and sex - Depression /suicide - Blended families and how to make it work SECTION 2 Page 6 of 20 area of high Teen Esteem partners with local doctors, marriage and family counselors, psychologists, psychiatrists, and school administrator who specialize in the identified topics. b. How would the PROPOSED PROJECT/PROGRAM address an unmet community need and improve the quality of life for Dublin residents. Why is this project/program needed? (Additional page may be added; if needed): The attached letter Students in Dublir pressures and cha types of challenge have the ability to hear about the typ a manner in which sorts the necessity for Teen Esteem - to agree with the truth that teens are f g high risk activities such as substa r also seeing an increase in the amou t some cases thoughts of suicide. Loo ants who have not only thought abou I mbly is to encour order to secure a future and to side, but to the a the types of so are the 31 youth and ;h as well as level and in students to ure that will a of plan. In the jast year there have been five junior high and high school `students who have committed suicide in our valley. As thefrequency fl# =these setbacks rise, the age of those who make them gets younger, due to the level of exposure that all children have'to these high risk activities (primarily through the ever ''changing world of techn"Ol!ogy and the media), There is a desperate need fofteens and pre- teens,to" hear ACCURATE information regarding PERTINENT issues in their lives, communicated by COMPASSSIONATE speakers who genuinely care about the well being of students today and :,in the future. The information we share is relevant, updated, and in touch with the real issues confronting the emerging generation. There is a great need today to come alongside youth and offer all the assistance we can to equip, educate and empower them as they navigate through the challenging adolescent years. Teen Esteem can be one avenue in which to do so. Healthy choices made by teens lead to healthier families which leads to a healthier community! SECTION 2 Page 7 of 20 94 N The goal of Teen Esteem is to equip, educate and empower teens, parents, educators and the community on issues related to teens and adolescent health while addressing the importance of self - respect and respect for others. Healthier choices lead to healthier families which lead to a healthier community for Dublin. C. What documentation/data /records support the need for this PROPOSED PROJECT/PROGRAM? Please: identify your data sources. (Additional page may be added, if needed.) America's newl =y defined at -risk group is preteens an families. They experience the highest rate? of depress: disorders and unhappiness of any group of children 1 Development, Luther S.Si & C. Sexton; CDC who begin drinking before the age of 1 dependence than those who wait until ma that teens use today has more than and feedback we receive from the indicAte that not only is our, mess ' I dialogue that manyountI,De©nl "The presentation was amazing. eens fr6m affluent, well- educated t, substance abuse, anxiety his country. (Advances in Child four times more lively to develop rww.theantidrua.com me "The speakers► seemed to understand teenagers a, lot more than other speakers. They did a good job talking about stuff that is tough to Wk about with parepts'an pl friends;" "After the presentation I felt empowered knowing that deserve more than just a hook -up." "I liked the presentation a lot. The speakers: weren`t just presenting, they were talking to us like friends. " "It made me think I realized that I need to start thinking about consequences before I act. " "I felt more empowered after I left. The speakers made an incredibly good point about not settling for less " What Teachers are saying about Teen Esteem: "The speakers related to the students, held their attention, and got the points across"; SECTION 2 Page 8 of 20 r- N City of Dublin Fiscal Year 2009 -2010 Application for Funds d. Specify the PROPOSED PROJECT/PROC Middle and high school students' Parents of middle and high. students e. Proj )gram goals are being met. ),ram's success and impact, 1 page may be added, if ne ants would ;fill out an anonymoUs evaluation arfter the assembly giving feedback as 1 the assembly did or did not Impact them. We would meet with identified aministra iers and students for further fdllow -u p. nts would fill out an evaluation providing us with their feedback. Follow up with nts would be available as requested (it warranted. Total Number of Participants Served by Agency (if applicable) 8,000 Total Number of Dublin Residents Served by A encv (if applicable) 2,500 Total Proposed Participants Served by this Project/Program 2,500 Total Number of Dublin Residents Served by this Project 2,500 SECTION 2 Page 10 of 20 lk City of Dublin Fiscal Year 2009 -2010 Application for Funds 5. Financial Informati a. Expense Budget` Employee Salaries & Benefits $ 66,900 $ 4,500 $ 4,500 Services `& Supplies 6,100 1,500 1,500 Capital Costs 0 " Other - Speaker Training 1.;;00.0 ' Other - Website MaiWFees 400 Other'— Insurance 3,400 Other — Ba"erchant Fees 600 TOTAL $ 78,400 $ 6,000 $ 6,000 Further Comments/E planatigns (if necessary): Progiram/Project costs include costs for speakers and support staff for the project. SECTION 2 Page 11 of 20 ■ City of Dublin Fiscal Year 2009 -2010 Application for Funds b. Revenue Budget ions 11 '1 $ 6,000 IFoundatians 1 20,0001 1 Further Teen Esteem currently o does not have restricted IP TOTAL; I, $ 79,000 $610001 SECTION 2 Page 12 of 20 rr M City of Dublin Fiscal Year 2009-2010 Application for Funds 6. General Agency Information X Past grant applicants may check this box in lieu of completing ite program/or"'ganizational description on file with the City is correct a. List all years that Organization has previously received City Community Development Block Grant - CDBG). NA a-d) if the current. d. Has your agency ever please specify in what No SECTION 2 Page 13 of 20 City of Dublin Fiscal Year 2009 -2010 Application for Funds 7. Required Attachm o Only one (1) co-oy Per AQ projects /programs subm o Applications, without the o Please label attachments; is required, e' be reviewed ; ig Board; identify, tax ;e of insurance Board and h multiple ding. coverage SECTION 2 Page 14 of 20 s IUD status. 5 TM �Sif�ATM Teen Esteem Board Members Tom Mason - Chairman of the Board Linda Turnbull- Director of Teen Esteem Jan Bnmkal - Secretary Tim Barley Becky Pine Dr. Bridget Melson P.O. Box 966 • Danville, California 94526 • Phone: (925) 855 -9941 Email: info @teenesteem.com • Website: www.teenesteem.com Teen Esteem Budget FY 2010: 7/09 thru 6/10 EXPENSE BUDGET: Personnel Costs Salaries and Benefits Non - Personnel Costs Services Supplies Bank and Merchant Fees Speaker Training Website Maintenance and Fees Insurance Total REVENUE BUDGET: Committed /Restricted Funds Non - Committed /Restricted Funds Private Donations Corporate Donations Grants Foundations Total Organization Total Dublin Healthy Choices Project Total Grant Request $ 66,900 $ 4,500 $ 4,500 3,300 2,800 1,500 1,500 600 1,000 400 3,400 $ 78,400 $ 6,000 $ 6,000 Dublin Grant Budget FY2010 $ 29,000 $ 10,000 $ 20,000 6,000 $ 20,000 79,000 $ 6,000 $ Dublin Grant Budget FY2010 i I I I Form 990 OMB No. 15450047 Return of Organization Exempt From I a o 2007 Under section 501(c), 527, or 4947(ax1) of the Internal Mev Co (except blackk lung benefit trust or private foun ) Department of the Treasurryy Internal Revenue Service(77) ► The organization may have to use a copy of this return to satisfy state reporting requirements. A For the 2007 calendar vear. or tax vear heninninn 7/01 . 2007. and endina 6/30 2 008 B Check if applicable: C D Employer Identification Number Please use Address change IRS label Teen Esteem 20- 1598494 or Name change r typ rint 85 Highbridge Court E Telephone number oe. sea Danville, CA 94526 Initial return specific 925- 743 -0438 Instruc• Accounting Termination tions. F method: Cash X Accrual Amended return Other (specify) Application pending • Section 501(cx3) organizations and 4947(a 1) nonexempt H and are not applicable to section 527 organizations. charitable trusts must attach a completed �chedule A H for ?... Yes � No (a) Is this a group return affiliates Form 990 or 990 -EZ )' H (b) If 'Yes,' enter number of affiliates I' G Web site: ► N/A H (C) Are all affiliates included ?.... , .... Yes n No J Organization ty a (If 'No,' attach a list. See instructions.) check only one ......... X 501(c) 3 '4 (insert no.) 4947(a)(1) or 527 H (d) Is this a separate return filed by an K Check here I" if the organization is not a 509(a)(3) supporting organization and its organization covered by a group ruling? n Yes X No gross receipts are normally not more than $25,000. A return is not required, but if the I Group Exem tion Number... ► organization chooses to file a return, be sure to file a complete return. M Check ► Hif the organization is not required L Gross receipts: Add lines 6b, 8b, 9b, and 10b to line 12... ► 76,435. to attach Schedule B (Form 990, 990•EZ, or990•PF). Revenue Expenses, and Changes in Net Assets or Fund Balances See the instructions. 1 Contributions, gifts, grants, and similar amounts received: a Contributions to donor advised funds ...... ............................... 1 a b Direct public support (not included on line la) ............................ 1 b 55,983. c Indirect public support (not included on line la) ........................... 1 c g' a, d Government contributions (grants) (not included on line 1 a) ................ 1 d e latthrough 1d) (cash $ 55, 983 . noncash $ ). 1 e 55,983. 2 2 Program service revenue including government fees and contracts (from Part VII, line 93) .............. 3 3 Membership dues and assessments .................................. ............................... 4 4 Interest on savings and temporary cash investments ...... . ........... ............................... 5 5 Dividends and interest from securities ................................ ............................... 6a Gross rents ............................................................. I 6a b Less: rental expenses .................... ............................... I 6 b c Net rental income or (loss). Subtract line 6b from line 6a .............. ............................... 6c 7 R 7 Other investment income (describe........ 0' ) E v 8a Gross amount from sales of assets other (A) Securities (B) Other E N th y ..... ............................... 8a i t an inventory E b Less: cost or other basis and sales expenses....... 8b c Gain or (loss) (attach schedule) .......................... 8c d Net gaip 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.... I►F] a Gross revenue (not including $ 26,898. of contributions reported on line lb) ............. ............................... I .... I ... 9a 20,452. b Less: direct expenses other than fundraising expenses .................... I 9bj 20,452 . c Net income or (loss) from special events. Subtract line 9b from line 9a ............ Statement..1.... 9c 10a Gross sales of inventory, less returns and allowances ..................... 10a bLess: cost of goods sold .................. ............................... I 10 b c Gross profit or (loss) from sales of inventory (attach schedule). Subtract line lob from line 10a ............................ 10C 11 11 Other revenue (from Part VII, line 103) ............................... ............................... 12 55,983. 12 Total revenue. Add lines 1e, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11 ....... ............................... 13 Program services (from line 44, column ( 8)) .. ............................... I ............... I ....... 13 80, 502. 14 8, 094. x 14 Management and general (from line 44, column (C)) .................. ............................... 15 P E 15 Fundraising (from line 44, column ( D)) ........................ ............................... . ....... N s 16 Payments to affiliates (attach schedule) ..................... . 17 88 596. S 17 Total expenses. Add lines 16 and 44, column (A) ..................... ............................... A 18 Excess or (deficit) for the year. Subtract line 17 from line 12 ........ ............................... . .. 18 —32, 613. 19 28,266. N s 19 Net assets or fund balances at beginning of year (from line 73, column (A)) ........................... 7 T 20 Other changes in net assets orfurrd balances (attach explanation) ..... ............................... 20 S, 21 Net assets or fund balances at end of year. Combine lines 18, 19, and 20 ............................. 21 —4,347. BAA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. TEEA0109L 12/27107 corm wu (zvul) Form 990 2007 Teen Esteem 20- 1598494 Page 2 Statement of Functional Expenses 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. (See instruct.) Do not include amounts reported on line 0. 0. (A) Total (B) Program (C) Management (D) Fundraising 6b, 8b, 9b, 10b, or 16 of Part 1. r 26 64,332. services and eneral 22a Grants paid from donor advised 27 28 funds (attach sch) 29 6,555. 6,555. (cash $ 30 non -cash $ ) 3,350, 3,350. 32 If this amount includes foreign grants, check here.. ► ..... 22a 33 628. 628. 22b Other grants and allocations (aft sch) 34 763. 763. 35 (cash $, 225. 36 non -cash $ ) 37 If this amount includes ► 87. 87 39 37. foreign grants, check here . ..... 22b 40 23 Specific assistance to individuals 41 42 (attach schedule) ..................... 23 227. 43a 12,392. 8,100. 24 Benefits paid to or for members 43b (attach schedule) ..................... 24 43d 25a Compensation of current officers, 43e directors, key employees, etc. listed in Part V- A ........................... 25a 0. 0. 0. 0. b Compensation of former officers, directors, key employees, etc. listed in Part V- B ........................... c Compensation and other distributions, not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958( c)( 3) (B) ............................ 26 Salaries and wages of employees not included on lines 25a, b, and c......... 27 Pension plan contributions not included on lines 25a, b, and c......... 28 Employee benefits not included on lines 25a . 27 ......................... 29 Payroll taxes ......................... 30 Professional fundraising fees........... 31 Accounting fees ....................... 32 Legalfees ............................ 33 Supplies ............................. 34 Telephone ............................ 35 Postage and shipping ................. 36 Occupancy ........................... 37 Equipment r7tal and maintenance..... 38 Printing and publications ............... 39 Travel ..................... :.......... 40 Conferences, conventions, and meetings ........ 41 Interest .............................. 42 Depreciation, depletion, etc (attach schedule) .... 43 Other expenses not covered above (itemize): a See Statement 2 ------------------- b ------------------- c ------------------- d ------------------- e ------------------- f 9------------- - - - - -- 44 Total functional expenses. Add lines 22a through 43g. (Or amzations completing columns B D), car these totals to lines 13.15..... 25b 0. 0. 0. 0. 25c 0. 0. 0. 0. 26 64,332. 64,332. 27 28 29 6,555. 6,555. 30 31 3,350, 3,350. 32 33 628. 628. 34 763. 763. 35 225. 225. 36 37 38 87. 87 39 37. 37. 40 41 42 227. 227. 43a 12,392. 8,100. 4,292. 43b 43c 43d 43e 43f 43 44 88,596. 80,502.1 8,094.1 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 ?....... 01E] Yes No If 'Yes,' enter (i) 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 $ BAA TEEA0102L 08/02 /07 Form 990 (2007) Form 990 (2007) Teen Esteem 20- 1598494 Page 3 FRIJJWStatement of Program Service Accomplishments (See the instructions.) 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. What is the organization's primary exempt purpose? ' _ _ _ _ _ _ Program Service Expenses All organizations must describe their exempt purpose achievements in a clear and concise manner. State the number of (R (4j organizations and and clients served, publications issued, etc. Discuss achievements that are not measurable. (Section 501(c)(3) and (4) organ- 4947(a)S1) trusts; but izations and 4947(a)(1 nonexempt charitable trusts must also enter the amount or rants and alllocations to others. options for others.) a Teen Esteem was organized for the purpose_of educating, eguipinc_ and _ -------- - - - - -- --- - - - - -- -- - - - -- _ e_ mpower _i_ng_teen_age_s_tuden_ts_ _a_nd_ parents_ _t_o_ma_ke_ healthy cho_i_c_es_ _in-the. areas of sex, drugs and alcohol. - ------------------------------------------------------ (Grants and allocations $ If this amount includes foreign grants, check here... ► 80,502. b ------------------------------------------------------ ------------------------------------------------ - - - - -- N------------------------------------------------ - - - - -- y------------------------------------------------ - - - - -- ---------------------------------------------------- (Grants and allocations $ ) If this amount includes foreign grants, check here... C ------------------------------------------------------ ------------------------------------------------ - - - - -- ------------------------------------------------ - - - - -- ---------------------------------------------------- Grants and allocations $ If this amount includes foreign grants, check here... d ------------------------------------------------------ ------------------------------------------------ - - - - -- ------------------------------------------------ - - - - -- ------ - - - -ns --------------------------------- - - ---- - (Grants and allocations $ If this amount includes foreign rants, check here... e Other program services ............................. (Grants and allocations $ If this amount includes foreign grants, check here... . f Total of Program Service Expenses (should equal line 44 column (B), Program services) ...................... ► 80,502. BAA Form 990 (2007) Z TEEA0103L 12/27/07 Form 990 (2007) Teen Esteem 20-1598494 Page 4 MMFMMMI Rnll2nra Qhaafc /Can tho incfrowfinnc 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 .................................................. 26,913. 45 14,636. 46 46 Savings and temporary cash investments ...................................... — 47a Accounts receivable ............................... 47a b Less: allowance for doubtful accounts .............. 47b 530.. 47c M %, WE VMS, 48a Pledges receivable ................................ 48a b Less: allowance for doubtful accounts .............. 48b 48c 49 49 Grants receivable ......................... I .......................... I ....... 50a 50 a Receivables from current and former officers, directors, trustees, and key employees (attach schedule) .................................................. b Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) (attach schedule) ............... 50b A s E T s 51 a Other notes and loans receivable (attach schedule) ................................. 51a b Less: allowance for doubtful accounts .............. 51 bi 51 c 52 52 Inventories for sale or use .................................................... 53 53 Prepaid expenses and deferred charges ....................................... 54a 54a Investments — publicly-traded securities ................. - H Cost H FIVIV 54b b Investments — other securities (attach sch) .............. 01 Cost FMV 11 55a Investments — land, buildings, & equipment: basis.. I 55al b Less: accumulated depreciation (attach schedule) ................................. I 55b 55cl 56 56 Investments — other (attach schedule) ........................................ is 57a Land, buildings, and equipment: basis .............. 57al 1,139. b Less: accumulated depreciation (attach schedule) ............. Statement.3 .... 57bi 974. 392. 57C 165. 58 Other assets, including program-related investments (describe I ► . 2,001. 58 29,836. 59 14,801. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Total assets (must equal line 74). Add lines 45 through 58 . ..................... 60 Accounts payable and accrued expenses ...................................... 1,570. 60 19,148. 61 61 Grants payable .............................................................. 62 L 62 Deferred revenue ............................................................ ME 63 A B L I T I 63 Loans from officers, directors, trustees, and key employees (attach schedule) .................................................. 64a Tax-exempt bond liabilities (attach schedule) .................................. b Mortga6s and other notes payable (attach schedule) ...................................... 64a E s 65 Other liabilities (describe I ►.. 65 1,570. 66 19,148. . . . . . . . . . . . . . . . . . . . . . . . 66 Total liabilities. Add lines 60 through 65 ....................................... T A Organizations that follow SFAS 117, check here ► 0 and complete lines 67 through 69 and lines 73 and 74. 67 Unrestricted ................................................................. 68 Temporarily restricted ........................................................ 28,266. 67 —4,347. 68 69 69 Permanently restricted ....................................................... 0 R Organizations that do not follow SFAS 117, check here 1, Eland complete lines 70 through 74. 1 70 Capital stock, trust principal, or current funds .................................. 71 D 8 A k N c 71 Paid-in or capital surplus, or land, building, and equipment fund . . . ............. 72 Retained earnings, endowment, accumulated income, or other funds............ 73 Total net assets or fund balances. Add lines 67 through 69 or lines 70 through 72. (Column (A) must equal line 19 and column (B) must equal line 21)......... 74 Total liabilities and net assets/fund balances. Add lines 66 and 73 .............. 72 28,266. I ~' 73 —4, 347 . 29,836. 74 14,801. IBAA Form 990 (2007) ITEEA0104L 08/02/07 r Form 990 (2007) Teen Esteem 20- 1598494 Page 5 Reconciliation of Revenue per Audited Financial Statements with Revenue per Return (See the instructions.) per week devoted to position (if not paid, enter -0 -) a Total revenue, gains, and other support per audited financial statements ..... ............................... account and other allowances a 55,983. compensation plans b Amounts included on line a but not on Part I, line 12: 1 Net unrealized gains on investments ............ ............................... bl 0. 0. 2Donated services and use of facilities .... . ...... ............................... b2 EEI 35.00 3Recoveries of prior year grants ................. ............................... 163 Danville, CA 94526 40ther (specify): ------------------ ------- JaMce A0y t ____________ Secretary 154 0. 0. Add lines b1 through b4 ................................................... ............................... 10.00 b c 55,983. c Subtract line b from line a ................................................. ............................... 4: d Amounts included on Part I, line 12, but not on line a: 1 Investment expenses not included on Part I, line 6b ............................. I d1 20ther(specify): ___________________ ----- - - - - -- 0. 0. 0. 85 Highbridge Ct.________ d2 Addlines d1 and d2 ...................................................... ............................... Danville, CA 94526 d el 55,983. e Total revenue (Part I, line 12). Add lines c and d ........................................................ 0-1 Reconciliation of Ex enses er Audited Financial Statements with Expenses per Return 0. a Total expenses and losses per audited financial statements ................. ............................... 0. a 0 88,596. _8_5_H_icihbridge_C_t_.________ Danville, CA 94526 b Amounts included on line a but not on Part I, line 17: 1 Donated services and use of facilities ........... ............................... b 1 Tom Mason Director 0. 2Prior year adjustments reported on Part 1, line 20 ............................... b2 --------------------- 85 Highbrigge Ct.________ 0 31-osses reported on Part I, line 20 ............... ............................... b3 Danville, CA 94526 40ther (specify): ------------------------------ Rick Weisser Director b4 0. 0. 85 Highbridge_Ct. ______ --------------------------------------- Addlines bl through b4 ................................................... ............................... b Danville, CA 94526 c 88,596. CSubtract line b from line a ................................................. ............................... d Amounts included on Part 1, line 17, but not on line a: 1 Investment expenses not included on Part I, line 6b ............................. I dill" 20ther(specify): -------------------------- - - -- d2l I d Addlines dl and d2 ...................................................... ............................... e ---88,596. e Total expenses (Part I, line 17). Add lines c and d ........................ ............................... 11 Current Officers, Directors, Trustees, and Key Employees nr kev emnlnvee nt anv time during the vear even if thev were not compensated.) (List each person who was an officer, director, trustee, (See the instructions.) BAA TEEA0105L 0810"1!0/ rorm vvu kzuv /) (B) Title and average hours (C) Compensation (D) Contributions to (E) Expense (A) Name and address s per week devoted to position (if not paid, enter -0 -) employee benefit plans and deferred account and other allowances compensation plans Linda President 0. 0. 0. _Turnbull ____ _____ 8_5_H_ighbridcie_C_t_. 35.00 J Danville, CA 94526 JaMce A0y t ____________ Secretary 0. 0. 0. 85 Highbridge_Ct._______ _ 10.00 Danville, CA 94526 Tim Barley Vice President 0. 0. 0. 85 Highbridge Ct.________ 5.00 Danville, CA 94526 Becky_ Pine_____________ Director 0. 0. 0. 0 _8_5_H_icihbridge_C_t_.________ Danville, CA 94526 Tom Mason Director 0. 0. 0. --------------------- 85 Highbrigge Ct.________ 0 Danville, CA 94526 Rick Weisser Director 0. 0. 0. 85 Highbridge_Ct. ______ 0 Danville, CA 94526 BAA TEEA0105L 0810"1!0/ rorm vvu kzuv /) 20- 1598494 Page 6 Teen Esteem 75 a Enter the total number of officers, directors, and trustees permitted to vote on organization business at board meetings.. ►_ — — — — — —p— —y — — b Are sted in Schedule A, Part Itror highest compensated prlofessional d9otOher independenticontractors sted compensated Scheodules A, Part II -A or II -B, related to each other through family or business relationships? If 'Yes,' attach a statement that 75EX' identifies the Individuals and explains the relationships) ....... • .... • • • • C Do d In SchedulelACPast Irorthighest compensated professional and9otherrrmd independent contractors listed in Schedule liste ► 75tions, whether tax exempt or taxable, that are related ed organization'............ ................... d in the instructions. 7 d Does the or anization have a written conflict of interest olic ? .............................. . Former Officers, Directors, Trustees, and Key Employees That Received Compensation or Other Benefits (If any former officer, director, trustee, or key employee received compensation fi other a benefits appropriate column. See during the year, list that person below and enter the amount of compensation or other benefits in the .L— }.,,,. +, ^^c � (E) Expense (B) Loans and (A) Name and address Advances None -------------- - - - - -- (C) Compensation (D) Contributions to (If not paid, employee benefit enter -0 -) plans and deferred compensation plans account and other allowances 76 Did the organization make a change in its activities or methods of conducting activities? 76 X If 'Yes,' attach a detailed statement of each change .............. . 77 Were any changes made in the organizing or governing documents but not reported to the IRS ?........... • • • • • • • • • • • • 77 If 'Yes,' adtach a conformed copy of the changes. 78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return ?... 7$b N A b If Yes, has It filed a tax return on Form 990 -T for this yearZ ...... ...........••.............••••• 79 Was there a liquidation, dissolution, termination, or substantial contraction during the ................... 80a Is the organization related (other than by association with a statewide or nationwide organization) through common ..., 80a X membership, governing bodies, trustees, officers, etc, to any other exempt or nonexempt organization ?........... b If 'Yes,' enter the name of the organization ► N/A — — — — — — — — — — — — — — — — - and check whether it is exempt or nonexempt, t ----------------------- - - - - -- 81a 81 a Enter direct and indirect political expenditures. (See line 81 instructions.) .... • • • • • • .......... 81 b X b Did the organization file Form 1120 -POL for this ear? ........... . .................. ..................... Form 990 (2007) BAA TEEA0106L 12/27107 Form 990 2007) Teen Esteem 20- 1598494 Page 7 Other Information (continued) Yes I 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 revenue in Part I or as an expense in Part 11. (See instructions in Part 111.) ................ I 82b N/A 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 oranization include with every solicitation an express statement that such contributions or gifts were nottax deductible? .................................................................. .............................. 84b N A 85a 501(c)(4), (5), or (6). 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. d Section 162(e) lobbying and political expenditures esmbers ................. ' ' .............. 85d N/A � 1`� �1 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 85f? .. ............................... 85g N A In 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? .............. ............................... 85h 86 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line12 ................................................. ............................... 86a N/A bGross 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 . bGross 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 a 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 .......................................................... ............................... . b At any time during the year, did the organization, directly or indirectly, own a controlled entity within the meaning of section 512(b)(13)? If 'Yes,' complete Part XI .. ............................... . ................. . ................. ► 88b OX 89a 501(c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under: �w 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 ......................................................... ............................... 89b X 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 . e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction ?.. 89e X f All organizations. Did the organization acquire a direct or indirect interest in any applicable insurance contract? ........ 89f X g For supporting organizations and sponsoring organizations maintaining donor advised funds. Did the supporting organization, or a fund maintained by a sponsoring organization, have excess business holdings at any time during theyear? .......................................................................... ............................... "89 X 90a List the states with which a copy of this return is filed ► CA -------------------------------- - - - - -- b Number of employees employed in the pay period that includes March 12, 2007 (See instructions.) ................................................................ ................. ............. 90b 0 91 a The books are in care of l- Linda Turnbull Telephone number ...25- 743 -0438 Locatedat► 85 Highbridcre —Cts— Danville, CA-------------------- ZIP +4 ►_9_45_2_6__ b At any time during the calendar year, did the organization have an interest in or a signature or other authority over a kYesNo, financial account in a foreign country (such as a bank account, securities account, or other financial account)? ......... 91 b If 'Yes,' enter the name of the foreign country... ► See the instructions for exceptions and filing requirements for Form TD F 90 -22.1, Report of Foreign Bank and Financial Accounts. BAA TEEA0107L 09/10/07 Form 990 (2007) ■ M A Form 990 (2007) Teen Esteem 20- 1598494 -- Yes No c At any time during the calendar year, did the organization maintain an office outside of the United States ? . ............ 91 c X If 'Yes,' enter the name of the foreign country... ►_ _ _ 92 Section 4947 a 1 nonexempt charitable trusts fllin Form 990 in lieu of Form 1041 — Check here. ► L ()() P g N /.A... ............... an enter the amount of tax - exempt interest received or accrued during the tax year ►� 92 I N/A #I Dnnlvme �.f 1 D .1 w Note: Enter gross amounts unless A otherwise indicated. Business code 93 Program service revenue: a b C 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............ 7 business income Excluded by section 512, 513, or 514 B E �) (�) (�) Related orexempt Amount Exclusion code Amount function income warn- rnrormauon Ke arclin T Name, address, and EIN of corporation partnership, or disregarded entity i N/A axable Subsidiaries and Disregarded Entities See the instructions. (B) (C) (D) (E) Percentage of Nature of activities Total End -of -year ownership interest income assets % 0 % EN. O Information Regarding Transfers Associated with Personal Benefit Contracts See the 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) BAA TEEA0108L 12/27/07 Form 990 (2007) -orm wu (2007) 'teen Esteem 20-1598494 Page 9 Information Regarding Transfers To and From Controlled Entities. Complete only if the organization is a controlling organization as defined in section 572(6)(73). Yes No 106 Did the reporting organization make any transfers to a controlled entity as defined in section 512(b)(13) of the Code? If Yes,' com fete the schedule below for each controlled entity ............................. ............................... X (B Name, addA re', of each Employer Identification ) Descr i ptD) ion of (D) controlled entity Number transfer Amount of transfer a Yes No 108 Did the organization have a binding written contract in effect on August 17, 2006, coverin g the interest, rents, ro alties, and annuities described in question 107 above ? .......................9 y X Under penalties of pein is ret rn, includ ing accompan ing sched les and stateinants, and to the Est of my knowledge and belief, it is true, correct, and cohn officer) cl based do all agin atwn o�whTCh preparer has any knowledge. Please ► U Sign Signature of officer Date Here ► Linda Turnbull, President Type or print name and title '9 Paid Preparer's rzy Date Prepar is SSN or PTIN (See signature ► Check if Genera Instruction X) Pre- g Dan Thompson , CPA d employed bl N/A parer's Firm's name (or THOMPSON & DE PRETIS use yours if self. employed), ► 6700 KOLL CENTER PKWY STE 160 EIN ► N/A Only address, and PLEASANTON, CA 94566 Phone no. (925) 600 -8500 BAA Form 990 (2007) TEEA0110L 08/03/07 ■ SCHEDULE A Organization Exempt Under (Form 990 or 990 -EZ) Section 501(cx3) (Except Private Foundation) and Section 501(e), 501(f), 501(k), 501(n), or 4947(ax1) Nonexempt Charitable Trust Supplementary Information — (See separate instructions.) Internal Revenue Serevice ry ► MUST be completed by the above organizations and attached to their Form 990 or 990 -EZ. Name of the organization Employer identification number Teen Esteem 120-1598494 Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See instructions. List each one. If there are none, enter 'None.') (a) Name and address of each (b) Title and average (c) Compensation (d) Contributions (e) Expense employee paid more hours per week to employee benefit account and other than $50,000 devoted to position plans and deferred allowances None ------------------- - - - - -- Total number of other employees paid over $50, 000 ..... ............................... ► 0 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 I (b) Type of service I (c) Compensation None ---------------------------------- - - - - -- Total number of others receiving over $50,000 for professional services.......... ► 0 I Compensation of the Five Highest Paid Independent Contractors for Other Services (List each contractor who performed services other than professional services, whether individuals or firms. If there are none, enter 'None.' See instructions.) (a) Name and address of each independent contractor paid more than $50,000 None ---------------------------------- - - - - -- Total number of other contractors receiving over $50,000 for other services ..... y. ► Q BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990 -EZ. (c) Compensation Schedule A (Form 990 or 990•EZ) 2007 4 41— Schedule A (Form 990 or 990 -EZ) 2007 Teen Esteem 20- 1598494 Pa e 2 MEM 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? ............................................. ............................... I 2al I X b Lending of money or other extension of credit? ................. ............................... . .................... I 2bi i X c Furnishing of goods, services, or facilities? ........................................... ..............................I 2cl I X d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)? .......................... L2d e Transfer of any part of its income or assets? ........................................ ............................... 2el I X 3a Did the organization make grants for scholarships, fellowships, student loans, etc? (If 'Yes,' attach an explanation of how the organization determines that recipients qualify to receive payments .) ........................... 3a X bDid the organization have a section 403(b) annuity plan for its employees? ............ ............................... 3b X c Did the organization receive or hold an easement for conservation purposes, including easements to preserve open space, the environment, historic land areas or historic structures? If 'Yes,' attach a detailed statement ........... . ................................................ I..................... 3c X d Did the organization provide credit counseling, debt management, credit repair, or debt negotiation services ?........... 3dJ I X 4a Did the organization maintain any donor advised funds? If 'Yes,' complete lines 4b through 4g. If 'No,' complete lines 4fand 4g .......................................................................... ............................... 4a X b Did the organization make any taxable distributions under section 4966? .............. ............................... 0 NIA C Did the organization make a distribution to a donor, donor advisor, or related person ? .......................... . ...... 4c N A d Enter the total number of donor advised funds owned at the end of the tax year . ............................... op. N/A e Enter the aggregate value of assets held in all donor advised funds owned at the end of the tax year............ 01 N/A f Enter the total number of separate funds or accounts owned at the end of the tax year (excluding donor advised funds included on line 4d) where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts .......................................... ............................... IN. 0 g Enter the aggregate value of assets held in all funds or accounts included on line 4f at the end of the tax year... ► 0. BAA T TEEA0402L 12/27/07 Schedule A (Form 990 or Form 990 -EZ) 2007 Schedule A Form 990 or 990 -EZ 2007 Teen Esteem 20- 1598494 Page 3 Reason for Non - Private Foundation Status (See instructions.) I certify that the organization is not a private foundation because it is: (Please check only ONE applicable box.) 5 F� A church, convention of churches, or association of churches. Section 170(b)(1)(A)(i). 6 Aschool, Section 170(b)(1)(A)(ii). (Also complete Part V.) 7 F] A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(iii). 8 F] 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 ► 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). 77 (Also complete the Support Schedule in Part IV -A.) 11a RI 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 n A community trust. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV -A.) 12 n An organization that normally receives: (1) more than 33 -1/3% of its support from contributions, membership fees, and gross receipts from activities related to its 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(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 otherwise meets the requirements of section 509(a)(3). Check the box that describes the type of supporting organization: ► Type I Type II Type III - Functionally Integrated nT pe III Other Provide the following information ahnnt fha cttnnn.tea .....ftn. .; A2 : a.. ._a:_ . Name(s) of supported organization(s) -- --- ----_ -. _.. -... Employer identification number (EIN) _... ...� ....pi.... ..... v.yw. - Type of organization (described in lines 5 through 12 above or IRC section) Ions. ,Vee Instructio Is the supported organization listed in the supporting organization's governing documents? ns.) Amount of support Yes No Total............................................................................ ............................... 0. 14 n An organization organized and operated to test for public safety. Section 509(a)(4) (See instructions.) IBAA Schedule A (Form 990 or 990 -EZ) 2007 TEEA0407L 12/27/07 Cl 1 Schedule A Form 990 or 990 -EZ) 2007 Teen Esteem , 20- 1598494 Page 4 Support Schedule (Complete only if you checked a box on line 10, 11, or 12.) Use cash method ofaccounting. Note: You may use the worksheet in the instructions for convertin from the accrual to the cash method of accountin Calendar year (or fiscal year beginning in) ► a) (( b) c (00 d �0 ..................... 2006 2005 2b04 2003 of Total 15 Gifts, grants, and contributions received. (Do not include unusual grants. See line 28.)... 103, 656. 177, 435. 180, 973. 462,064. 16 Membership fees received...... 0 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 ............. 0 18 Gross income from interest, dividends, amts recd from payments on securities loans (sec. 512(a)(5)), rents, royalties, income from similar sources, and unrelated business taxable income (less sec. 511 taxes) from businesses acquired by the or anzation after June 30, 1975 .. 0 19 Net income from unrelated business activities not included in line 18....... 0 20 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf ................... 0 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 ....... 0 22 Other income. Attach a schedule. Do not include gain or (loss) from sale of capital assets . • ............... 0. 23 Total of lines 15 through 22 .... 103 656. 177 435. 180, 973. 462,064. 24 Line 23 minus line 17.......... 103, 656. 177 435. 180, 973. 462, 064. 25 Enter 1% of line 23............ 1 1 037. 1 1,774.1 1,810.1 26 Organizations described on lines 10 or 11: a Enter 2% of amount in column (e), line 24 ............... 0, 26a 94241. 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 2003 through 2006 exceeded the amount shown in line 26a. Do not file this list with your return. Enter the total of all these excess amounts .................................. ............................... ► 26b: 759. c Total support for section 509(a)(1) test: Enter line 24, column ( e) .......... ............................... 0, 26c 462 064 . d Add: Amounts from column (e) for lines: 18 19 : 22 26b 759. 26d 759. e Public support (line 26c minus line 26d total) ............................. ............................... ► 26e 461 305. f Public support percentage line 26e numerator divided b line 26c (denominator)) ...... .................. � 26f 99.84 % 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: (2006) ------ - - - - -- ( 2005)---=-- - - - - -- (2004)------ - - - - -- (2003)---- - 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 b, 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: (2006) ------ - - - - -- (2005)------ - - - - -- (2004)------ - - - - -- (2003)--------- - - -- ( Add: Amounts from column (e) for lines: 15 16 17 20 21 27c d Add: Line 27a total..... and line 27b total............ 27d e Public support (line 27c total minus line 27d total) ........................ .............. ......... ........ 27e f Total support for section 509(a)(2) test: Enter amount from line 23, column (e) .. 0- 27f g Public support percentage (line 27e (numerator) divided by line 27f ( denominator )) ....................... ► 27 g, $ h Investment income ercenta a line 18, column a numerator divided by line 27f denominator ......... ► 27h % 28 Unusual Grants: For an organizatiomdescribed in line 10, 11, or 12 that received any unusual grants during 2003 through 2006, 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 file this list with your return. Do not include these grants in line 15. SAA TEEA0403L 12/27/07 Schedule A (Form 990 or 990 -EZ) 2007 Schedule A (Form 990 or 990-EZ) 2007 Teen Esteem 20-1598494 Page 5 11IR Private School Questionnaire (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 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, andscholarshipsZ ................................................................................................ 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 servesZ ............................................. 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? ..................................................................................... bAdmissions policies? .............................................................................................. c Employment of faculty or administrative staff? ...................................................................... d Scholarships or other financial assistance? ......................................................................... e Education �l policies? .............................................................................................. fUse of facilities? ................................................................................................... gAthletic 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? ............. ............................... 31 If you answered 'Yes' to either 34a or b, please explain using an attached statement. 35 Does the organization certify that it K6s complied with the applicable requirements of sections 4.01 through 4.05 of Rev Proc �, 1975.2 C.B. 587, covering racial nondiscrimination? If 'No,' attach an explanation ................................................................... 3E SAA TEEAD404L 12/27/07 le A (norm 99V or No ITEEAD405L 12/27/07 G 7 I I Schedule A (Form 990 or 990•EZ) 2007 Teen Esteem 20- 1598494 Page 7 WIRM Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations (See 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 (i) Cash ...................................................................... ............................... 51a i X (ii)Other assets ............................................................... ............................... a ii X 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 ii X (iii)Rental of facilities, equipment, or other assets ............................... ............................... b (iiii) X (Iv) Reimbursement arrangements .............................................. ............................... b iv X (v)Loans or loan guarantees ................................................... ............................... b v X (vi)Performance of services or membership or fundraising solicitations ........... ............................... b vi X c Sharing of facilities, equipment, mailing lists, other assets, or paid employees ..... ............................... c X 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 fair in the goods, other assets, or services given by the reportin organization. If the organization received" less than market value an transaction or sharin arrangement, show in column d the value of the oods, other assets, or services received: no. b ( d Linea Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements N/ 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? .......................... ► Yes Q No C{AA xnauuie M krUnn Vw vi 77V-Lc) cvvi TEEA0406L 12/27107 Schedule B (Form 990, 990 -EZ, Schedule of Contributors or 990 -PF) Department of the Treasury Supplementary Information for lntr 41 Revemie Service line 1 of Form 990, 990 -EZ and 990 -PF (see instructions) Name of organization Teen ve+-acm OMB No. 1545.0047 2007 Employer identification number 20- 1598494 Organization type (check one): Filers of: Section: Form 990 or 990 -EZ X 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 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 — For organizations filing Form 990, 990 -EZ, or 990 -PF that received, during the year, $5,000 or more (in money or property) from any one contributor. (Complete Parts I and II.) Special Rules — XOFor a section 501(c)(3) organization filing Form 990, or Form 990 -EZ, that met the 33-1/3% support test of the regulations under sections 509(a)(1) /170(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 11.) ❑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, ll, 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 exclusivelyfor 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 ear. ) .................................... b. $ 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 -PF) but they must check the box in the heading of their Form 990, Form 990 -EZ, or on line 2 of their Form 990 -PF, to certify that they do not meet the filing requirements of Schedule B (Form 990, 990 -EZ, or 990•PF). BAA For Paperwork Reduction Act Notice, see the Instructions Schedule B (Form 990, 990 EZ, or 990 PF) (2007) for Form 990, Form 990 -EZ, and Form 990 -13F. Z a TEEA0701L 07/31/07 Schedule B (Form 990, 990 -EZ, or 990 -PF ) (2007) Page 1 of 1 of Part Name of organization Employer identification number Teen Esteem 120-1598494 Contributors (See Specific Instructions.) (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate Type of contribution contributions 1 Cornerstone_ Fellowship_____ Person X ______ __ ________ Payroll 348 North_ Canyons_ Parkway _____ _____ ____ __ ___ $ - - - - -- 8,000_ Noncash' (Complete Part II if there Livermore CA 94 551 — — _ _ _ — — — is a noncash contribution.) (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate Type of contribution contributions 2 Walsh Foundation ------------------------------------- Person X Payroll PO_Box_566_ ____________ ____ ______ $ - - - - -- 5L000_ Noncash (Complete Part II if there Diablo, CA 94528 - - - -_ -- ------------------------------ is a noncash contribution.) (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate Type of contribution contributions Person ------------------------------- - - - - -- Payroll $ Noncash (Complete Part II if there ------------------------------------- is a noncash contribution.) (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate Type of contribution contributions Person ------------------------------- - - - - -- Payroll $ Noncash (Complete Part II if there r is a noncash contribution.) (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate Type of contribution contributions Person ------------------------------- - - - - -- Payroll $ Noncash (Complete Part II if there ------------------------------------- is a noncash contribution.) (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate Type of contribution contributions Person ------------------------------- - - - - -- Payroll $ Noncash (Complete Part II if there is a noncash contribution.) BAA TEEA0702L 07131/07 5cheoule 0 (corm yyu, yyu -tz, or yyu -i--r) (zuul) ' IT ' ` � No. from Part I or Nomcmsh Property (See Specific !�-------' Description of noncash Property given ^ TN21 ---------------------________________ No. from Part I No. from Part I No. from Part I Description of noncash Property given I of 1 of Part 8 47t! 27 FMV (or estimate) Date received (see instructions) I ----------- 1- W FMV (or estimate I te Da received (see _____________________________________ ________________________________________ __—_—_—____________—__________—__—______ -------------------------------------- �* ( --�`-------___—L________ Description of noncash Property given (C) FMV (or estimate | Date (see / received instruction s� ____________________________ ______________________________ ------------------------------ ---------------------_________/�__________ Description of noncash Property given -j ______________________________________ ______________________________________ No. from Part I No from Fart I BAA Description of noncash Property given _--___—________ ___________________ _____—__________—______—___ ____—_______—_--________ Description of noncash property given ' (d) FMV / Da��c�ved (see � ----------- l' ' (d) FMV | Dw�enwkmd (see 1 ----------- 1. --------- FMV (or estimate Date received ______________________________________ ---------------------------------------- ---- _________________________________ --------- ------------______ |� / -------------�--------__—L________ TcsA0703L 08m1x07 from xiianlzation tra e 1 of 1 of Part III esteem Employer identification number Exclusive /y religious, charitable, etc, individual contributions to section 501(c)(7),(8), 20- or (104 organizations aggregating more than $1,000 for the year.(Complete cols (a) through ndhefol owing 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 (b) — see instructions.) ........... b. $ N/A (c) M Purpose of gift Use of gift (d) Description of how gift is held N/A (e) Transferee's name, address, and ZIP + q Transfer of gift Relationship of transferor to transferee I Purpose of gift Use of gift -- — — — — — — — — — — — — , `d Description of how gift is held (e) Transferee's name, address, and ZIP + q Transfer of gift Relationship of transferor to transferee Purpose of gift Use of gift Description of how gift is held (e) Transferee's name, address, and ZIP + q Transfer of gift Relationship of transferor to transferee Purpose of gift I (p) Use of gift Description of how gift is held (e) Transferee's name, address, and ZIP + q Transfer of gift Relationship of transferor to transferee TEEA0704L 08/01!07 Schedule B (Form 990, 990 -EZ, or 990 -PF) (2007) e 2007 Federal Worksheets Teen Esteem Page 1 20- 1598491 Excess Contributors Schedule A, Part IV -A, Line 26b Contributor 2006 2005 2004 2003 Total Pack Memorial Found $ 10,000. $ 0. $ 0. $ 0. $ 10,000. Total 10,000. Line 26a x 1 (# of contributors) - 9,241. Excess Contributions 759. Projected Support Schedule for 2008 This worksheet projects if the organziation will meet the support test for the tax year 2008 based on the data entered in screen 55 for the column 2007 . Support Items 2007 2006 2005 2004 (a) (b) (c) (d) Total (e) 15. Gifts, grants, and 55,983. 103, 656. 177, 435. 180, 973. contributions 518,047. 16. Membership fees received 0 17. Gross receipts from 0 admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's charitable purpose 18. Gross income from interest, 0 dividends, samount received from payments on securities loans, rents, royalties, and unrelated business taxable income from businesses acquired by the organization after 6/30/1975 19. Net income from unrelated 0 business activities not included in line 18., 20. Tax revenues levied for the 0 organization's benefit and either paid to it or expended on its behalf 21. The value of services or 0 facilities furished 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. Do not include 0 gain (or loss) from sale of capital assets 23. Total of lines 15 through 22 55,983. 103, 656. 177, 435. 180, 973. 518,047. 24. Line 23 minus line 17 55,983. 103, 656. 177, 435. 180, 973. 518, 047. 25. Enter 1% of line 23 560. 1,037. 1,774. 1,810. Organizations described on lines 10 or 11: 2007 Federal Worksheets Page 2 Teen Esteem 20- 1598494 Projected Support Schedule for 2008 (continued) This worksheet projects if the organziation will meet the support test for the tax year 2008 based on the data entered in screen 55 for the column 2007 . 26a. 2% of amount in column (e), line 24 10,361. 26b. Total of all individual contributions that exceed the line 26a amount 3,639. 26c. Total support for section 509(a)(1) test (line 24, column (e)) 518,047. 26d. Add the amounts from column (e) for lines 18, 19, 22, and 26b 3,639. 26e. Public support (line 26c minus line 26d) 514,408. 26f. Public support percentage (line 26e divided by line 26c) 99.30% P2 2007 Federal Statements Page 1 Teen Esteem 20- 1598494 Statement 1 Form 990, Part I, Line 9 Net Income (Loss) from Special Events Less Less Net Gross Contri- Gross Direct Income Special Events Receipts butions Revenue Expenses (Loss) Golf Tournament 47,350. 26,898. 20,452. 20 452. 0. Total 47,350. T26,898. $ 20,452. 20,452. 0. Statement 2 Form 990, Part II, Line 43 Other Expenses Statement 3 Form 990, Part IV, Line 57 Land, Buildings, and Equipment Accum. Book Category Basis Deprec. Value Machinery and Equipment $ 1,139. $ 974. $ 165. Total 11139. $ 974. �_— 165. (A) (B) (C) (D) Program Management Total Services & General Fundraising Bank Fees 248. 248. Educational Events 66. 66. Insurance 3,348. 3,348. Marketing Expense 1,142. 1,142. Other Operating Expense 1,376. 1,376. Payroll Service Fee 1,594. 1,594. Professional Services 2,450. 2,450. Speaker Expense 1,149. 1,149. Workers Compensation Insurance Total 1 019. 12,392. 1 019. 8,100. $ 4,292. $ 0. Statement 3 Form 990, Part IV, Line 57 Land, Buildings, and Equipment Accum. Book Category Basis Deprec. Value Machinery and Equipment $ 1,139. $ 974. $ 165. Total 11139. $ 974. �_— 165. Teen Esteem Board of Directors Meeting January 8, 2009 Addendum A Board Resolution The board hereby approves the submission by Teen Esteem of the City of Dublin Community Group /Organization Funding Request Application for the fiscal year 2009 through 2010. The board resolves further that Linda Turnbull, Director, and Tom Mason, Chairman of the Board, are authorized and directed, in the name of and on behalf of Teen Esteem, to make, execute and deliver the application to the City of Dublin by the application due date. 1o: doan LOCRle rrom: rror ueiie Lese i -0 -ul I,caam P. 3 Or 0 ' Ar" (It C`. Via 7Ci 1 f L A CORDM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 1/21/2DUB PRODUCER (510) 273 -8888 FAX: (510) 273 -8867 Saylor &Hill Co, 1939 Harrison St. #900 Oakland CA 94612 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC k INSURED Teen Esteem P.O. BOX 966 Danville CA 94526 INSURERA:NOn rofits Insurance PDATE EXPIRATION INSURER B: North American Elite AUTHORIZED REPRESENTATIVE c_• INSURER C GENERAL LIABILITY INSURER D INSURER EACH OCCURRENCE AGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. REG NTE LIMITS SHOWN MAY HAVE BEE 4 REDUCED BY PAID CLAIMS. INSR 00'L TYPE OF INSURANCE POLICY NUMBER DATEYMM /DDNYE PDATE EXPIRATION LIMITS AUTHORIZED REPRESENTATIVE c_• GENERAL LIABILITY Gregg Blair /FLOR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occunence $ 100, 000 A X COMMERCIAL GENERAL LIABILITY CLAIMSMAOE a OCCUR 2008- 18706 -NPO 2/6/2008 2/6/2009 MEDEXP (Any one erson $ 10,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOP AGG $ 2,000,000 X I POLICY ,PERCT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1, 000 , OOOX BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULED AUTOS 2008- 18706 -HPO 2/6/2008 2/6/2009 BODILY INJURY (Per accident) $ X HIREDA.UTOS X NON -UWNEO AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA A CC $ ANYAUTO $ AUTO ONLY AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE 3 OCCUR CLAIMS MADE DEDUCTIBLE $ RETENTION WORKERS COM PENSATION AND WCY TATI - OTH- E.L. EACH ACCIDENT EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDEW E.L. DISEASE - POL ICY LIMIT $ It yes. describe under SPECIAL PROVISIONS below g OTHER Buss. Personal Prop CWB0005896 -00 -18706 2/6/2008 2/6/2009 BPe Limit $5,000 A D 6 0 2008 -18706 DO 2/6/2008 2/6/2009 Liability Limits $1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Proof of coverage *10 Days Notice of Cancellation for non - payment will apply. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) © ACORD CORPORATION 1988 I qnw; ro-lnal nay Party I M 7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Insured' s Copy EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE c_• Gregg Blair /FLOR ACORD 25 (2001/08) © ACORD CORPORATION 1988 I qnw; ro-lnal nay Party I M 7 io: joan Locxie rcum: riui UC11C Le�,r , -c. of I ;LJUNI N, 1 VL IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/06) INS0251owspon Page 20 2 Jo: Joan LOCKle rrom. rior Ue11e Lese 1 -c�7-w tivaut N. i Va ACORDra CERTIFICATE OF LIABILITY INSURANCE 1/29/2009 mm/DDiYYYY) PRODUCER (510) 273 -8888 FAX: (510) 273 -8867 Saylor &Hill Co. Y CA License: 0003950 1999 Harrison Suite 1230 Oakland CA 94612 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:NOn Profit Ins Alliance of POLICY DTE MMIDDIVY N INSURERB:North American Elite INSURER C. GENERAL LIABILITY INSURER IJ INSURER E EACH OCCURRENCE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. kTE LIMITS SHOWN MAY HAVE BEE 4 REDUCED BY PAID CLAIMS. INSR AOD'L TYPE OF INSURANCE POLICY NUMBER POLICY DAE (MMIDDNYE POLICY DTE MMIDDIVY N LIMITS INSURER, ITS AGENTS OR REPRESENTATIVES. GENERAL LIABILITY Gregg Blair /FLOR EACH OCCURRENCE $ 1,000,000 , PREMISES Ea RENTED $ 100,000 X COMMERCIAL GENERAL LIABILITY A LAIMSMADE rXOCCUR MED EXn one $ 10,000 PERSONAL & AJJV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCT S _ COMP/OP AGG $ 2,000,000 X POLICY ,PECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ee ecadent) $ 1,000,000 BODIL'i INJURY (Per person) $ A ALL OVMVED Auros SCHEDULEOAUTOS 2009 - 18706 -NPO 2/6/2009 2/6/2010 BODILY INJURY (Per acadent) $ X HIREDAU70S X NON- UVMIED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ ANYAUTO $ AUTO ONLY AGG EXCESSNMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE 3 OCCUR F� CLAIMS MALE DEDUCTIBLE $ RETENTION WORKERS COMPENSATION AND I T v Y TAT�- OTH- E.L. EACH ACCIDENT EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER /EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ OFFICER/NIEMBER EXCLUDED'? EL. DISEASE - POLICY LIMIT $ It yes, describe under SPECIAL PROVISIONS below B OTHER Buss. Personal Prop. CWB0005896 -03 -18706 2/6/2009 2/6/2010 Repoacement. cost $5,000 A Directors & Officers 2009 -18706 DO -NPO 2/6/2009 2/6/2010 Liability LiMItS $1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES ,EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS *10 day Notice of Cancellation for non - payment of premium will apply. r wT^kl C En IIrn m 1 r nvLL rn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE INSURED' S COPY EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE c_• `�sy Gregg Blair /FLOR ACORD 25 (2001/06) nwrcu �.vnrvl�n nv,. r��.. INRn" tn- .nu.nae Pang t N Io: Joan LOCKle r rrON: r10r Uelle LeSe 1-C2"4.07 I:Cidol 1). u ut u IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/06) INS0251oinpsa Page 2 of 2 POLICYHOLDER COPY NO STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08 -01 -2008 GROUP: 000484 POLICY NUMBER: 0000327 -2008 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 08 -01 -2009 08- 01- 2008/08 -01 -2009 CITY OF DUBLIN NB 100 CIVIC PLZ DUBLIN CA 94568 -2658 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the emplafer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. EMPLOYER TEEN ESTEEM PO BOX 966 DANVILLE CA 94526 NO M0409 IREV.2 -051 PRINTED : 07 -17 -2008 City of Dublin Fiscal Year 2009 -2010 Application for Funds I attest that the ii the funds reques Attached is a res approved the am 31, to APPLICATION VERIFICATION letter, or as subm any required to nest, but not SECTION 2 Page 15 of 20 FA and that Board of Director submit a summary later, than August ng!! NTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: DEC 2 2 2005 TEEN ESTEEM 85 HIGHBRIDGE CT DANVILLE, CA 94526 Dear Applicant: / TH ttei -) I-) '1C't`) t DEPARTMENT OF THE TREASURY Employer Identification Number: 20- 1598494 DLN: 17053319033005 Contact Person: DEL TRIMBLE ID# 31309 Contact Telephone Number: (877) 829 -5500 Accounting Period Ending: June 30 Public Charity Status: 170 (b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: September 9, 2004 Contribution Deductibility: Yes Advance Ruling Ending Date: June 30, 2009 We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. During your advance ruling period, you will be treated as a public charity. Your advance ruling period begins with the effective date of your exemption and ends with advance ruling ending date shown in the heading of the letter. Shortly before the end of your advance ruling period, we will send you Form 8734, Support Schedule for Advance Ruling Period. You will ham 90 days after the end of your advance ruling period to return the completed form. We will then notify you, in writing, about your public charity status. Please see enclosed Information for Exempt Organizations Under Section 501(c)(3) for some helpful information about your responsibilities as an exempt organization. Letter 1045 (DO /CG) n I TEEN ESTEEM —2_ We have sent a copy of this letter to your representative as indicated in your power of attorney. Enclosures: Information for Organizations Exempt Under Section 501(c)(3) Statute Extension Letter 1045 (DO /CG) ENDORSED d FIL.EC In the office of the Secretary of State of the State of California ARTICLES OF INCORPORATION SEP 0 9 2004 OF KEVIN ShELLEY TEEN ESTEEM secretary of State ONE: The name of this corporation is Teen Esteem. TWO: This corporation is a nonprofit public benefit corporation ,and is not organized for the private gain of any person. It is organized under the Nonprofit Public Benefit Corporation Law for charitable purposes. The specific purpose for which this corporation is organized is to equip, educate and empower teens, parents, educators and the community on issues related to teens. THREE: The name and address in the State of California of this corporation's initial agent for service of process is Linda Turnbull, 85 Highbridge Court, Danville, California 94526.. FOUR: (a) This corporation is organized and operated exclusively for charitable purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code. (b) Notwithstanding any other provision of these Articles, the corporation shall not carry on any other activities not permitted to be carried on (1) by a corporation exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code or (2) by a corporation contributions to which are deductible under Section 170(c)(2) of the Internal Revenue Code. (c) No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or intervene in any political campaign (including the publishing or distribution of statements) on behalf of, or in opposition to, any candidate for public office. FIVE: The name and address of the person appointed to act as the initial Director of this corporation is: Name Address Linda Turnbull 85 Highbridge Court, Danville, CA 94526 lb SIX: The property of this corporation is irrevocably dedicated to charitable purposes and no part of the net income or assets of the organization shall ever inure to the benefit of any director, officer or member thereof or to the benefit of any private person. On the dissolution or winding up of the corporation, its assets remaining after payment of, or provision for payment of, all debts and liabilities of this corporation, shall be distributed to a nonprofit fund, foundation, or corporation which is organized and operated exclusively for charitable purposes and which has established its tax - exempt status under Section 501(c)(3) of the Internal Revenue Code. Date: O Signed: t 6nda"Yurnbull,' Director I, the above - mentioned initial director of this corporation, hereby declare that I am the person who executed the foregoing Articles of Incorporation, which execution is my act and deed. X urnbul , Director .. TV ;. A NATIONAL SCI IOOL of EXCELLENCE ,4 CALIFORNIA DISTINGUISHED SCHOOL Joseph Ianora Principal, 552 -3013 Sylvia Ryan Vice Principal, 552 -3036 John McMorris Vice Principal, 552 -3046 Bill Morones Vice Principal, 552 -3020 John Raynor Student Services, 552 -3005 1") Merll- San Ramon Valley High School Dome of the Wolves High School Teacher Testimonial: As an educator I am constantly discouraged and disheartened by the enormous peer pressure, and the sexual behavior that exists for teens in our world today. The media bombards our student constantly and our students are constantly battling issues they don't usually have the maturity or strength to face. As a leadership teacher and high school advisor I would like to recommend the Teen Esteem assemblies to any school. Twice in the past five years San Ramon Valley School has hosted two of these school -wide assemblies. These programs speak about respect and integrity and encourage students to set the bar high; not allowing others to set the standards for them, especially in the areas of sexual and drug activity. The response has been incredibly positive and thought- provoking. The assembly easily grabs the student's attention and then has the ability to get students to think about the risky behaviors they constantly encounter and many partake in. These assemblies have been hosted for the 9th thru 12th grade and the speakers have been able to hit all the issues of dangerous behaviors at every level. Students are challenged by the message. I have seen many behaviors challenged and changed due to Teen Esteem's message. I highly recommend a Teen Esteem assembly! Sincere , Janet Wi lford Tel: (925) 552 -5580 Fax: (925) 838 -7802 140 Love Lane, Danville CA 94526 EM