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Attch 2l Pacific Chamber Symphony
~ C®li~IlVIIJI~I'I'Y GIZO~P/®RGAl~TIZA'I'I®l~AL ~`IJ~1I)Il~:G QUEST APPTJICATI®1®1 PAC~'I' Fiscal Yec~~ 2010-2011 Secti®~ ~ o Appli~ati®n f®r SECTION 2 Page 1 of 17 0~ ~ W ~ _ CITY ®F TJ~I,Il~ Fiscal ~ea~ 2010-2011 . ~®l~l~IINI'I'Y R~IJP/®l~GANIZA'I'Y®N 1~PPI,I~A~IOI~ F~TI~1~~ 1~GEll1CY I~TA~~: PACIFIC' C'HAl~~ER ~~'l~P~-I®1~~' PREP®SED PR®JEC'T/PI~OGRAl~ 1~~51~~ o A SECTION 2 Page 2 of 17 r :i:. :.L". ,v.. e~a>uw'Z.e~C~_A.~^a'~^~..-. ~T..',... ~..-iC.b.`^`a.^:.F.A:.. 4"vv~'lC'.4."~.w^ , :F .z a-'..'.R...w'~4"'~"".' ..:+'T'uCLR~Y.'v~^W^...^.>`...L"'S%. CITY ®F I)I.T~I.Il~ o Fiscal fear 2010-2011 A~PI,ICATIO~ FOR FIJI~DS 1. Please select orne expense category: ' ? Capital X Operating 2. Applicant Information: Organization/AgencyHame Pacific Chamber Sv~iphon~~ `Mailing A@ress P.O. Box 3134 Liveriilore, CA 9451-3134 Street Address 1155 East 14`~ Street, Suite''215 City San~I;eandro State CA Z.ip94~63 Lawrence'Kohl 925=324-277 Lau-rerice~ z~PaciticChambcrSvinphony o`rg Music Director/CEO Work Phone En1ai1 Board President(if applicable) Work Phone Email Please list the Primary Project Contact~P.erson who would be able to answer. questions about this application and project/program during the funding period: Lawrence Kohl ~ Music Director/CEO Contact Person for Project/Program Job Title 925-324-2775 LawrenceKohl@hotmail,com 925-253-7943 Work Phone .Email Fax Federal Tax Identification No. (required) 94-3105631 City of Dublin Business License No. (required) .SECTION 2 Page 3 of 17 m ..e ~„-~TM.ac mss.... ~:x Q.... City of Dublin Fiscal Year 2010-2011 E ~ Application fog Finds ` 3. Proposed Project/Program.Inforr~Iation (po not describe Organization.) Amount of Funds Requested $ 12,000 (Maximum $25,000 per project.) Proposed Project/Program Name: "MUSIGIS FUN" ASSEMBLY PROGRAM FOR DUBLIN ELEMENTARY SCHOOLS - Pro osed Pro'ect/Pro ram Date(s): Start l / 1 / 10 and End 5 / 3;0 /10. P.: J g 'mo. day yr. , 'mo. day yr Please`note ':City Council Grant Fuiids are distributed on a Yeimbursement basis` If your Agency needs a 100% disbursement at the beginning of the Fiscal .Year, please indicate this below aid`provide justification for this need. X Agency,is requesting 100% disbursement at the beginning of the Fiscal Year. If selecting this'option, please provide justification in the blank space below. _ ? Agency is not requestmg.1;00% disbursement at the beginning of the Fiscal Year. ` Please provide the frequeney,that reimbursements will be submitted to;the City in the - blank space below; e.g ,monthly, quarterly, at project completion etc: - The Pacific Chamber Symphony has always had its grants from_the City of Dublin given a 100% disbursement at the beginning of the Fiscal Year'PCS operates on a cash accounting - system. Grants are typically received upon the award of the grant. This enables PCS to make payments to musicians with grant funds as required during the course of the project. SECTION 2 Page 4 of 17 8 City of Dublin ' Fiscal Year 2010-2011 14pplication foY ~'uncls a. How would the requested funds be used? a Describe, in detail, the PROPOSED PROJECT/PROGRAIVI (not the Agency). Bulleted text is acceptable.,, . . .a Identify if the proposed pro~ect/program is a new service; or extension of an existing: orie. An additionalpage may be added,. if needed. Overview;; of Educational'Program for Elementary :Grades _ Music in school: facilitating a'cniid's capacity for;. discovery.. and mental growth. ?.;Quintet performance and teacher packet: basic musical concepts and how each instrument makes it's unique sounds This program goes beyond a simple exploration'of what dif,f.erent instruments look .like and the instrumental families they belong. to, to an.,in.dep~h uresentatiom through accessible::: classical music, :demonstration on how each instrument really'achiev,es it's unique acoustical'profle and the exploration'of a basic musical concept. Thus over a>period of several years the student°will -lean about what mus~cal~y makes rhy~nm, melody,'liarmony:;., scales, character of music, texture; etc. This ensemble-conssts"of the five orchestral and band instruments children are most likely to choose: violin, cello, trumpet; clarinet and flute., In various combinations they,produce a compelling blend of the individual voices. The members of .t.Yie,ensemble have literally done thousands of concerts for kids. and.have led assembly organizers in our g. - feedback reviews to ve rare accolades. This..assembl'y is >su~~~ported;,by a comprehensive educational package that covers music teaching theory," developmental milestones in children's ';relatonsYiip to.,music, clas.`s projects.;arid .activities. .:It also contains tkie opportunity for each student to. create ,artwork or wrrte'..a letter describing the concert: :..This zs:a,.proven method reinforcing ahe.meaning.and joy of the musical experience. SECTION 2 Page 5 of 17 _ e a'~ 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): _ Music in school: facilitating a child's capacity for discovery and mental growth. 1. Music helps-the child - o It engages the whole child and stimulates integration of left and right. brain; process and'.:goal driven `learning c It-facilitates sensory learning'and,offers.r>opp~rtunities to link learning styles... ' o It honors iridididuality and expression e It establishes a space for reelection in lfe;,,in schooh:..and in the community. 2: Our. program helps the music programs: - Best practices: 'Mo:at theorists agree that musrc is best Teamed:through recurring . sensory experiences that provide berth varie.~y and repetition. Next; concepts that categorize elements in'music and help students develop::. ;awareness (~~Ear Training") are introduced.".This teaches'students to identify riusical:concepts as they listen. .Also, students 'should be ericoutaged` to develop, nd~ T.~dual musreal 'epimons and preferences, as a .':.first step to establishing a-relationship to music. 3 Curriculum: The.foll.owng package is 'designed with respect 'to the>teleological considerat:i:ons outlined 'above . Each `year> the curriculum takes on a; specific :mus_ical concept with a corresponding`;,musical ensemble: ?~'s - - , children. learn about the basic concepts of music (rhythm, melody, acoustics ahd'timbre, harmony, form; styl,e., Etc.) throughout 'the elementary,, grades awareness,,understandina and discerning ..appreciation are developed - < c. What documentation/data/records support the need for. tlus.PR.OPOSED PROJECTlPROGRA1Vh Please .identify your data'sources. (Additional page may be added, if needed ) Our program has been endorsed by the School Board and by the Dublin Partners in Education. Our feedback forms as well as informal comments demonstrate that the program is needed and enjoyed by the students. It has been pointed out that our program gives teachers a common language to talk about music and to do follow-up activities with their students. Enrollment in music programs has increased in the school districts where our ensemble has performed. SECTION 2 Page 6 of 17 g City of Dublin Fiscal Year 2010-2011 Application foY Funds . d. Specify the PROPOSED PROJECT/PROGRAM population to be served. The program is for elementary school children K - 5 of the Dublin Unified School District Elementary Scfiools. _ ; . e. Projects/programs must be evaluated to determine if they are being carried out efficiently and if project/program goals are being niet. Please describe how you plan to monitor :'your project/pro.gram's success and impact. An additional page may be added, if needed. a ' An additional page maybe added, if needed.. Pacific Chamber Symphony~evaluatesthe'success ofonr in school performances from the compiled``°results of feedback forms to participating teachers and: the drawings and letters of;~the stu~~nts who are remarkably articulate.about their>experiende. PCS in discussion with the elementary schools seeks to gain a greater understanding of specific needs and preferences. ,The feedback is :when :::processed by the PCS musicJ~ director and the professional :musicians who:.make`;up the ensemble and influences the shaping of ,future programs. f. Specify numbers of clients served byagency, then by.`PROPOSED PROJI'CT/PROGRAM: 1~cnr~ ParticipanYlnformation= _ _ _ _ Total Number of Partici arits'Served by Agency (if a pli~ <<hle) - TotalNun~h~~r~fDublin~~l2esidentsServedbv'~Agenc~ (ii~~~~~~~licabl~~1 ~ ~'r,o~ectil'r~~ram 1'artici~~antlni~urliiatiun Total Pro osed Partici ants Served by this Project/Program 3150 Total Number of Dublin Residents Served by this Project 3150 SECTION 2 Page 7 of 17 .c. ~ °.i.a ..w.. emu..... '"'i8 City of Dublin F-fiscal Year 2010-2011 14ppliccction for p'unds 5. financial Info>t-mation - ®pe>ratng budget . a. Expense Budget' _ . ~Y 2-~}~ n-fin? ~ rl'T~TC PRt).I1:('l / ~~._o1~rRSF 131'uGl~~l~ Orzt;~ti~[z_~Tl~a~ PIZO(;1~:~11 '(oiz~ti~r [~r:c~l i~.sT - - - - - 'Pee-sunl~el CuSts i - Administration a~i~t < _~l~U,l1(1U $14,000 X12,000 Musicians '~~qn-t'ersudinel Costs - - - - Program Sertii.;c~ 1. ~(IU X1,000 0 ':Supporting Services ~%'~Z7 - $500: 0 Other'(please specify) Other (please specify) T®'I'AI. 199,127 ' ` '$15,500 $12,000 Further `CominenfsBxplanations (if necessary): SECTION 2 Page 8 of 17 3'~. City of Dublin Fiscal Year 2010-2011 Application foY funds _ . . b. Revenue Budget - 2010-2~d1 ~ 1 - _ - _ 11i~ ~r~~1~=~1~~r__~,- I, ~~~z~~.~~iz:~~rl~_~~ Px~~.iFC~T/P~zc>c:iz ~~1 E - ~~~o~~~e~~ift~d/F~ct~-Q~tedF'unc~~ - Hacienda Cluld Dev. Fund - $1;000_ ~~~n C oenrn~t~ed/1~estrieted.Funds~ ~ ~ 1~~~~~ui}T~~.~ur~c) ~ Fund-raising ; $2;5.00 City of Dublin ` $12,000 'I'®'TAY~ ` : $15:,500 Further Comnents/Explanations (if necessary) ' SECTION 2 Page 9 of 17 City of Dublin Fiscal Year 2010-2011 14pplication for Funds 6. General Agency Information X Past grant applicants may check this box in lieu of completing item`6.(a-d) if the program/organizational description ori'file-'with the City is correct and current. a. List all years that .Organization has previously received City of Dublin funding.,(not . Corrimunity Development Block Grant -CDBG). b.:: Describe the population(s) served by the Organization. c. ~ Describe. all the services the'Organization currently.provides to Dublin residents: ~i additional page may be added, if needed. ' d. Has your agency ever previously received funds from the City of Dublin? If yes, please specify in what Fiscal Years and the amount received each year. SECTION 2 - Page 10 of 17 r ~ City of Dublin Fiscal Year 2010-2011 14pplicaction fog p'unals 7. Required Attachments: _ , o Only one (1) copy per Agency of each of the. following is required, even w~tli`multiple projects/programs submitted. " ' o Applications. without the following' documents will not be reviewed, for funding. , o Please label atfachmeits: A, B, C, etc. ? A: Names of Governing Board;'identify current Board officers. _ ? B. Current total Organization operatin budaet;<including revenue. Clearly' label/identify the`prograi7-that includes.the PROPOSED PROJECTlPROGRAM. o C. Most recent audit. report or tax return (if applicable). ? D. Resolution, letfer or other document providing evidence,'of Board/Organization approval of application, and date approval was granted. Board/Organizationapproval may be pending. ? E. '.Organization's certificate of insurance showing coverage for liability and' . - workers' compensation. ? F.> Application Verification Declaration' Signature Page.. ? G. Signed aff davit form from each'collaborating agency named 'iii proposed . w. _ , _ ro'ect/ ro am" lan if a licable ? H. Copy of IRS Letter of Determination indicating tax exempt status. SECTION 2 Page 11 of 17 S i£ ~e~.~ ~ ~~:~=mar. W; ~ City of Dublin Fiscal Year 2010-2011 14pplication fog p'u~ds 1~PPLICA`I'I®1V VLRIFICATI®N->;; I attest that the information contained m.this FY-2010-201.1. grant application inaccurate and that the funds requested will not supplant any other-monies secured by the organization Attached is a resolution; letter, or other doctunert prop-idirig evidence that the~Board of Directors approved the application as submitted. Successful applicants are required to;submit a summary - report as; soon as possible after subtnittinb the reimbursement'request, but not later than `August 31, 2011. Failure to submit a"report ~~~ill result in ineligibility for fixture funding;; Signatures: . _Executive Director Date Board President/Chairperson Date SECTION 2 Page 12 of 17 !4 a:. ' City of Dublin Fiscal Year2010-2011 Application fog Funds ECOLLAB®RA`I'I®~ 1~GENCY _ _ 1~FFIDAVIT F®R1VI o This form is to be completed by each collaborating organization as named by the applicant agency in the,proposed project[program: ` o Completed;formsrnust be submitted of time of application . Collaborating Agency Name: Dublin Unified :School District Agency Di~iszonlDepartment: instruction; Elementary , Project/P.rograrri Title: "Music is Fun.!" concert assembly programs Project/Program Role Description~(i.e., facility space, staff support, etc':): facility; space for concerts s; staff support for coordinating assemblies with the elementary, schools Agency Pibject/Program Contact Person: Bryce Custodio T1tle Coordulato~ of Educational Services Phone 925-828-25~ 1 e"xt. 8016 Email CustodiaBryce@Dublin.kl2.ca us ` I attest that the 'applicant agency and our organization agree to work-collaboratively to implement the proposed project/prograin as`identified in the:.FY 2010-2011 fundmg.application. Executive Director Dafe. Project/Program Contact Person Date SECTION 2 _ Page 13 of 17 s Pacific Chamber Symphony Tri-Valley Board of Director Walter Davies Chuck Hartwig Herman Leider Mort Mendelsohn Joyce Nevins, Secretary Doris Ryon Art Scott Lynn Seppala, Past Chair - Clark Streeter, Treasurer Kathy Streeter, Chair Lawrence Kohl, Music Director/ CEO Maurie Louis Susan Dupree 12/16/2009 PACIFIC CHAMBER SYMPHONY PROJECTED STATEMENT OF ACTIVITIES Projected July 2010 - June 30. 2011 Total Dublin Project Public support and revenues: Contributions $117,000 $3,500 Government grants 20,127 12,000 Contracts and tuition 7,000 Ticket sales 40,000 Special Events 15,000 Total public support and revenues 199,127 15 500 Expenses: Program services: Community performances 130,000 Education and outreach 40,000 14 000 Total program services 170,000 14 000 Supporting services: Management and general 24,000 $750 Fundraising 5,127 $750 Total supporting service 29,127 1 500 Total expenses 199,127 15 500 CHANGE IN NET ASSETS - Paci c Chamber~~mphon~ - Community Grant Committee City of Dublin December 16, 2009 Dear Community Grant Committee, The Board of Trustees of the Pacific Chamber Symphony approved the submission of this grant proposal fora $12,000 one year grant in support of the Pacific Chamber Symphony's "Music is Fun!" assembly program for the Dublin schools at our November 17, 2009 Board meeting. Thank you for your consideration and your support. Cordially, Kathy Streeter, Chair of the Board of Directors Pacific Chamber Symphony 1155 East 14`h Street Suite 215 114 Sansome Street Suite 825 6834 Garland Court San Leandro, CA 94577 San Francisco, CA 94108 Pleasanton, CA 94588 P 510.352.3945 F 510.352.3947 a 415.989.6872 F 415.989.6873 a 925.484.9783 PacificChamberSymphony.org LAWRENCEKONLMusicDirector&Conduetor FRl7M FA;~, hd1~. J'un. 4~5 ~~~5 11: ~:2AP9 F1 lnterri<at i ~er,~enc~e Serri~:e t~apartrner3t of the Treasury f'.+~. lox 2508 nclnnatl; ~H- X5201 - . - Gate: ~ewember 2aa1 Person to Cotttaat; Sheila Schram 31-fltt336 Customer S+rntlce FtepresentaEave Pacific G;-,amf;~er Symphony Tal! Free Telept~ane ~lcarnber; 1155 E, St.2 ~ 5 t~:ra0 A.t~. to ~:3d ~.Ml. tS"r San Lear±dra, Ck '34577-~t549 877-829-5500 fr•ax Number: 513-X63-37b6 Federal ldentificetian Numt7ar; ga-~~o~~;3.3 1Jear Sir ~r madam; This is Ir ;'eSponSe to the A.merrdment C4~ your organization's Articles cf InrDrporation filed yrrlth the State of California on August 20+1. We have updated our records to reflect the Warne change as shorn shave. n February 1 X85 we issued a ~taterrninatlon ietta~r that recognized your nrganicaiion ab exempt from fade°eI inccme tax under section 501(cj(3) of the Internal Revenue Cade. That Is~tt6r !s still in effect. Based on the informa#ion supplied; vvr~ recognized the subordinates named on the list your or~anizaiicn submitted as exempt from fedarai lnaome tax under section 5074x)(3} of the: Code, A~ditlonafly, we have dasslfled the ixubardir~ates yaurorganlzatlar~ operates, SUpb2NlSE5, or cantrois, and which era covered by written ns~tlflcatian to us, as orgartizatlons that are not prEvafie foundaflon.s because they are organixatic~ns of the type described in sections ~ta9(a)(2)of the Cade. TT' Conars may deduct con#ributions to yo,ar organization's subordinates as provided in secfiion 174 of tns Cade. 3~quests, legacies, devises, transfers or gifts to the subordinates or fur their use are deductible for federal estate and gift tax purposes if they meet the applicable provision;, rsf sections 2055, 2105, and 2522 of the Code. Your orc~anizatian anc# its subordinates are required to file Form 9'~0, Return of Qr~enizatlon exempt ft om Income Tax., only if the gros7 receipts ©arh y~-ar are normally more than $25,Of70. !fare#ur!~ is requirer~, it must be filed Iay the 15th ds~ of tt~e fifth month off©r the end of the arganizaiion`s annual accauntin0 period. Tha fau+ irnpnses a penalty of $2b a day, up to a rrtaximum of ;~10;000, when a return is fiiec!'ate, unless there is reasonable cause for thy: delay. Your organization and its subardinate;~ are not requirer? td file federal incr.~rne tax returns ursless subject to the tax on unrclsted business inccme under section 511 of the Cede. !f subject to this tax, the organization must file an inccme tax re#urn on Form 99Q-T, Exemp# Organization Business lncor7e 'Tax return, In this fetter, we are nr~t deterrnining whether onyx of your crganization ar its subordinates' present or proposed activitims are asnrelatPd trade or business as defined in section 513 df the Cade. Short Form ome No. lsas-llso Form 990-EZ Return of Organization Exempt From Income Tax Under section 501(c), 527, or4947(ax1) of the Internal Revenue Code 2008 (except black lung benefit trust or private foundation) ? Sponsoring organizations of donor advised funds and controlling organizations as defined in section 512(b)(13) must file Form 990. All other org- anizations with gross receipts less than $1,000,000 and total assets less than $2,500,000 at the end of the O eh t0 FUbIiC Department of the Treasury year may use this form. p Internal Revenue Service ? The organization may have to use a copy o/ this return to satis/y state reporting requirements. In SpeCtlOh A For the 2008 calendar year, or tax ear beginning 7/01 ,2008, and ending 6/30 2009 B Check if applicable: C ~ Employer identification number Address change usealRS PACIFIC CHAMBER SYMPHONY 94-3105631 Name change label or 480 CLEMENTINA STREET E Telephone number tpyrint or Initial return S ee• SAN FRANCISCO, CA 94103 510-352-3945 Termination Specific Amended return I^stn,c• F Group Exemption Lions. ~ Number........... . Application pending • Section 501(cX3) organizations and 4947(a~1) nonexempt charitab/e trusts G Accounting method: X Cash Accrual mustattach a corn /eted Schedu/e.d (Form 990 or990- Other s eci ) ? H Check ? if the organization is not 1 Website: ? www. acificchambers hon . or reqquired to a tach Schedule B (Form 990, J Or anization a check onl one - X 501 c 3 ~ insert no. 4941 a 1 or 527 990-EZ, or 990-PF). K Check ? if the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $25,000. return is not required, but if the organization chooses to file a return, be sure to file a complete return. L Add lines 5b, 6b, and 7b, to line 9 to determine gross receipts; if $1,000,000 or more, file Form 990 instead of Form 990-EZ ? $ 169, 934 . Part;l Revenue Ex enses and Chan es in Net Assets or Fund Balances See the instructions for Part I. 1 .Contributions, gifts, grants, and similar amounts received 1 124, 642 . 2 Program service revenue including government fees and contracts 2 44, 790 . 3 Membership dues and assessments 3 4 Investment income 4 2 . 5a Gross amount from sale of assets other than inventory 5a b Less: cost or other basis and sales expenses 5b R c Gain or (loss) from s81e of assets other than inventory (Subtract In 5b from In 5a) (att sch) 5c ~ 6' Special events and activities (complete applicable parts of Schedule G). If any amount is from gaming, check here ? E N a Gross revenue (not including $ of contributions e reported on line 1) 6a 500. b Less: direct expenses other than fundraising expenses 6b 500. e Net income or (loss) from special events and activities (Subtract line 6b from line 6a) 6e 7a Gross sales of inventory, less returns and allowances 7a b Less: cost of goods sold 7b c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) 7c 8 Other revenue (describe ? ) 8 9 Total revenue add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8 ? 9 169, 434. 10 Grants and similar amounts paid (attach schedule) 10 11 Benefits paid to or for members 11 X 12 Salaries, other compensation,~and employee benefits 12 44, 231 . P E 13 Professional fees and other payments to Independent contractors 13 1, 055 . N s 14 Occupancy, rent, utilities, and maintenance 14 E 15 Printin ublications, osta e, and shi In 15 s 9, P P 9 PP 9 16 Other expenses (describe ? See Statement 1 16 114, 783 . 17 Total expenses (add lines 10 through 16) ? 17 160, 069. 18 Excess or (deficit) for the year (Subtract line 17 from line 9) 18 9, 365 . N s 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end•of-year E E figure reported on prior year's return) 19 -18, 847 . T r 20 Other changes in net assets or fund balances (attach explanation) 20 s 21 Net assets or fund balances at end of ear. Combine lines 18 throw h 20 ? 21 -9, 482 . Part'II Balance Sheets. If Total assets on line 25, column B) are $2,500,000 or more, file Form 990 instead of Form 990-EZ. (See the instructions for Part II.) A) Be innin of ear (B) End of ear 22 Cash, savings, and investments? -588. 22 1, 785. 23 Land and buildings 23 2a Other assets (describe ? See Statement 2 ) 299. 24 77 . 25 Total assets -289. 25 1, 862 . 26 Total liabilities (describe ? See Statement 3 ) 18, 558. 26 11 344 . 27 Net assets or fund balances (line 27 of column (B) must agree with line 21)........... -18, 847. 27 -9, 482 . BAA For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990. Form 990-EZ (2008) TEEA0803L 09/18/08 Form 990-EZ 2008 PACIFIC CHAMBER SYMPHONY 94-3105631 Pa e 2 ~I°art'fll _ Statement of Pro ram Service Accom lishments See the instructions. Expenses What is the organization's primary exempt purpose? See Statement 4 (Required for 501(c)(3) Describe what was achieved in carrying out the organization's exempt purposes. In a clear and concise manner, and (4) organizations and describe the services provided, the number of persons benefited, or other relevant information for each 4947(a)(1) trusts; optional ro ram title. for others. 28 Community_chamber symphony~erformances at local concert venues, in addition to education and outreach_through_local schools and youth_ - _o_r a_n_iz_a_t_io_n_s._______________________________________ Grats $ If this amount includes foreign grants, check here ~ 28a 133, 639. 29 Grants $ ) If this amount includes foreign grants, check here ~ 29a 30 ------------------------------9------------------- Grants $ If this amount includes forei n rants, check here ~ 30a 31 Other program services (attach schedule} Grants $ If this amount includes forei n rants, check here ~ 31 a 32 Total ro ram service ex enses add lines 28a throu h 31a ~ 32 133, 639. Part;IV List of Officers Directors Trustees and Ke Em to ees. List each one even if not com ensated. See the instrs. (b) Title and average hours (c) Compensation (If (d) Contributions to (e) Expense account (a) Name and address per week devoted not paid, enter -0-.) employee benefit plans and and other allowances to osition deferred compensation Lawr_enc_e Kohl _ _ _ Executive Direc 43,395. 0... 0. 1155E .14th Street, #215 40.00 San Leandro, CA 94577 Nelson Mosher ~ Chairman 0. 0. 0. 1155 E. 14th Street #215 10.00 San Leandro, CA 94577 Joyce Nevins _ _ _ _ _ _ _ _ _ _ _ Secretar 0 . 0 . : ~ 0 . 1155 E. 14th Street #215 10.00 San Leandro, CA 94577 Sheldon Ciment Treasurer 0. „0. 0. 1155 E: 14th Street #215 10.00 San Leandro, CA 94577 Larry_ Goldfarb_ _ _ _ _ _ _ _ _ _ Trustee 0 . : 0 . - ~ 0 . 1155 E. 14th Street #215 10.00 San Leandro, CA 94577 Joel Wienstein Trustee 0. 0. 0. 1155 E. 14th Street #215 10.00 San Leandro, CA 94577 Gil Roeder Trustee 10. 0. 0. _1_15_5__E. 14th Street______ 0 San Leandro, CA 94577 Brian Fowler Trustee 0. 0. 0. 1155 E. 14th Street #215 _ _ 10.00 San Leandro, CA 94577 Larry Thorpe _ _ _ _ _ _ _ _ _ _ _ Trustee 0 . 0 . 0 . 1155 E.' 14th Street #215 10.00 San Leandro, CA 94577 Lynn Se~pala _ _ _ _ _ _ _ _ _ _ _ Trustee 0 . 0 . 0 . 1155 E. 14th Street #215 10.00 San Leandro, CA 94577 Rob_ert_Belknap_ _ _ _ _ _ _ _ _ _ Trustee 0 . 0 . 0 . 1155E 14th Street #215 10.00 San Leandro, CA 94577 BAA TEEA0812L 01114/09 Form 990-EZ (2008) Form 990-EZ 2008 PACIFIC CHAMBER SYMPHONY 94-3105631 Pa e 3 ,Part V Other Information Note the statement re uirement in General Instruction V. Yes No 33 Did the organization engage in any activity not previously reported to the IRS? If 'Yes,' attach a detailed description of each activity 33 X 34 Were any changes made to the organizing or governing documents but not reported to the IRS? If 'Yes,' attach a conformed copy of the changes......... 34 X - I 35 If the organization had income from business activities, such as those reported on lines 2, 6a, and 7a (among others), but not reported on Form 990-T, attach a statement explaining your reason for not reporting the income on Form 990•T. a Did the organization have unrelated business gross income of $1,000 or more or 6033(e) notice, reporting, and proxy tax requirements? 35a X b If 'Yes,' has it filed a tax return on Form 990-T for this year? 35b 36 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If 'Yes,' complete applicable parts of Schedule N 36 X 37a Enter amount of political expenditures, director indirect, as described in the instructions ? 37a 0 . b Did the organization file Form 1120-POL for this year? 37 b X 38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made in a prior year and still unpaid at the start of the period covered by this return? 38 a b If 'Yes,' complete Schedule L, Part II and enter the total amount involved 38b 8 000. 39 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 9 39a N/A b Gross receipts, included on line 9, for public use of club facilities 39b N/A 40a 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 (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,' complete Schedule L, Part t 40 b X c Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 ~ 0 . d Enter amount of tax on line 40c reimbursed by the organization ? 0 . e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If 'Yes,' complete Form 8886-T 40e X 41 List the state's with which a copy of this return is filed ? CA 42a The books are in care of ? Lawrence Kohl, _ExeC _ Director _ _ _ _ _ _ _ _ _ _ _ _ Telephone no. ? 510-352-3945 Located at ? 1155 East Fourteenth St, Suite_215_ San Leandro CA_ _ _ _ _ ZIP + 4 ? 94577 b At any time during the calendar year, did the organization have an interest in or a signature or other authority over a Yes No financial account in a foreign country (such as a bank account, securities account, or other financial account)?........... 42b X If 'Yes,' enter the name of the foreign country:. ~ See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of a Foreign Bank and Financial Accounts. c At any time during the calendar year, did the organization maintain an office outside of the U.S.? 42c X If 'Yes,' enter the name of the foreign country:. ~ 43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 -Check here ? ~ N/A and enter the amount of tax-exempt interest received or accrued during the tax year 43 ~ N/A Yes No 44 Did the organization maintain any donor advised funds? If 'Yes,' Form 990 must be completed instead of Form 990-EZ 44 X 45 Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)? If 'Yes,' Form 990 must be com leted instead of Form 990-EZ 45 X BAA TEEA0812L oinaoe Form 990-EZ (2008) Form 990-EZ 2008 PACIFIC CHAMBER SYMPHONY 94-3105631 Page 4 PartVl Section 501(c~3) organizations only. All section 501(c)(3) organizations must answer questions 46-49 and complete the tables for lines 50 and 51. See Statement 5 46 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates Yes No for public office? If 'Yes,' complete Schedule C, Part I 46 X 47 Did the organization engage in lobbying activities? If 'Yes,' complete Schedule C, Part II 47 X 48 Is the organization operating a school as described in section 170(b)(1)(A)(ii)? If 'Yes,' complete Schedule E 48 X 49a Did the organization make any transfers to an exempt non charitable related organization? 49a X b If'Yes,' was the related organization(s) asection 527 organization? 49b 50 Complete this table for the five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of com ensation from the or anizatlon. If there is none, enter 'None.' (b) Title and average (c) Compensation (d) Contributions to employee (e) Expense (a) Name and address of each employee paid hours per week benefit plans and account and more than $100,000 , devoted to position deferred compensation other allowances None Total number of other employees paid over $100,000....... ~ 51 Complete this table for the five highest compensated independent contractors who each received more than $100,000 of compensation from the organization..lf there is none, enter 'None.' (a) Name and address of each independent contractor paid more than $100,000 (b) Type of service (c) Compensation None < ---I Total number of other independent contractors receiving over $100,000 ~ 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 officer) is based on all information of which preparer has any knowledge. Sign ~ ~ Here Signature of officer Date ~ Lawrence Kohl Executive Director Type or print name and title. Date Check if Preparer's Identi ing Number Paid Pg^atures ~ FRED STOREK self- ~ (See instructions Pre- employed P00022536 parer's Firms name (or STOREK, CARLSON & STRUTZ U yours if self- ~ 100 V12W Street Sulte 208 EIN ~ $e employed), , Only zlP+q'and Mountain View, CA 94041-1374 Phoneno. ~ 650-961-5520 Ma the IRS discuss this return with the reparer shown above? See instructions ~ X Yes• No BAA Form 990-EZ (2008) TEEA0812L O1/1M09 OMB No. 1545-0047 SCHEDULE A Public Charity Status and Public Support 2008 (Form 990 or 990-EZ) To be completed by all section 501 (c 3) organizations and section 4947(ax1) - nonexempt charitable trusts. Open to Public Department of the Treasury Inspection Internal Revenue Service ? Attach to Form 990 or Form 990-EZ. ? See separate instructions. Name of the organization Employer identification number PACIFIC CHAMBER SYMPHONY 94-3105631 :.Part I Reason for Public Chari Status All or anizations must com lete this art. see instructions The organization is not a private foundation because it is: (Please check only one organization.) 1 A church, convention of churches or association of churches described in section 170(bXlxAxi). 2 A school described in section 170(bxlxAxii). (Attach Schedule E.) 3 A hospital or cooperative hospital service organization described in section 170(bxlxAxiii). (Attach Schedule H.) 4 A medical research organization operated in conjunction with a hospital described in section 170(bxlxA~iii). Enter the hospital's name, city, and state: 5 ? An organization o erated for the benefit of a college or university owned or operated by a governmental unit described in section 170(bxlxAxiv). Complete Part II.) 6 ? A federal, state, or local government or governmental unit described in section 170(bxlxAxv). 7 X An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(bxlxAxvi). (Complete Part II.) 8 ? A community trust described in section 170(b~1XAXvi). (Complete Part II.) - 9 ? 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 exempt 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). (Complete Part III.) 10 ? An organization organized and operated exclusively to test for public safety. See section 509(ax4). (see instructions) 11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or carry out the purposes of one or - - more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 09(ax3). ~ Check the.box that - describes the type of supporting organization and complete lines l le through l lh. , a ?Type I - b ?Type II c ?Type III -Functionally integrated d ? Type III-Other e ? By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described In section 509(a)(1) or section. 509(a)(2). - - f If the organization received a written determination from the IRS that is a Type I, Type II or Type III supporting organization, ? check this box g Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? Yes No (i) a person who directly or indirectly controls, either alone or.together with persons described in (ii) and (iii) below, the goverrnng body of the supported organization? 11 g (i) (ii) a family member of a person described in (i) above? .11 g ii . (iii) a 35% controlled entity of a person described in (i) or (ii) above? 11 ill) h Provide the followin information about the or anizations the or anization su orts. ' (i) Name of Supported (ii) EIN (ii) Type of organization (iv) Is the (v) Did you notify (vi) Is the (vii) Amount of Support Organization (described on lines 1-9 or anization in col. the organization in organization in col. above or IRC section listed in your col. (i) of (i) organized in the (seeinstrudions)) governing your support? U. S.? document? Yes No Yes No Yes No r Total BAA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule A (Form 990 or 990-EZ) 2008 TEEAI)401L 12/17/08 Schedule A Form 990 or 990-E 2008 PACIFIC CHAMBER SYMPHONY 94-3105631 Pa e 2 P,,,art ILM Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv)snd 170(b~1xA)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I.) Section A. Public Su ort ' Calendar year (or fiscal year (a) 2004 (b) 2005 (c) 2006 (d) 2007 (e) 2008 (f) Total beginning in) 1 Gifts, grants, contributions and membership fees received. Do not include 'unusual grants.' 198, 629. 204, 916. 171, 540. 210,113. 124, 642. 909, 840 . 2 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf 0 3 The value of services or facilities furnished to the organization by a governmental unit wlthout charge. Do not include the value of services or facilities generally furnished to the public without charge....... 0 4 Total. Add lines 1-3............ 198, 629. 204, 916. 171, 540. 210,113. 1.24, 642. 909, 840. 5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) 0 - 6 Public support. Subtract line 5 from line 4 909, 840 . Section B. Total Su ort ~ Calendar year (or fiscal year (a) 2004 (b) 2005 (c) 2006 (d) 2007 (e) 2008, (f) Total beginning in) 7 Amounts from line 4.,...: '1'98', 629. ' 204 916: 171, 540. 210, 113. 124, 642.: 909, 840 . 8 Gross income from interest, - dividends, payments received on securities loans, rents, royalties and income form similar sources................ 7 . 21. 125. 15 . 2 . 170 . 9 Net income form unrelated business activities, whether. or - not the business is regularly carried on 0 . 10 Other income. Do not include - gain or loss form the sale of . capital assets (Explain in Part lV.) 0. 11 Total support. Add lines 7 through 10 _ - 910, 010. 12 Gross receipts from related activities, etc. (see instructions) 12 0 . 13 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) I~1 organization, check this box and stop here ~ I Section C. Com utation of Public Su ort Percents e 14 Public support percentage for 2008 (line 6, column (f) divided by line 11, column (f) 14 100.0 15 Public support percentage for 2007 Schedule A, Part IV-A, line 26f 15 100.0 16a 33-1/3 support test - 2008. If the organization did not check the box on line 13, and the line 14 is 33-1/3 % or more, check this box and stop here. The organization qualifies as a publicly supported organization ~ X? b 33-113 support test - 2007. If the organization did not check a box on line 13, or 16a, and line 15 is 33-1/3% or more, check this box ? and stop here. The organization qualifies as a publicly supported organization ~ 17a 10%-facts-and-circumstances test - 2008. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the 'facts-and-circumstances' test, check this box and stop here. Explain in Part IV how ? the organization meets the 'facts-and•circumstances' test. The organization qualifies as a publicly supported organization........... ~ b 10%-facts-and-circumstances test - 2007. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the 'facts-and-circumstances' test, check this box and stop here. Explain in Part IV how the organization meets the 'facts-and-circumstances' test. The organization qualifies as a publicly supported organization- ~ 18 Private foundation. If the organization did not check a box on line, 13, 16a, 16b, 17a, or 17b, check this box and see instructions ~ BAA Schedule A (Form 990 or 990-EZ) 2008 TEEA0402L 12/17108 Schedule A Form 990 or 990-E 2008 PACIFIC CHAMBER SYMPHONY 94-3105631 Pa e 3 ;:Part ll Support Schedule for Organizations Described in Section 509(a~2) (Complete only if you checked the box on line 9 of Part I.) Section A. Public Su ort Calendar year (or fiscal yr beginning in)? a 2004 (b 2005 c) 2006 d 2007 a 2008 Total 1 Gifts, grants, contributions and membership fees received. Do not include 'unusual grants.'5... 2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in a activity that is related to the organization's tax-exempt purpose 3 Gross receipts from activities that are not an unrelated trade or business under section 513 . 4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf 5 The value of services or facilities furnished by a governmental unit to the organization without charge 6 Total. Add lines 1-5........... . 7a Amounts included on lines 1, 2, 3 received from disqualified persons b Amounts included on lines 2 - and 3-received from other than - • - ~ ~ - - ~ • disqualified_persons that exceed the greater of 1 % of ~ the total of lines 9, l Oc, 11, ' and_12 for the year or $5,000._.. ' c Add lines 7a and 7b ~ 8 Public support (Subtract line _ - ~ - 7c from line 6 . Section B. Total Su ort Calendar year (or fiscal yr beginning in) ? a 2004 b 2005 c 2006 d 2007 e 2008 Total 9 Amounts from line 6......:.... 10a Gross income from interest, dividends, pa ments received on securities ~oans, rents, royalties and income form similar sources b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.. . c Add lines l0a and lOb......... 11 Net income from unrelated business activities not included inline lOb, whether or not the business is regularly carried on . 12 Other income. Do not include ' gain or loss from the sale of capital assets (Explain in Part IV.) _ _ _ 13 Total support. (add Ins 9, lac, ll, and 12J 14 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) n organization, check this box and stop here ~ I I Section C. Com utation of Public Su ort Percenta e 15 Public support percentage for 2008 (line 8, column (f) divided by line 13, column (f)) 15 16 Public su ort ercentage from 2007 Schedule A, Part IV-A, line 27g 16 Section D. Com utation of Investment Income Percenta e 17 Investment income percentage for 2008 (line lOc, column (f) divided by line 13, column (f)) 17 18 Investment income percentage from 2007 Schedule A, Partly-A, line 27h 18 19a 33-113 support tests - 2008. If the organization did not check the box on line 14, and line 15 is more than 33-1/3%, and line 17 is not ? more than 33.1!3%, check this box and stop here. The organization qualifies as a publicly supported organization ~ b 33-1/3 support tests - 2007. If the organization did not check a box on line 14 or 19a, and line 16 is more than 33-1/3%, and line 18 is not more than 33-1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ~ 20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ~ BAA Teeaoaos~ ov29~oe Schedule A (Form 990 or 990-E~ 2008 Schedule A Form 990 or 990-E 2008 PACIFIC CHAMBER SYMPHONY 94-3105631 Pa e 4 l?art';tV Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Provide any other additional information. (see instructions) BAA TEEA0404L ioio~ioa Schedule A (Form 990 or 990-EL7 2008 Schedule B ome rvo. lsas-ooa7 (Form 990, 990-EZ, Schedule of Contributors 2008 or 990-PF) ? Attach to Form 990, 990-EZ and 990-PF Department of the Treasury ? See separate instructions. Internal Revenue Service _ Name of the organization Employer identification number PACIFIC CHAMBER SYMPHONY 94-3105631 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 Speclal 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 - - - X? For a section 501(c)(3) organization filing Form 990; or Form 990-EZ, that met tfie 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 (1) $5,000 or'(2) 2% of the amount on Form 990, Part Vlll, line lh or 2% of the amount on Form 990-E line 1. 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, II, and III. 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 organizatloh because it received nonexclilsively 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-PF) but they must answer 'No' on Part IV, line 2 of their Form 990, or check the box in the heading of their 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 Privacy Act and Paperwork Reduction Act Notice, see the Instructions Schedule B (Form 990, 990-EZ, or 990-PF) (2008) for Form 990. These instructions will be issued separately. TEEA0701L 12!18!08 Schedule B Form 990, 990-EZ, or 990-PF 2008 Page 1 ~ of 1 of Part Name of organization Employer identification number PACIFIC CHAMBER SYMPHONY 94-3105631 Patt Contrlbutor5 (see instructions.) (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate Type of contribution contributlons 1 Dean Lesher Foundation Person X Payroll C/o 1155 E. 14th St. #215___________________$_____ 20,000_ Noncash (Complete Part II if there San Leandro,_ CA 94577 is a noncash contribution.) (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate Type of contribution contnbutions 2 Bernard Osher Foundation Person X Payroll c/o 1155 E. 14th St #215 5,000_ Noncash (Complete Part II if there San Leandro,_ CA 94577_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ is a noncash contribution.) (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate Type of contribution contributions 3 Doris R. Marx Person X ' ' Payroll c/o 1155 E. .14th St #215 $ 25,000. Noncash (Complete Part I I if there San Leandro, CA 94577 is a noncash contribution.) ' (a) (b) (c) (d) Number Name, address, and ZIP + 4 Aggregate Type of contribution contrlbutlons 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.) (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 osiosios Schedule B (Form 990, 990-EZ, or 990•PF) (2008) Schedule B Form 990, 990-EZ, or 990-PF 2008 Page 1 of 1 of Part II Name of organization Employer identification number FACIFIC CHAMBER SYMPHONY 94-3105631 Part'I~ NonCash Property (see instructions.) (a) - (b) (c) ' No. from Description of noncash property given FMV (or estimate) Date received Part I (see instructions) N/A (a) (b) (c) (d) No. from Description of noncash property given FMV (or estimate) Date received Part I (see instructions) (a) (b) (c) (d) No. from D_ escription of noncash property given FMV (or estimate) Date received Part I (see instructions) (a) (b) (c) (d) No. from Description of noncash property given FMV (or estimate) Date received Part I (see instructions) (a) (b) (c) (d) No. from Description of noncash property given FMV (or estimate) Date received Part I (see instructions) (a) (b) (c) (d) No. from Description of noncash property given FMV (or estimate) Date received Part I . (see instructions) BAA Schedule B (Form 990, 990-EZ, or 990-PF) (2008) TEEA0703L 08/05/08 Schedule B Form 990, 990-EZ, or 990-PF 2008 Pa e 1 of 1 of Part III Name of organization Employer iderdifiwtion number PACIFIC CHAMBER SYMPHONY 94-3105631 +Part U Exc/usive/yreligious, 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) (b) (c) (d) No. from Purpose of gift Use of gift Description of how gift is held Part.l N/A (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) (b) (c) (d) No. from Purpose of gift Use of gift Description of how gift is held Part I (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) (b) (c) (d) No. from Purpose of gift Use of gift Description of how gift is held Part I (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) (b) (c) (d) No. from Purpose of gift Use of gift Description of how gift is held Part I (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee BAA Schedule B (Form 990, 990-EZ, or 990-PF) (2008) TEEA0704L 04/01/06 2008 Federal Statements Page 1 PACIFIC CHAMBER SYMPHONY 943105631 Statement 1 Form 990-EZ, Part I, Line 16 Other Expenses Advertising and Promotion $ 2, 688 . BANK SERVICE CHARGES 6, 522 . CONCERT HALL OPERATIONS 8, 715 . CONCERT HALL RENTAL 16, 634 . CONTRACT LABOR 882. Depreciation .222 . DIRECTOR FEE 4 , 67 6 . INSURANCE 2, 0 6 6. Interest 30 . ORCHESTRA MUSICIANS 65, 884. PRINTING &REPRODUCTION 420. SOLOISTS/SPECIAL GUESTS 2, 700. SUPPLIES 643 . TELEPHONE &INTERNET 844. TVYO RENTAL 1 857. Total 114,783. Statement 2 Form 990-EZ, Part II, Line 24 ,Other Assets. Beginning_._, Ending Furniture and Fixtures $ 299. $ 77. Total 299. 77. Statement 3 ~ . Form 990-EZ, Part II, Line 26 Total Liabilities Beginning Endinc~_ Payable to Officers, Directors, Etc $ 14, 000. $ 8, 000. PAYROLL TAXES PAYABLE 4, 558. 3, 344 . Total $ 18,558. $ 11,344. Statement 4 Form 990-EZ, Part III Organization's Primary Exempt Purpose Promotion of chamber symphony in the San Francisco Bay Area by offering quality performances at several community concert venues, in addition to educational outreach through local schools and youth organizations. 2008 Federal Statements Page 2 PACIFIC CHAMBER SYMPHONY 943105631 Statement 5 Form 990-EZ, Part VI Regarding Transfers Associated with Personal Benefit Contracts (a) Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? No (b) Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? No OP ID NL DATE (MM/DDIYYYI~ ACORD CERTIFICATE OF LIABILITY INSURANCE pACI-10 12 16 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McDermott-Costa Co. , Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic # 0167057 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 27 6 Dolores Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Leandro CA 94577 Phone: 510-351-7460 Fax:510-357-3230 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Nonprofits' Ins Alliance of CA INSURER B: State Compensation ins. pvaa Pacific Chamber Symphony INSURER C: 1155 East 14th Street #215 INSURER D: San Leandro CA 94577 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY E PDATE MMPDD/YY N LIMITS GENERAL LIABILfTY EACH OCCURRENCE $ l O O O O O O A X COMMERCIAL GENERAL LIABILITY 200900695NP0 11/17/09. 11/17/10 PREMISES (Eaoccurence $ SOOOOO . CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 2 O O O O PERSONAL&ADVINJURY $ lOOOOOO GENERAL AGGREGATE $ 2 0 0 0 O O O GEN'L AGGREGATE LIMIT APPLIES PER: ~ ~ PRODUCTS -COMP/OP AGG $ 2 O O O O O O X POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ l O O O O O O ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS 2009-00695-NPO 11/17/09 11/17/10 X HIRED AUTOS 8001LY INJURY ~ $ X NON-0WNEDAUTOS (Per'accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN ~'0'~ $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE' ~ ' $ OCCUR ~ CLAIMS MADE ~ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X TORY LIMITS ER B EMPLOYERS'LIABILITY 1600067-2009 07/22/09 07/22/10 E.L. EACH ACCIDENT $1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED'? E.L. DISEASE - EA EMPLOYEE $ l O O O O O O If Yes, describe under SPECIAL PROVISIONS below E. L. DISEASE-POLICY LIMIT $lOOOOOO OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Proof of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION . DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 O * DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Cl ty O f Dub l I n IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE E ACORD 25 (2001/08) ©ACORD CORPORATION 1988