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Home My WebLink AboutItem 8.1 Budget Study Attch 7 k Teen Esteem Funding Request Review Checklist PART I - AIPlleA TIOlilllllllllJllREVIEW A. Application 1. Date application received*...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... (Completed applications are due by 5:00 p.m. on February 5, 2007) 2. Two copies of the completed application form are submitted....... B. Organization Information 1. Name of the organization..................................................... I 2. Is the applicant a nonprofit organization?...................................... I 3. Does the organization has a 501 (c)3 State of California ID#?....... I 4. Does the organization have a current City Business License?..... I C. Funding Request 1. Funding amount requested..................... .............................. 2. Funding Source (Le. General Fund, CDBG Fund)..................... D. Project Information 1. Proposed project name....................................................... 2. Project start date......... ... ...... ...... .................. ..................... 3. Project complete date... ... ........................... ... ..................... 4. Total # of organization clients... ... ... ... ... ... ... ... ...... ... ... ... ... ..... 5. # of Dublin businesses / residents will serve......... ... ... '" ...... .... E. Attachments 1. Name and home address of governing board of the organization.. 2. List of current board officers of the organization... ... .................. 3. Current total organization operating budget, including revenue.... 4. Most recent audit or tax return is submitted... ... ... ... ... ... ... ... ... ... 5. Document providing evidence of board/organization approval of application and date of approval........................................... 6. Organization's certificate of insurance showing coverage of liability and worker's compensation.... ... ... .... ...... ..... .... ... ....... 7. Signed affidavit form from each collaborating agency identified for the proposed project (if applicable)... ... ... ... ... ... ... ... ... ... ... .. 8. Application verification declaration signature page.................... PARTlJ 02/05/07,5:09 Yes Teen Esteem Yes 20-1598494 No $25,000 General Fund Teen Esteem 7/1/2007 6/30/2008 All Teens All Residents Yes Yes. Yes Pending for 3 board members approval Yes N/A Yes Yes 1. Is the application complete?* (Y/N).................................................I If no, which sections are incomplete?.............................................1 2. Did the applicant organization complete a mandatory I presentation at City Council Public Hearing?* (Y/N).................. 3. Date notification letter of Council Approval of funding & I mandatory financial reporting packet sent............................... 4. Date summary report is submitted to City*............................... I (Report must submit to City by the end of August 2008. Failure to submit a report will result ineligibility for future funding) * FailuretoisU requirements 'All II Part I A1, E5 II No X H:\Budget\COMMGRPS\Teen Esteem Funding Request Checklist.xls Attachment k Date Printed: 2/23/2007 4:35 PM LJ CITY OF DUBLIN~~fiYt~lIN ,/'.. .CITY MANA~cl1'~ \.Ifh~t COMMUNITY GROUP/ORGANIZATIONAL FUNDING REQUEST ApPLICATION PACKET Fiscal Year 2007-2008 Section 2: Application for Community Group/Organizational Funding SECTION 2 Page 1 of 18 cr!jSOCE/llliD .. F:DU CITY OF DUBLIN it' Si/tv Fiscal Year 2007-2008 e/}}' ,..." . ~GERS OFfiCe COMMUNITY GROUP/ORGANIZATION ApPLICATION FOR FUNDS COVER PAGE AGENCY NAME: TEEN ESTEEM PROPOSED PROJECT/PROGRAM NAME: TEEN ESTEEM FUNDING AMOUNT REQUESTED: $25,000 SECTION 2 Page 2 of 18 CITY OF DUBLIN Fiscal Year 2007-2008 ApPLICATION FOR FUNDS 1. Please select one expense category: 0 Capital lEI: Operating 2. Applicant Information: Organization/Agency Name: Teen Esteem Mailing Address: P.O. Box 966 Street Address City Danville State CA Zip 94526 Linda Turnbull Executive Director/Chairperson 925-828-3685 Work Phone teenesteem@aol.com Email Thomas Mason (Acting) Board President (if applicable) 925-785-8825 Work Phone tr_ mason@msn.com Email Please list the Primary Project Contact Person who would be able to answer questions about this application and project/program during the funding period. Debra Mason Contact Person for Project/Program Director, Fundraising Job Title Email 925-314-0543 Fax 925-314-3006 Work Phone DebramClSO!1r(l/t11sn. com Nonprofit Identification No. (required): 20-1598494 City of Dublin Business License No. (required) _n/a SECTION 2 Page 3 of 18 City of Dublin Fiscal Year 2007-2008 Application for Funds 3. Proposed ProjectlProgram Information (Do not describe Organization.) Amount of Funds Requested $ 25,000 (Maximum $25,000 per project.) Proposed ProjectlProgram Name _Teen Esteem Proposed Project/Program Date(s): Start "7-\ - 0 '7 .fo ~~\-C7 a. How would the requested funds be used? · Describe, in detail, the PROPOSED PROJECTIPROGRAM (not the Agency). · Bulleted text is acceptable. · Identify if the proposed project/program is a new service. or extension of an existing one. · An additional page may be added, if needed. Teen Esteem is a local non-profit organization that equips, educates and empowers teens. parents, educators and the community on issues related to teens and adolescent health. Our goal is to reach out to help our youth understand the importance of making healthy decisions in the area of high risk adolescent behavior during their junior high and high school years. Specifically in the areas of sex, drugs and alcohol. We discuss the importance of respect for self and for others, risk avoidance, boundary setting and building healthy relationships. Teen Esteem provides parent education to help parents understand the culture in which their children are growing up in, the type of high risk behavior youth in our community are involved in and how they can help their children during these turbulent years. We provide up-to-date information regarding the internet (my space and pornography) and the media. We are comprised of trained volunteer speakers along with help from professionals, ie: medical doctors, licensed family counselors, police, for parent education events. Funds are requested to support classroom presentations, school-wide assemblies, parent education events, community youth events, presentations at PTSA meetings, conferences and workshops. Each assembly costs approximately $1,500. Due to the number of students, typically two assemblies are required for each school. Our website ':]\-n'!. te,:,:n(;cst'"em. ..>:.'H! costs $1500 per year which is available to all Dublin residents for teens and parents. SECTION 2 Page 4 of 18 At Dublin High School, we currently speak to between 350-600 students twice a year to 9th and 12th grade classes. At Wells Middle School, we speak to approximately 250-320 students per year four times per year to 8th grade classes At Valley Christian Middle School and High School, we speak to approximately 100-300 students once a year to 7th, 8th and 9th grades. 7th, 8th and 9th grades Goals for future: -To speak to the students at other Dublin middle and high schools: Fallon middle school and Valley High School -To be able to reach the entire 7th, 8th and 9th grade student body with the TE message -To be able to re-visit the students in 11th or 12th grade to review information and provide new information for their stage of maturity. SECTION 2 Page 5 of 18 City of Dublin Fiscal Year 2007-2008 Application for Funds d. Specify the PROPOSED PROJECTIPROGRAM population to be served. All middle school children and high school children and their parents in Dublin e. Projects/programs must be evaluated to determine if they are being carried out efficiently and if project/program goals are being met. Please describe how you plan to monitor your project/program's success and impact. · An additional page may be added, if needed. With written feedback from the students, teachers and educators in survey format f. Specify numbers of clients served by agency, then by PROPOSED PROJECTIPROGRAM: 15,000 All Teens All Residents City of Dublin Fiscal Year 2007-2008 Applicationfor Funds d. Specify the PROPOSED PROJECTIPROGRAM population to be served. Q I \ (e ~ ,d -tf~ q" -DL~b~/J" C'S~ E: \ (~ b I ~ ~~\O~ '.i Vl-> QDutct b-tv\'Q.~ t fyt)rr- I.{-k~ $~C)L~\Q1c_L (~er-- 8 ~ . 'J ~ -P{es,4(~ 'tc "t-l\L CD~Vlt~n1f\ e. Projects/programs must be evaluated to determine if they are being carried out efficiently and if project/program goals are being met. Please describe how you plan to monitor your project/program's success and impact. · An additional page may be added, if needed, -rk D~,-- ~\J..V $"is' r (0 ~ U "",.h c!. ~-- ~"J<" .-te..~~Q\S.i -e..(h~.~v ~ (\~ cui~l^i~JV(~{~ Q\--kv t9-~ 'y(es.0'--U'~. f. Specify numbers of clients served by agency, then by PROPOSED PROJECTIPROGRAM: SECTION 2 Page 7 of 18 City of Dublin Fiscal Year 2007-2008 Application for Funds 5. Financial Information - Operating Budget a. Expense Budget FY2007-2008 THIs PROJECT! EXPENSE BUDGET ORGANIZATION PROGRAM GRANT REQUEST Personnel Costs Employee Salaries & Benefits 98,000 20,000 20,000 Non-Personnel Costs Services & Supplies 30,000 5,000 5,000 Capital Costs Other (please specify) Other (please specify) TOTAL 128,000 25,000 25,000 Further CommentslExplanations (if necessary): SECTION 2 Page 7 of 16 City of Dublin Fiscal Year 2007-2008 Application/or Funds b. Revenue Budget FY 2007-2008 REVENUE BUDGET ORGANIZATION PROJECTIPROGRAM CommittedlRestricted Funds (specify source) N/A Non-CommittedlRestricted Funds (specify source) TOTAL N/A Further CommentslExplanations (if necessary): SECTION 2 Page 8 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 6. General Agency Information a. List all years that Organization has previously received City of Dublin funding (not Community 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. · An 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 9 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 7. Required Attachments: o Onlv one (I) copv per A2;encv of each ofthe following is required, even with multiple projects/programs submitted. o Applications without the following documents will not be reviewed for funding. o Please label attachments: A. B. C. etc. CJ A. Names of Governing Board; identify current Board officers. CJ B. Current total Organization operating budget, including revenue. · Clearly label/identify the program that includes the PROPOSED PROJECTIPROGRAM. CJ C. Most recent audit report or tax return (if applicable). CJ D. Resolution, letter or other document providing evidence of Board/Organization approval of application, and date approval was granted. · Board/Organization approval may be pending. CJ E. Organization's certificate of insurance showing coverage for liability and workers' compensation. CJ F. Application Verification Declaration Signature Page. CJ G. Signed affidavit form from each collaborating agency named in proposed project/program plan (if applicable). SECTION 2 Page 10 of 16 A Teen Esteem Board February 5, 2007 Tim Barley Board Member Janyce Hoyt Secretary, Board Member Tom Mason Finance Committee Chair, Board Member, Acting President Becky Pine Board Member Linda Turnbull Director of Teen Esteem, Board Member Rick Weisser Board Member Teen Esteem FINANCIAL SUMMARY & BUDGET - FY2007 v.OlO107 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 F eb-07 Mar-07 Apr-07 May-07 Jun-07 TOTAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL Income: Donations $ 1,825 $ 1,965 $ 8,836 $ 6,205 $ 1,009 $ 19,825 $ 1,350 $ 61,350 $ 3,350 $ 1,350 $ 3,350 $ 1,350 $ 111,765 Expenses: Payroll & Related: Payroll & Taxes & ADP Fees $ 7,116 $ 6,673 $ 8,817 $ 8,326 $ 8,178 $ 8,924 $ 8,200 $ 8,200 $ 8,400 $ 8,400 $ 8,400 $ 8,400 $ 98,034 Workers Comp Insurance 672 (254) 600 $ 1,018 Professional Services: Consulting: - O'Callaghan 138 500 500 500 500 500 500 $ 3,138 Accounting 510 240 240 150 300 300 300 300 300 300 $ 2,940 Accounting - Thompson & Depretis 1,200 (70) 2,000 $ 3,130 Legal & Other Outside Services 98 50 13 $ 161 Supplies & Misc: Telephone 30 30 351 72 70 74 70 70 70 70 70 70 $ 1,047 Postage & Delivery 74 102 50 50 50 50 50 50 $ 476 Office Supplies, Printing 313 326 10 80 100 100 100 100 100 100 100 $ 1,429 Bank Fees - Merchant & Paypa1 35 49 31 30 65 76 30 30 30 30 30 30 $ 466 Miscellaneous 300 21 141 73 $ 535 Printing: Newsletters 2,190 2,000 $ 4,190 Brochures & Training Material (a) 400 2,000 $ 2,400 Letterhead & Mailings 500 $ 500 Marketing Expenses Website 578 47 100 100 100 100 100 100 $ 1,225 Training and Promo Videos $ Resource Infonnation - Books, Videos 100 $ 100 Educational Events: Speaker Assembliesrrraining 51 126 870 $ 1,047 Breakfasts (d) $ Speaker Per Diem 300 300 $ 600 Speaker AppreciationIHoliday Party 316 300 500 $ 1,116 Insurance - PropertylNP/Director (c) 4,200 $ 4,200 Total Expenses $ 7,319 $ 8,547 $ 13,227 $ 8,793 $ 9,346 $ 10,420 $ 14,150 $ 10,450 $ 12,050 $ 9,550 $ 11,550 $ 12,350 $ 127,752 Total Net Income/(Expense) $ (5,494) $ (6,582) $ (4,391) $ (2,588) $ (8,337) $ 9,405 $ (12,800) $ 50,900 $ (8,700) $ (8,200) $ (8,200 ) $ (11,000) $ (15,987) Assumptions: (a) Originally planned to reprint brochures and training material in Oct06 ($2K). Due to funding, the current plan is to delay the expense until May. (c) Assumes annual renewal cost consistent with prior year cost. Includes property, general liability, and directors & officers liability (d) Assume breakfast events are breakeven in revenue and costs. Printed on 2/5/2007 Budget FY2007 v010107 (3)-Budget CJI -.. Teen Esteem FINANCIAL SUMMARY & BUDGET - FY2007 v.OlOlO7 Jul-06 Aug-06 Sep-06 Ocl-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 TOTAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL ACTUAL Cash Flow Summarv Beginning Cash Balance $ 41,813 $ 35,644 $ 29,747 $ 24,293 $ 20,545 $ 12,408 $ 21,552 $ Il,187 $ 60,237 $ 52,237 $ 42,787 $ 35,587 Add: Income $ 1,825 $ 1,965 $ 8,836 $ 6,205 $ 1,009 $ 19,825 $ 1,350 $ 61,350 $ 3,350 $ 1,350 $ 3,350 $ 1,350 Less: Expenses Payroll - 100% $ 7,Il6 $ 6,673 $ 8,817 $ 8,326 $ 8,178 $ 8,924 $ 8,200 $ 8,200 $ 8,400 $ 8,400 $ 8,400 $ 8,400 Other - 50% (A) $ 878 $ 1,189 $ 5,473 $ 1,627 $ 968 $ 1,757 $ 3,515 $ 4,100 $ 2,950 $ 2,400 $ 2,150 $ 3,550 Ending Cash Balance $ 35,644 $ 29,747 $ 24,293 $ 20,545 $ 12,408 $ 21,552 $ I 1,187 $ 60,237 $ 52,237 $ 42,787 $ 35,587 $ 24,987 AlP Balance at Month End $ 138 $ 824 $ 1,760 $ 600 $ 801 $ 540 $ 2,975 $ 1,125 $ 1,825 $ 575 $ 1,575 $ 1,975 (A) Assumes that 50% of expenses, excluding payroll, are paid for in month incurred. Remaining 50% carry over into Accounts Payable at end of each month. Printed on 2/512007 Budget FY2007 v010107 (3)-Budget c 2005 TAX RETURN Client Copy Client: T-ESTEEM Prepared for: Teen Esteem 85 Highbridge Court Danville, CA 94526 925-743-0438 Prepared by: Dan Thompson, CPA Thompson & De Pretis, LLP 5820 Stoneridge Mall Rd Ste 113 Pleasanton, CA 94588 (925) 924-1500 Date: February 5, 2007 Comments: Route to: FDIl2001L 04112/05 2005 Exempt Org. Return prepared for: Teen Esteem 85 Highbridge Court Danville, CA 94526 Thompson & De Pretis, LLP 5820 Stoneridge Mall Rd SteI13 Pleasanton, CA 94588 (925) 924-1500 Teen Esteem Page 1 20-1598494 2005 Federal Exempt Organization Tax Summary NET ASSETS OR FUND BALANCES Excess or (deficit) for the year.,.,.,..... Net assets/fund bal. at beg. of year.,.., Net assets/fund bal. at end of year....... 2005 2004 177,435 180,973 177,435 180,973 144,246 155,312 10,521 6,814 154,767 162,126 22,668 18,847 18,847 0 41,515 18,847 Diff -3,538 -3,538 REVENUE Contributions, gifts, and grants..,........ Total revenue....................................... EXPENSES Program services.....,.............,........ _ . . . . . . Management and generaL...........,............. Total expenses,............,....".........,..,..... -11,066 3,707 -7,359 3,821 18,847 22,668 2005 California 199 Tax Summary Teen Esteem Page 1 20-1598494 2004 Diff 26,775 -6,608 180,973 -3,538 207,748 -10,146 50,000 0 44,288 -18,078 9,069 6,178 125 287 85,419 -2,354 188,901 -13,967 18,847 3,821 10 0 10 0 0 23,136 0 23,136 23,136 19,193 23,136 19,193 2005 REVENUE Other income....................................,.... Gross contributions, gifts, & grants...., 20,167 177,435 Total income.............................,........... 197,602 EXPENSES AND DISBURSEMENTS Compensation of officers, etc....,.......,... Other salaries and wages....,.,.,.....,...,.,.. Taxes,...........,.......,.............................. Depreciation and depletion..,......,....,..,.. Other deductions.....,....,.........,.............. Total deductions..........,..............,......... 50,000 26,210 15,247 412 83,065 174,934 22,668 Excess of receipts over disbursements.... FILING FEE Filing fee........,........"............,....,....... Balance due...........................,.............. 10 10 SCHEDULE L Beginning Assets.,....,.........,.................. Beginning Liabilities & Net Worth.."...,.. Ending Assets.........,........,................,.., Ending Liabilities & Net Worth............,. 23,136 23,136 42,329 42,329 2005 General Information Page 1 Teen Esteem 20-1598494 Forms needed for this return Federal: 990, Sch A California: 199, 3885, RRF-1 Carryovers to 2006 None 2005 Federal Book Depreciation Schedule Teen Esteem f)~srriDtion Date Arqllir~rl Date Solrl Cost! R~sis Cur Bus, 179 -.EeL --Bonus- Special Depr. Allow Prior 179/ Bonus/ Sp f)f\pr Prior Dec. Bal. f)f\pr Sa Ivage /Basis ..Red.uc.tIL Depr. R~sis Prior f)f\pr M~thorl ..Life.. ..JJ F : Equipment j Machine eciation 9/13/04 752 752 125 S/L 5 6/22/05 300 300 S/L 5 1,052 0 0 0 0 0 1,052 125 1,052 0 0 0 0 0 1,052 125 1,052 0 0 0 0 0 1,052 125 ipment linery and Equipment 11 Depreciation 2005 California Book Depreciation Schedule Teen Esteem Oe~r.ription Date Ar.qllireei Date Solei Cost! Ra~i~ Cur Bus. 179 .hL ....B!lnus...- Special Depr. Allow Prior 1791 Bonusl Sp Oepr Prior Dec. Ba!. Oepr Sa Ivage IBasis ..Bllduc1rL Depr. Ra~i~ Prior Oepr Methoei J.i.fe.. -B i Equipment j Machine 9/13/04 752 752 125 S/L 5 ipment 6/22/05 300 300 S/L 5 linery and Equipment 1,052 0 0 0 0 0 1,052 125 eciation 1,052 ~ 0 0 0 0 1,052 125 = II Depreciation 1,052 0 0 0 0 0 1,052 125 = Form 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) Department of the Treasury Internal Revenue Service ... The organization may have to use a copy of this return to satisfy state reporting requirements. A For the 2005 ca endar year, or tax year beginmng 7/01 ,2005, and endina 6/30 OMS No, 1545.0047 2005 Open to Public Inspection ,2006 ~I~s"i'ab:t Teen Esteem or print 85 Highbridge Court or type. ~. Danvi11e, CA 94526 specIfIC instruc- tions. 20-1598494 E Telephone number o Employer Identification Number B Check if applicable: - _ Address change _ Name change Initial return - Final return - Amended return - _ Application pending 925-743-0438 F ~~i~g~ling 0 Cash ~ Accrual n Olher (specify) ~ H and I are not applicable to section 527 organizations, H (a) Is this a group return for affiliates? . .. 0 Yes H (b) If 'Yes: enter number of affiliates ~ H (c) Are all affiliates included? . . . , , . . ,. 0 Yes (If 'No: attach a list. See instructions.) . Section 501 (c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach a completed Schedule A (Fonn 990 or 990-EZ). [Kl No DNo J Organization type [Ul [J n (check only one) . . . . . . ., ~ IX I 501 (c) 3'" (insert no,) 4947(a)(1) or 5Z1 H (d) Is this a separate return filed by an K Check here ~ U if the organization's gross receipts are normally not more than organization covered by a group ruling? n Yes [Xl No $25,000. The organization need not file a return with the IRS; but if the organization chooses to file a return, be sure to file a complete return. Some states require a I Group Exemption Number. .. ~ complete return. M Check'" [KJ if the organization is not required L Gross receipts: Add lines 6b, 8b, 9b, and lOb to line 12 ~ 197, 602. to attach Schedule B (Form 990, 990.EZ, or 990.PF). IPart I I Revenue, Expenses, and Changes in Net Assets or Fund Balances (See Instructions) 1 Contributions, gifts, grants, and similar amounts received: a Direct public support. . . . . . . . . . . . . . . . . . . . . . . . , . . . . . , . . . . . . ' . . . . . . . . . . . . . b Indirect public support. ...................."........,...,.,.........,. c Government contributions (grants) . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . dTotal(addlines $ 177 435 $ lathrough lc) (cash ,. noncash )....................... 2 Program service revenue including government fees and contracts (from Part VII, line 93) . . . . . . . . . . . . . . . 3 Membership dues and assessments. . . . . . . . . . . , . . . . . . , . . , . . , . , . . , , , , . . . . . , , . . , , . . . . . , . , . . . . . . . . . . . , 4 Interest on savings and temporary cash investments. . . . . . . , . . , . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :a ~~~~:~:~t:,nd interestfro~ .securities: : : : : : : : : ' : : : : : . : : : : : : : : : : : : : : : : : : : : i . '6~ i . . . , . . , . . . . . . . . . . , . , b Less: rental expenses, . . , . . . . . . . . . . , . . . , , . , , . . . , . . . . . . . , , . . . . . . . . . . . , . . 6b c Net rental income or (loss) (subtract line 6b from line 6a) . . , , . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . 6c 7 Other investment income (describe. . . . . . .. ~ ) 7 G Web site: ~ N/A 1a lb lc 109,466. 67,969. ld 2 3 4 5 R E V E N U E (A) Securities (B) Other 8a Gross amount from sales of assets other than inventory, . , . , , . . . , . . , . , . . , . . . . . . , . , , , . . . , . . 8a b Less: cost or other basis and sales expenses. . . . . . . 8b c Gain or (loss) (attach schedule). . . . . . . . . . . . . . . . , . . . . . . . . . 8c d Net gain or (loss) (combine line 8c, columns (A) and (B)) . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Special events and activities (attach schedule). If any amount is from gaming, check here. . . . .. ~D a Gross revenue (not including $ 75, 801 . of contributions reported on line 1 a) . . . . . , . . . . ...... . . . . . . . , . . . . . . . . . , . . , . . . . , . . . . . . ..1 9a 1 b Less: direct expenses other than fundraising expenses. . . , ' . . . . . . . . . . . . . . . 9b c Net income or (loss) from special events (subtract line 9b from line 9a). , , ' . , . . . . . . . . . lOa Gross sales of inventory, less returns and allowances. . . . . . . . . . . . . . . . , . . ' . .ll0al b Less: cost of goods sold. . . , . . , , , .' .., . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . '. lOb c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line lOb from line lOa) . . . . . . . , . . . . . . . . . . . . . . . . . , . . 11 Other revenue (from Part VII, line 103). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , , , , . . . . . , . . . , . . , , . . 12 Total revenue (add lines 1d, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11)...,.....................,..."..,.., E 13 Program services (from line 44, column (B)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , , . , , . . . . . . . . . . . . ~ 14 Management and general (from line 44, column (C)). . , . . . . . . . . . . . . . . . . . . . . , . . . . . . . . , , , , . . , . , . . . , . , , , ~ 15 Fundraising (from line 44, column (D)) . , . . . . . . . . . . . , . . . . . . . . . , . . . . . . . . . . . . . . . . , , , , . . , . . . . , , . . , . , , . . ~ 16 Payments to affiliates (attach schedule) . . . . . . . . . . . . . . . . . . . . . . , . . . . ' . . . . . . . . . . , . . ' . . . . . . . . . . . . , . . . . . s 17 Total expenses (add lines 16 and 44, column (A)). . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . , . ' . . . . . . . . . . . . . . . 18 Excess or (deficit) for the year (subtract line 17 from line 12) . . . . . . . . . . . . . , . . . . . , . . . . , . . . . , , . . . . . . . . . , 19 Net assets or fund balances at beginning of year (from line 73, column (A)). . . . . , , . , , . . , . . , . . . . . . . . . , . . 20 Other changes in net assets or fund balances (attach explanation) . . , . . . . . . . . . . . . . . , . . . . . . . . . . . . , . . . . . 21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) . ., . . . . . . . . . . . . .. . . . . . . . . . . . . 8d 20,167. 20,167. . Statement. .1 9c 10c 11 12 13 14 15 16 17 18 19 20 21 A NS ES TE T S BAA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. TEEA0109L 02103/06 177,435. 177,435. 144,246. 10,521. 154,767. 22,668. 18,847. 41,515. Form 990 (2005) 2005) Teen Esteem 20-1598494 Statement of Functional Expenses All organizations must complete column (A). Columns (8), (C), and (D) are required for section 501 (c)(3) and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others. Pa e2 Do not include amounts reported on line (A) Total (8) Program (C) Management (0) Fundraising 6b, Bb, 9b, lOb, or 76 of Part I. services and general 22 Grants and allocations (att sch) (cash $ non-cash $ ) If this amount includes foreign grants, check here. ,. .. 0 . . , . 22 23 Specific assistance to individuals (att sch). . . . . . , 23 24 Benefits paid to or for members (att sch) . . , . . . , 24 25 Compensation of officers, directors, etc. . . . . . . . . 25 50,000. 50,000. O. O. 26 Other salaries and wages. , . , , . , , , , . , . 26 26,210. 26,210. 27 Pension plan contributions, . . . . . . . . . . . 27 28 Other employee benefits . . . . . . . . . . . . . . 28 29 Payroll taxes , . , . , , . . . . . . . . . . , , , . . . . . 29 15,247. 15,247. 30 Professional fundraising fees. . . . . . . . . . 30 31 Accounting fees. . . . . . . . . . . . , . . . . . . . . . 31 2,120. 2,120. 32 Legal fees. . . . . . . . . . . . . . . . . . . . . . . . . . . 32 33 Supplies. . . . . , . . . . . . . . . . . , . . . . , . , . . . 33 2,080. 1 039. 1,041. 34 Telephone. . . . . . . . . . . . . . . . . . . . . . . . . . . 34 836. 836. 35 Postage and shipping. . , . . . . . . . . . . . . . . 35 380. 380. 36 Occupancy. . . . . . . . . . . . . . . . . . . . . . . . . . 36 37 Equipment rental and maintenance. . . . . 37 38 Printing and publications. . . . . . . . . . . . . . 38 7,562. 7,378. 184. 39 Travel, . . . . . . . . . , , . . . . . . , , . , . . , . . . . . 39 40 Conferences, conventions, and meetings . . . . . . . , 40 2,575. 2 575. 41 Interest. . . . . . . . , . . , , . . . . . . . . , . . . , . . . 41 42 Depreciation, depletion, etc (attach schedule). . , . . 42 412. 412. 43 Other expenses not covered above (itemize): aSee Statement 2 43a 47,345. 40, 96l. 6,384. ------------------ b 43b ------------------ c 43c ------------------ d 43d ------------------ e 43e ------------------ f 43f ------------------ 9______------------ 43g 44 Total functional expenses. Add lines 22 thro~ 43. (Organizations completing columns (B) - ( , 154,767. 144,246. 10,521. O. carry these totals to lines 13 - 15) . . , . . . . . . . , 44 Joint Costs. Check, "U if you are following SOP 98-2. Are any joint costs from a combined educational campaign and fundraising solicitation reported in (8) Program services? . . . . . . . .. "0 Yes !Kl 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 Form 990 (2005) TEEA0102l 11101105 Form 990 (2005 Teen Esteem 20-1598494 Page 3 Statement of Pro ram Service Accom Iishments 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 mariner. Staie the number of (R(~)i~~~:~[z~~~~~~~nd clients served, lJublications issued, etc. Discuss achievements that are not measurable. (Section 501 (c) (3) and (4) organ- 4947(a)(1) trusts; but izations and 4947(a)(1 ) nonexempt charitable trusts must also enter the amount of grants and allocations to others.) optional for others.) a J'~~~n_ .E;~~e~I.!! _WE-~ _O.!'g:~nj~~d_ !Q.r_ ~l.le_ :Q~J]>.2~~.2f _eg.~~.!!.I!9"-L _ ~~~!:I2.i.!?-g: _a'!?-Q __ _e!!lEo_w~~~.ng_ ~e~!!<!9~ _ ~t.}:lg~nj:~ _a..!lQ "p_a!~I!..t~ _~..o _ ~a_k~ _lleE-!.1J1.Y _ ~hE~~~e3 _ -!.n_ ~l.l~ _a!~~a_s_2.~~~~_ Q~u9~_a'!?-Q _aJS:Q.h...ol::.. _ _ _ _ _ __ _ __ _ __ _ _ _ _ _ _ _._ _ _ _ _ _ _ __ (Grants and allocations $ b ) If this amount includes foreign grants, check here ~ 144,246. (Grants and allocations $ ) If this amount includes foreign grants, check here ~ c (Grants and allocations $ d ) If this amount includes foreign grants, check here ~ (Grants and allocations $ ) If this amount includes foreign grants, (;heck 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 (8), Program services). . . . , , , , . . . . . . , . . . . . ,. ~ BAA 144,246. Form 990 (2005) TEEA0103L 10114105 Form 990 (2005) Teen Esteem IPart IV ] Balance Sheets (See Instructions) 20-1598494 Page 4 Note: ~here required, attached schedules and amounts within the description (A) (8) column should be tor end-ot-year amounts only. Beginning of year End of year 45 Cash - non-interest-bearing. ... . .. . .. , ...... . ... . ..... , ...... . ..... " . ,..... 22,209. 45 41,814. 46 Savings and temporary cash investments. . . ."... . ,.. " .."..... . .... . ......, . 46 47a Accounts receivable, . , , , , , . , . . . . . . . . . , . . . . . . . . . 47a b Less: allowance for doubtful accounts. . . , . . , . . . . . 47b 47c 48a Pledges receivable. . . . . . . . . . . . . . . . . . . . . . . , . . , , . 48a b Less: allowance for doubtful accounts. . . . . . . . . . . . 48b 48c 49 Grants receivable. ....... . '" . ... . " . , . . , ... . ,.. . ,.. . ..... . 49 A 50 Receivables from officers, directors, trustees, and key 5 employees (attach schedule) , . . . . . . . , . . . . . , . . . . . . , , , , ' . . . ................. . 50 5 51 a Other notes & loans receivable (attach sch). . . . . . . . . . . . . . .. I 51 a I E T 51c 5 b Less: allowance for doubtful accounts. , , , . , , , . , , , 51 b 52 Inventories for sale or use. ......... , .. . ... . .... . ..........,.... . ......... , 52 53 Prepaid expenses and deferred charges ... . ........... . ,.,. . ........ . 53 54 Investments - securities (attach schedule). . . , . . , , . . . . . , , -'0 Cost 0 FMV 54 55a Investments - land, buildings, & equipment: basis. 55a b Less: accumulated depreciation 55c (attach schedule). . . . . . . . . . . . . . . . , . . , , , . . . , . , . , . 55b 56 Investments - other (attach schedule), . , . . . ...... . ,..".., . .......... , .... . 56 57a Land, buildings, and equipment: basis, . . . , . , . . . . . 57a 1,052. b Less: accumulated depreciation 537. 927. 57c 515. (attach schedule). . . . . . .. . . . .Statement. 3. . . 57b 58 Other assets (describe ~ ) . 58 59 Total assets (must equal line 74). Add lines 45 through 58. ..... . ...... . ,... . 23,136. 59 42,329. 60 Accounts payable and accrued expenses . , . ... . ... . .... . 4,289. 60 814. L 61 Grants payable. . . ,...... . ... . ... . ... , ., . .. . .. . ... . ... . . . -... . ... . 61 I A 62 Deferred revenue, , ,... . 62 B I 63 Loans from officers, directors, trustees, and key employees (attach schedule), ........ . 63 L I 64a Tax-exempt bond liabilities (attach schedule). ... . ... . ... " ... . ., . . . , . ...... . 64a T I b Mortgages and other notes payable (attach schedule). , .... . -. -... ..... . ..... . 64b E 5 65 Other liabilities (describe ~ ). . 65 66 Total liabilities. Add lines 60 through 65 . . . . . . . .......... . ..... . ... . 4,289. 66 814. N Organizations that follow SFAS 117, check here ~ ~ and complete lines 67 E through 69 and lines 73 and 74. T A 67 Unrestricted, . . .... . .... . ............ , .......... . .... . .....,. . .... . ...... , 18,847. 67 41,515. ~ 68 Temporarily restricted. . . . . . . ... . .... . .......... , ......... . 68 E ~ 69 Permanently restricted. . . , . . .... . . . . . . . . . . ,. . . . .. . ... . ....... . .".. . ..... . 69 ~ Organizations that do not follow SFAS 117, check here ~ o and complete lines F 70 through 74. u 70 Capital stock, trust principal, or current funds. . 70 N ....,.. . ... . 0 71 Paid,in or capital surplus, or land, building, and equipment fund. _ 71 B ... . , . ... . .. . t 72 Retained earnings, endowment, accumulated income, or other funds . , . . . . . . , . 72 A N 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through c 41,515. E 72; column (A) must equal line 19; column (B) must equal line 21). . _ , . . , . . . . . . 18,847. 73 5 74 Total liabilities and net assetsffund balances. Add lines 66 and 73. . ...... . 23,136. 74 42,329. BAA Form 990 (2005) TEEA0104L 10/17/05 Form 990 2005 Teen Esteem 20-1598494 I Part IV..A Reconciliation of Revenue per Audited Financial Statements with Revenue per Return (See instructions.) Page 5 a Total revenue, gains, and other support per audited financial statements. . . . . b Amounts included on line a but not on Part I, line 12: 1 Net unrealized gains on investments. . . , . . . . . . . , . . . . . , . . , . , . . . . , . , . . . . . . . ., , . 'f.E1 2Donated services and use of facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . b2 3Recoveries of prior year grants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b3 40ther (specify): ______ ___ __ _ ______ ______ ___ ___ b4 --------------------------------------- Add lines b1 through b4. . . . . . . . . . . . , , , , , . . . , . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Subtract line b from line a . . . . . . . . . . . , . . , . . , . . . . , . , , , , . . . . . . . , , . . , . . . . , , , . . , . . , . . . . . . , d Amounts included on Part I, line 12, but not on line a: 1 Investment expenses not included on Part I, line 6b...............".......... .tJ=1 20ther (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ d2 --------------------------------------- Add lines d1 and d2 . . . . . . . , . . . . . , . . . ' , , , . . . . . . , e Total revenue (Part I, line 12). Add lines c and d,................."..,........,...........,.........., I Part Iv.ID Reconciliation of Expenses per Audited Financial Statements with Ex enses a 177,435. b c 177,435. d ... e er Return 177,435. a Total expenses and losses per audited financial statements. . . . ., ..... .......,..........',..... b Amounts included on line a but not on Part I, line 17: 1 Donated services and use of facilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 'f.E1 2Prior year adjustments reported on Part I, line 20 . . . . . . . . . . . . . . , , . . . . . . . . . . . . . . b2 3Losses reported on Part I, line 20. . , . . , , . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b3 40ther (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _______________________________________ b4 Add lines b1 through b4. . . . . , . . . . , . . ' . . . . . . . . . ., ,. . . . . . . . . . . c Subtract line b from line a. . . . . . . . . . . . . . . . . . . . . . . , , . . . . . . . . . . . . . . . . . . d Amounts included on Part I, line 17, but not on line a: 1 Investment expenses not included on Part I, line 6b . . . . . . . . . . . . . . . . . . . . . . . . , . . .tJ=1 20ther (specify): ___ ___ ___ __ _ ___ ___ ___ ___ ___ ___ d2 --------------------------------------- a 154,767. b c 154,767. Add lines d1 and d2 . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d e Total expenses (Part I, line 17). Add lines c and d .. .. .. .. . .. .. .. . .. .. .. ... e 154, 767. I Part V-A Current Officers, Directors, Trustees, and Key Employees (List each person who was an officer, director, trustee, or key employee at any time during the year even if they were not compensated.) (See the instructions.) (B) Title and average hours (C) Compensation (0) Contributions to (E) Expense (A) Name and address per week devoted (if not paid, employee benefit account and other to position enter -0-) plans and deferred allowances compensation plans --------------------- --------------------- See Statement 4 50,000. O. O. --------------------- --------------------- --------------------- --------------------- --------------------- --------------------- --------------------- --------------------- --------------------- --------------------- BAA TEEAO 1 05L 1 0/17105 Form 990 (2005) Form 990 2005) Teen Esteem I Part V-A Current Officers, Directors Trustees, and Ke Em 10 ees (continued) 75a Enter the total number of officers, directors, and trustees permitted to vote on organization business as board meetings.. ..} _ _ _ _ _ _ _ _ _ _ b Are any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensated employees listed in Schedule A, Part I, or highest compensated professional and other independent contractors listed in Schedule A, Part II-A or 11,8, related to each other through family or business relationships? If 'Yes: attach a statement that identifies the individuals and explains the relationship(s). . . . . ' . . . . . . . ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , . . . . . . . . , . . . , . .. 75b c Do any officers, directors, trustees, or key employees listed in form 990, Part V-A, or highest compensated employees listed in Schedule A, Part I, or highest compensated professional and other independent contractors listed in Schedule A, Part II-A or 11-8, receive compensation from any other organizations, whether tax exempt or taxable, that are related to this organization through common supervision or common control? . . . . . . . . . , . . ' . , . . . . . . . . . . _ . . ' , , , . , . . . . . , , . , , , , ., 75c Not,e. Related organizations include section 509(a)(3) supporting organizations. If 'Yes,' attach a statement that identifies the individuals, explains the relationship between this organization and the other organization(s), and describes the compensation arrangements, including amounts paid to each individual by each related organization d Does the organization have a written conflict of interest policy? . , . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . , . . . . . . . . . . . . " 75d X IPart V-I[lFormer Officers, Directors, Trustees, and Key Employees That Received Compensation or Other Benefits (If any former officer, director, trustee, or key employee received compensation or other benefits (described below) during the year, list that person below and enter the amount of compensation or other benefits in the appropriate column. See the instructions.) 20-1598494 Pa e 6 Yes No X X (B) Loans and (C) Compensation (D) Contributions to (E) Expense (A) Name and address Advances employee benefit account and other plans and deferred allowances compensation plans --- -------------------- ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ ------------------------ I Part VII I Other Information (See the instructions,) Yes No 76 Did the organization engage in any activity not previously reported to the IRS? If 'Yes,' I attach a detailed description of each activity. . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... . .. . ..... . .... . ..... . 76 X 77 Were any changes made in the organizing or governing documents but not reported to the IRS? . . . , , , ......, . ..... . ... . 77 X I If 'Yes: attach a conformed copy of the changes. 78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? . . . . _ 78a X I b If 'Yes,' has it filed a tax return on Form 990-T for this year? . . . , . . . . ......" . "'. . ...... . ....... " ,..., . ......... . 78b N A I 79 Was there a liquidation, dissolution, termination, or substantial contraction during the I year? If 'Yes: attach a statement. . . , . , . . , . _ _ . . . . . . . . . . . . . , . . ' . ' , , . . , . . , . . . . . . . . . _ ... . " , ... . . . . . . . . . . . . . . . . ,. . 79 X 80a Is the organization related (other than by association with a statewide or nationwide organization) through common 80a xl membership, governing bodies, trustees, officers, etc, to any other exempt or nonexempt organization? _ , ..... . " . b If 'Yes,' enter the name of the organization ~ N/A _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _-_-_-_-_-_-_- ;nd ~h;ck ;h-;the~ iti~ 1] ;x;~-pt; - -0 ~o-;:;~;mpt. 81 a Enter direct and indirect political expenditures. (See line 81 instructions.). . . . . . . . . . . . . . . , .. lJ!! al 0 . b Did the organization file Form 1120-POL for this year?, , . . . . . . . . . . .......... . .............. . ... . ........... . ....... . 81b X I BAA Form 990 (2005) TEEAO 1 06L 11/03/05 Form 990 (2005) Teen Esteem I Part vO Other Information (continued) 20-1598494 Paae 7 Yes No 82a X 83a X 83b X 84a X 84b N A 8Sa NA 8Sb N A 82a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? . . . . . . . . . , . . . . . . . . . . . . . . . . .. ..,....,......."...,........................ b If 'Yes,' you may indicate the value of these items here. Do not include this amount as I ft, I revenue in Part I or as an expense in Part II. (See instructions in Part 111.)......,.......... ~!bl N/A 83a Did the organization comply with the public inspection requirements for returns and exemption applications? . . .' ....... b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? . . . . . . . , . . . . . . . . . . . . 84a Did the organization solicit any contributions or gifts that were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' . . . . . . . b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? , . . , . . . . . . . . . , . . . . . , . . . . . . . . . . . . . . . . . . , . . . ' . . . . . . . . . . . . . . . . . . .. ............................, 85 507(c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members?...,........,..,.......... b Did the organization make only in, house lobbying expenditures of $2,000 or less? . . , . . . . . . . . . . . . . . . . . , . . . . . . . . , . . . . , . , If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year. c Dues, assessments, and similar amounts from members. . . . . . . . . . . .. . . . . . . . . . .. . ., , ., . . . ~5C d Section 162(e) lobbying and political expenditures. . , . . , . . . . . . . . . . . . . . . , , . . . . . . , , , , , , . . ,. 85d e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices. . . . . , . . . . . . , . ., " .. 85e 1 Taxable amount of lobbying and political expenditures (line 85d less 85e). . . , . . . . . . . . . . . . .. 851 9 Does the organization elect to pay the section 6033(e) tax on the amount on line 85f?, , . , , , . . . . . . . . . . . , . . , , . . . . . . . . . . . . h If section 6033(e)(1 XA) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? . . . , . . . . . . . . . ' , . . . . . . . . . . . , . . . . . . . . . . . . . . . . . 86 507 (c)(?) organizations. Enter: a Initiation fees and capital contributions included on b ~:s~2~~~~i'~~: 'i~~;~~~~ '~~ 'Ii'~~ '1';,';;; ~~~;i~' ~~~ .~; ~;~~ ~~~;I;t;~~: : : : : :: :: : : : : : : : : : : : : : :: ~8~: 87 507 (c)(12) organizations. Enter: a Gross income from members or shareholders........,. 87a b Gross income from other sources. (Do not net amounts due or paid to other sources agalinst amounts due or received from them.). . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . .. 87b N/A 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301.7701-~! and 301.7701-3? If 'Yes,' complete Part IX, .......,...............,..,.............,..,.....,....."....,......,....".........., 88 89a 507(c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under: section 4911 .. _ _ _ _ _ _ _ _ _ .Q .:... ; section 4912" _ _ _ _ _ _ _ _ _ ..9..:. ; section 4955" _ _ _ _ _ _ _ _ _ ..9 ..:. b 507(c)(3) and 50 7 (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. , . , , . , , . . . . . , . . , , . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . ' . , . , . . . . . . , . . . , ' . , , . N/A N/A N/A N/A 8Sg N A 8Sh NA N/A N/A N/A X 89b X c ~~~::r~~~~~~~tf~~~~~'V~~4~5~na~~e .r9g~~.i~~~i~~. ~~~~~~:~ .~r, ~~~~~~Ii~i~~, ~~~~~~~ .~~r.i~~. t~,~ . . , , , , , . . . . . . . . ., ~ 0 . d Enter: Amount of tax on line 89c, above, reimbursed by the organization. . . . . . . . . . . . . . . . . . . . . . . . , , . . . . . . . . . ,. ~ 0 . 90a list the states with which a copy of this return is filed .. CA b Number of employees employed in the pay period that incl~d-;sM;~hl2,2005 (S;ein~t;-ucti-;;n~,). ~~. ~~. ~.~,~.~.~.~.~~T- - --2: 91a The books are in care of" Linda Turnbull Telephone number" 925-743-0438 Located at.. _8E _H_igh.~rl~<Le= ~(:= Q"~nyI:[l~~=C~~== === == _ _ _ _ ___ __. _ __ ZIP-+4 -..-j.f~2J_-_- - ----- b At any time during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial 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 Fore,ign Bank and Financial Statements c At any time during the calendar year, did the organization maintain an office outside of the United States? . 91 c If 'Yes,' enter the name of the foreign country ~ 92 Section 4947(a)(7) nonexempt charitable trusts ,iii;;g F;;;;;; 99'0;;' lie~ -;;iFo~ 1041:' -Che~k-h;r;~ ~ ~ ~~.~.~. ~.~.~.~.~.-. . N/A. .. ~ 0 and enter the amount of tax-exempt interest received or accrued during the tax year. . , ' . , . . . . , . , . . , . . . . .. ~I.!LI N/A BAA Form 990 (2005) Yes No X X TEEA0107L 02/03/06 Form 990 (2005) Teen Esteem I Part vn I Analvsis of Income-Producin Activities (See the instructions.) Unrelated business income Excluded bv section 512, 513, or 514 (E) Note: Entf" gross amounts unless (A) (B) (C) (0) Related or exempt otherwise indicated. Busi ness code Amount Exclusion code Amount function income 93 Program service revenue: a b c d e f MedicarelMedicaid payments. . . . , . , . 9 Fees & contracts from government agencies, . . 94 Membership dues and assessments. . 95 IntEirest on savings & temporary cash invmnts. . 96 Dividends & interest from securities. . 97 Net rental income or (loss) from real estate: a debt-financed property. , . . . . . . . . . . . . b not debt-financed property. . . . . . . , , . 98 Net rental income or (loss) from pers prop. . . . 99 Other investment income. , . . . . , . . , . 100 Gain or (loss) from sales of assets other than inventory. . . . . . . . . . , . . , . . 101 Net income or (loss) from special events. . , . , 102 Gross profit or (loss) from sales of inventory. . . . 103 Other revenue: a b c d e 104 Subtotal (add columns (B), (D), and (E)), . . . . 20-1598494 Page 8 105 Total (add line 104, columns (8), (D), and (E)). . . . . . . . . . . . . . . . , . . . . . . . . Note: Un€! 705 plus line 7d, Part I, should equal the amount on line 72, Part I. ~ O. I Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See the instructions.) Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment ... of the organization's exempt purposes (other than by providing funds for such purposes). N/A I Part IX Information Regarding Taxable Subsidiaries and Disregarded Entities (See the instructions.) (A) (B) (C) (0) (E) Name, address, and EIN of corporation, Percentage of Nature of activities Total End-of-year partnership, or disregarded entity ownership interest income assets N/A % ~ 0 ~ 0 ~ 0 Part X Information ReQardinQ 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 contraclt? . . . . . . . . . . . . . . . .. DYes b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . . . . . . . .. DYes Note: If 'Yes' to (b), file Form 8870 and Form 4720 (see instructions). 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. ~No ~No Please Sign Here ~ J Signature of officer Date ~ Linda Turnbull, President Type or print name and title. Preparer's signature ~ Date Check if self- employed ... Preparer's SSN or PTIN (See General Instruction W) P00139244 Paid Pre- parer's Use Only BAA Firm's name (or Thompson & De Pretis, LLP yours if self- employed), ~ 5820 Stoneridge Mall Rd Ste1l3 address, and ZIP+4 Pleasanton, CA 94588 EIN ... 94-3334028 Phone no. ... (925) 924-1500 TEEA0108L 10118105 Form 990 (2005) Department of the Treasury Internal Reve,nue Service Name of the organization Organization Exempt Under Section 501(cX3) (Except Private Foundation) and Section 501(e), 501(f), 501(k), 501 (n), or 4947(a)(1) Nonexempt Charitable Trust Supplementary Information - (See separate instructions.) · MUST be completed by the above organizations and attached to their Form 990 or 990.EZ. Employer Identification number OMB No. 1545-0047 SCHEDULE A (F onn 99(1 or 990-EZ) 2005 Teen Esteem 20-1598494 I Part I _ 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 compensation None ------------------------- ------------------------- ------------------------- ------------------------- ------------------------- Total number of other employees paid 0 over $50,000, . , , , . . , . , . , , . , , . . . , , . . , . . , . . . , . . , ~ I Part" -- A I Compensation of the Five Highest Paid Independent Contractors for Professional Services (See instructions. List each one (whether individuals or firms). If there are none, enter 'None:) (a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation None ---------------------------------------- Total number of others receiving over $50,000 for rofessional services, , , . . . . .. ~ 0 I Part" - B 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 (b) Type of service (c) Compensation None ---------------------------------------- Total number of other contractors receiving over $50,000 for other services. . . . . , . . _ .. ~ 0 BM For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Fonn 99o.EZ. Schedule A (Form 990 or 990-EZ) 2005 TEEA0401L 08/09/05 Schedule A (Form 990 or 990-EZ) 2005 Teen Esteem 20-1598494 Paae2 I Part III ~ Statements About Activities (See instructions.) Yes No 1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If 'Yes,' enter the total expenses paid or incurred in connection with the lobbying activities, . . ., ~ $ 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 Vl-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, majonty owner, or principal beneficiary? (If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions.) a Sale, exchange, or leasing of property? . . . , . 2a X b Lending of money or other extension of credit? . 2b X c Furnishing of goods, services, or facilities? . 2c X d Payment of compensation (or payment or reimbursement of expenses if more than $1 ,OOO)? . . . . 2d X e Transfer of any part of its income or assets? . 2e X 3a Do you make grants for scholarships, fellowships, student loans, etc? (If 'Yes,' attach an explanation of how you determine that recipients qualify to receive payments.) . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . , . . . . , . . . . 3a X b Do you have a section 403(b) annuity plan for your employees? . . . , . . . . . ' , , . . . . . . , , . . .. ' . . . , . . . . . . , . . . , . . . . , . 3b X c During the year, did the organization receive a contribution of qualified real property interest under section 170(h)? , . . . . . . 3c X 4a Did you maintain any separate account for participating donors where donors have the right to provide advice on the use or distribution of funds? , . , , . , . , . . . , . . . ' , . ' , . . , . , ' . , . , . . . . , . , , ' . . . . . . . . . . . . . . . . . . . ' , . . ' . . . . . , ' , . . , . . . ,4a X b Do you provide credit counseling, debt management, credit repair, or debt negotiation services? . ' . , , . . . . . , . . . 4b X , Part IV ~ Reason for Non-Private Foundation Status (See instructions.) The organization is not a private foundation because it is: (Please check only ONE applicable box.) 5 ~ A church, convention of churches, or association of churches. Section 170(b)(1 )(A)(i). 6 A school. Section 170(b)(1)(A)(ii). (Also complete Part V.) 7 A hospital or a cooperative hospital service organization. Section 170(b)(1 )(A)(iii). 8 A Federal, state, or local government or governmental unit. Section 170(b)(1)(A)(v). 9 L..J 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 DAn organization-ope-;:ated fo;t~ t;;;'clit of;; ~I~ge ~;:-u-;;i;e~ity ~;n-;d-07 ~p;r;;d t;ya-g;-v:;r;:;-;e;:;-t;i -;:;nit.-S-;;ctio~ liO(b)(l)(A)(iv~- (Also complete the Support Schedule in Part IV-A.) 11 a ~ An organization that normally receives a substantial part of its support from a governmental unit or from the general public. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.) 11 b D A community trust. Section 170(b)(1 ) (A) (vi). (Also complete the Support Schedule in Part IV"A..) 12 D An orgar:i~<:ttion that nor~ally re~eives: (1) more. than 33-1/3% of its sUf?port frorry contributions, membership fees, and woss receipts from activities related to Its chantable, 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 D An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in: (1) lines 5 through 12 above; or (2) section 501 (c)(4), (5), or (6), if they meet the test of section 509(a)(2). Check the _bOX that describes the type of supporting organization: ~ n Type 1 nType 2 -----DType 3 Provide the following information about the supported organizations. (See instructions.) (a) Name(s) of supported organization(s) (b) Line number from above ~A.n organization organized and operated to test for public safety. Section 509(a)(4). (See instructions.) BAA TEEA0402L 08/09/05 SGhedule A (Form 990 or Form 990-EZ) 2005 Schedule A (Form 990 or 990,EZ) 2005 Teen Esteem 20-1598494 Ipart IV-A Support Schedule (Complete only if you checked a box on line 10, 11, or 12.) Use cash method of accounting. N Pa e 3 ote: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting. Calendar year (or fiscal year (a) (b) (c) (d) (e) beginnin~1 in). . . . . . . . . . . . . . . . . . . .. ~ 2004 2003 2002 2001 Total 15 Gifts, grants, and contributions received, (Do not include 180,973. 180,973. unusual grants. See line 28.). " . 16 Membership fees received. . , O. 17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's O. charitable, etc, purpose, ....... . 18 Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organ, O. ization after June 30, 1975. . . . . . . ... . 19 Net income from unrelated business activities not included in line 18. .. . .. . O. 20 Tax revenues levied for the organization's benefit and either paid to it or expended O. on its behalf. . . . . . . ' . . . . . . . . . . 21 The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to O. the public without charge. . . ." . 22 Other income. Attach a schedule. Do not include gain or (loss) from sale of O. capital assets. ..... . ..... . ... . 23 Total of lines 15 through 22. . 180,973. 180,973. 24 Line 23 minus line 17. . . , . , . . 180,973. 180,973. 25 Enter 1 % of line 23 . , . , . . . . . . . 1,810. 26 Organizations described on lines 10 or " : a Enter 2% of amount in column (e), line 24.. . . . . . . . . . . . . . ~ 26a 3,619. 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 2001 through 2004 exceeded the amount shown in line 26a. Do not file this list with your ~ return. Enter the total of all these excess amounts. . . . . . . . . . . , . . . . , . . , . . . , , . , . . . . . , . . . . . . , . . . . , . . . , . , , , . . . . . . . . . . , 26b c Total support for section 509(a)(1) test: Enter line 24, column (e). . . . . . . . . . . . . . . . , . . . ~ 26c 180 973. .................... . d Add: Amounts from column (e) for lines: 18 19 22 26b 26d e Public support (line 26c minus line 26d total) . . . , . . . . . . . . ~ 26e 180,973. ......,............. ........................... f Public support percentage (line 26e (numerator) divided by line 26c (denominator)) . ~ 26f 100.00 5!c ........... . .. . 0 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: (2004) ___ _ __ ___ __ _ (2003) _ _ __ ___ _ __ _ _ (2002) _ __ _ __ _ ___ __ (2001) __ ___ ___ __ ___ 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: (2004) _ _ _ _ _ _ _ _ _ _ _ _ (2003) _ _ _ _ _ _ _ _ _ _ _ _ (2002) _ _ _ _ _ _ _ _ _ _ _ _ (2001) _ _ _ _ _ _ _ _ _ _ _ __ c Add: Amounts from column (e) for lines: 15 16 17 20 21 d Add: Line 27a total. . . . . and line 27b total, , . . . . . . , . . e Public support (line 27c total minus line 27d total). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f Total support for section 509(a)(2) test: Enter amount from line 23, column (e). . ., ~ 27f g Public support percentage (line 27e (numerator) divided by line 27f (denominator)). . . . . . . . . . . . . . . . . . . . . . .. ~ 27 h InvE!stment income ercenta e (line 18, column (e) (numerator) divided b line 27f (denominator)). . . . . . ~ 27h 28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 2001 through 2004, 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. BAA TEEA0403l 02/03/06 27c 27d ~ 27e % % Schedule A (Form 990 or 990-EZ) 2005 Schedule A Form 990 or 990- 2005 Teen Esteem IPart V Private School Questionnaire (See instructions.) (To be completed ONLY by schools that checked the box on line 6 in Part IV) 20-1598494 Pa e 4 N/A Yes No 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing instrument, or in a resolution of its governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . 29 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships? . . . , . . . . . . . . , . . , . . . . . . . . . . . . . . . . . . . . , . . . . . , . , . . . . . . . . . . . . ' . . . . . . . . . . . . . . ' . . . . . . . . . . . . . . .. .... 30 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves? . , . . . . . . . . , . . , . . . . , . , . . . . . . . . , . . . . , . . . . . , . . ,. 31 If 'Yes,' please describe; if 'No,' please explain. (If you need more space, attach a separate statement.) 32 Does the organization maintain the following: a Records indicating the racial composition of the student body, faculty, and administrative staff? . . b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? . . . . . . , , . . , . . . . . . . . . . . . . . . . . . . . . , . . . . . . , , . , . . . . . . . , . . . . , . . . . . . . . . 32a 32b c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships? . . . , , . . , ' . , . , . , . , . , . , . . . . . . . . . . . . . . . . . . , . . . . . .. ............. 32c d Copies of all material used by the organization or on its behalf to solicit contributions? , . . . , , . , . . . . . . . . . . . . , . . . . . . . . . . . 32d 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? . , 33a b Admissions policies? . . . . . . . . . . . . . . . . . . 33b c Employment of faculty or administrative staff? . . . 33c d Scholarships or other financial assistance? . 33d e Educational policies?, '.. 33e f Use of facilities? .. 33f 9 Athletic programs? . ,... 33g h Other extracurricular activities? . . . . . . . . 33h If you answered 'Yes' to any of the above, please explain. (If you need more space, attach a separate statement.) 34a Does the organization receive any financial aid or assistance from a governmental agency? . . ... 34a b Has the organization's right to such aid ever been revoked or suspended? . . , . . . . . . . . . If you answered 'Yes' to either 34a or b, please explain using an attached statement. 34b 35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev Proc 75-50, 1975,2 C.B. 587, covering racial nondiscrimination? If 'No,' attach an explanation.. . . . . . . . . , . . . , , . . . . . . . . . . . . . . . . . . . . . . . . . BAA TEEA0404L 08/08/05 .................... 35 Schedule A (Form 990 or 990-EZ) 2005 Schedule A (Form 990 or 990- 2005 Teen Esteem IPart VI-A Lobbying Expenditures by Electing Public Charities (See instructions.) (To be completed ONLY by an eligible organization that filed Form 5768) 20-1598494 Pa e 5 Check ~ a il if the organization belongs to an affiliated group. Check ~ b I I if you checked 'a' and 'limited control' provisions apply. Limits on Lobbying Expenditures (a) (b) Affiliated group To be completed totals for ALL electing (The term 'expenditures' means amounts paid or incurred.) organizations 36 Total lobbying expenditures to influence public opinion (grassroots lobbying). . . . , . . ,. . 36 37 Total lobbying expenditures to influence a legislative body (direct lobbying) , . . , ...... . 37 38 Total lobbying expenditures (add lines 36 and 37), . , . , . . . . . . . , . . . ....... . . T..... .. . 38 39 Other exempt purpose expenditures. . . . . . . . , . . . . , ,. . ......,... . .... . .......... , . , 39 40 Total exempt purpose expenditures (add lines 38 and 39). . . . .....,....... . ,... . ... . 40 41 Lobbying nontaxable amount. Enter the amount from the following table - If the amount on line 40 is- The lobbying nontaxable amount is- Not over $500,000. . . . . , . . , . . . . . . , . . . , , 20% of th, .moon! 00 "0' 4{). . . . . . G Over $500,000 but not over $1,000,000. . . . . . . . . . . $100,000 plus 15% of the excess over $500,000 Over $1,000,000 but not over $1,500,000. . . . . . . . . . $175,000 plus 10% of the excess over $1,000,000 41 Over $1,500,000 but not over $17,000,000. . . , . . . . . $225,000 plus 5% of the excess over $1,500,000 Over $17,000,000..............,....... $1,000,000 ' , . ' . . . . , . . , . , , . , ' , . ' . 42 Grassroots nontaxable amount (enter 25% of line 41). ... . ......, . '. . . . . . . . . . . . . . . . . 42 43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36. '. . . . ... . ...... . 43 44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38. ,. . ...... , .... . 44 Caution: If there is an amount on either line 43 or line 44, you must file Form 4720. N/A Lobbying Expenditures During 4 .Year Averaging Period Cal4mdar year (a) (b) (c) (d) (e) (or l!iscal year 2005 2004 2003 2002 Total beginning in) ~ 45 Lobbying nontaxable amount. . , . . . , , . , . . , . 46 LobbVing ceiling amount (150% of line 45(e)), . , . . . 47 Total lobbying expenditures. . . . . . . . . 48 Grassroots non, taxable amount. . . . . . . 49 Grassroots ceiling amount (150% of line 48(e)). . . . . . 50 Grassroots lobbying expenditures. . . . . . . . . IPart VI-B I Lobbyin Activity by Nonelectin Public Charities 4 -Year Averaging Period Under Section 501(h) (Some organizations that made a section 501 (h) election do not have to complete all of the five columns below. See the instructions for lines 45 through 50.) (For reportPng only by organizations that d~ not complete Part VI-A) (See instructions.) During the year, did the organization attempt to influence national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of: a Volunteers. . . . . , . . . . . . . .. ,'...., . . . . . . . . . . . ., ,. , . . . . . . . . . . ' , . . . . , . . , . . . , . . . . , b Paid staff or management (Include compensation in expenses reported on lines c through h.) . . c Media advertisements. . . . . . . , , , , . . . , . , . . . . . . . . . . , . , . . . . . . , . . . . . . . . . . . . . . d Mailings to members, legislators, or the public. . . , . . . . , . . . . . . ' , , , . ' . . . . . . . . . . . . . . e Publications, or published or broadcast statements. . . . . . . . . . . . . . . ' f Grants to other organizations for lobbying purposes . . , , , . , , , . . . . , . . . . . . . . , . . ' . . . . . . . , . . . , g Direct contact with legislators, their staffs, government officials, or a legislative body. . . . . . . . ' , . ' . ' h Ralliies, demonstrations, seminars, conventions, speeches, lectures, or any other means. . . . . . . . . , . . . , ' i Total lobbying expenditures (add lines c through h.). . ' . . . . . . . . . . . . . . . . . . . , , , ' . . , . . . , . . . , . . . . . , . ' If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities. BAA Schedule A (Form 990 or 990-EZ) 2005 N/A Yes No Amount TEEA0405L 08108/05 Schedule A (Form 990 or 990-E 2005 Teen Esteem 20-1598494 IPart VII 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 . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. . .. . .. . . . . . . . . . .. . . . . .. . 51 a (i) X (ii)Other assets. . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' . . , . . . . . . a (ii) X b Other transactions: (i) Sales or exchanges of assets with a non charitable exempt organization. , . .. . . , . , . . . . . , . . , , . . . . . . . . . . . . . . b (i) X (ii)purchases of assets from a noncharitable exempt organization, . . . . ' , . . . . . . . , . ' . . . . . . . . . . . b (ii) X (iii)l~ental of facilities, equipment, or other assets. . . . . . . . . . . , . . . . . . . . ' . ' . . . . . . . ' . . . . . . . , , . b (iii) X (iv)l~eimbursement 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 the (/OOdS, other assets or services given by the rep.ortin~ orH,anization If the or~nization received less than fair market value in Pa e 6 any' ransaction or shari'na arrangement, show in column d) e value of the gooas, other assets, or services received: (a) (b) (c) (d) Line no. Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements N/j~ 52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501 (c) of the Code (other than section 501 (c)(3)) or in section 5277. . , . . . . . . . . . . . . . . . . . . . . . . . . . b If 'YI~S,' complete the following schedule: (a) Name of organization ~ 0 Yes rID No (b) Type of organization (c) Description of relationship N/A BAA Schedule A (Form 990 or 990.EZ) 2005 TEEA0406l 08108105 2005 Federal Statements Page 1 Teen Esteem 20-1598494 Statement 1 Fon'll 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) Banquet 95,968. 75,80l. 20,167. 20,167. O. Total $ 95,968. $ 75,80l. $ 20,167. $ 20,167. $ O. Statement 2 Fon'll 990, Part II, Line 43 Other Expenses (A) (B) (C) (D) Program Management Total Services & General Fundraising Advertising 393. 393. Bank Fees 19. 19. Educational Events 5,763. 5,763. Insurance 4,143. 4,143. Marketing Expense 19,343. 19,343. Other Operating Expense 1,908. 1,908. Payroll Service Fee 1,627. 1,627. Professional Services 9,095. 4,750. 4,345. Speaker Expense 4,448. 4,448. Workers Compensation Insurance 606. 606. Total $ 47,345. $ 40,96l. $ 6,384. $ O. Staltement 3 Form 990, Part IV, Line 57 Land, Buildings, and Equipment Accum. Book Category Basis Deprec. Value Machinery and Equipment $ 1,052. $ 537. $ 515. Total $ 1,052. $ 537. $ 515. Staltement 4 Form 990, Part V-A List of Officers, Directors, Trustees, and Key Employees Ti tle and Contri- Expense Average Hours Compen- bution to Account/ Name and Address Per Week Devoted sation EBP & DC Other Linda Turnbull President $ 50,000. $ o. $ O. 85 Highbridge Ct. 35 Danville, CA 94526 2005 Federal Statements Page 2 Teen Esteem 20-1598494 Statement 4 (continued) Form 990, Part V-A List of Officers, Directors, Trustees, and Key Employees Name and Address Janyce Hoyt 85 Highbridge Ct. Danville, CA 94526 Ti tle and Average Hours Per Week Devoted Secretary $ 10 Compen- sation Contri- bution to EBP & DC O. $ o. $ Expense Account/ Other O. Tim Barley 85 Highbridge Ct. Danville, CA 94526 Vice President 5 O. O. O. Becky Pine 85 Highbridge Ct. Danville, CA 94526 Director o O. O. O. Tom Mason 85 Highbridge Ct. Danville, CA 94526 Director o O. O. o. Rick Weisser 85 Highbridge Ct. Danville, CA 94526 Director o O. O. o. Janet Wilford 85 Highbridge Ct. Danville, CA 94526 Director o O. O. o. Total $ 50,000. $ O. $ o. California Exempt Organization Annual Information Return For calendar or fiscal year beginning month 07 IMPORTANT: Your number is required. California corporation number Federal employer identification number (FEIN) YEAR 20l~5 2628003 FORM 199 day 0 1 year 2005, and ending month 06 day 30 year 2006 A Final return? Check applicable box. . Yes [Kl No O . 0 W' hd 0 Merged/Reorganized . Dissolved It rawn (attach explanation) If a box is checked, enter date. B tl:J~1~r~';'r: State: 0 109 0 100 0 looS 0 lOOW Fed: X 990 Fed: 0990EZ o 990T 0990PF 01041 01120H 1120 Corporation/Organization name 20-1598494 Teen Esteem Address PMB no. C If organization is exempt under R&TC Section 23701d and is a school, public charity, religious organization, or is controlled by a religious operation, check box. See General Instruction F. No filing fee is required. o Is this a group filing? See General Instruction N. . . . . . .. 0 Yes E Accounting method used. Accrual F Type of X Exempt under Section 23701 ~ (insert letter) organization IRC Section 4947(a) 1 trust .0 [KlNo 85 Hiqhbrid e Court City State ZIP Code Part I Danville, CA 94526 Complete Part I unless not required to file this form. See General Instructions Band C. Filing Fee 12 Penalty for failure to file on time. See General Instruction L. . , . , , , . . . , . . . . . . . . . . . . . . ' . , . . , , . . 12 13 Use tax. See instructions. . . . . . . . . . . . . . . . , , , . . . . . . . . . , , , . . , . . . . . . , . . . , . , . . , , . , . . . . . . . . .. 13 14 Balance due. Add line 11, line 12, and line 13 . . , . . . , . , . , . . . , . . . . . . . , , , , ' . , . . , . . , . . . . . . . . , , . . . . . . . . , 14 15 If exempt under R&TC Section 23701d, has the organization during the year: (1) participated in any political campaign or (~~) attempted to influence legislation or any ballot measure, or (3) made an election under R&TC Section 23704.5 (relating to lobbying by public charities)? If 'Yes,' complete and attach form FTB 3509, Political or Legislative Activities by Section 23701 d Organizations. . . . . . , , . , . , , . . . , . . . , . . . . . , , . , , , , , . . , . . . . , ' , . . . . . . , , , . , , , . , . . . . . . . . . . . . , . . . . . . . . . 16 Did the organization have any changes in its activities, governing instrument, articles of incorporation, or bylaws that have not been reported to the Franchise Tax Board? If 'Yes,' complete an explanation and attach copies of revised documents. . , . , . . . , , . . . . . , , . , , . . . . . , , . . , , , . . , . , . , , . . , . . . . ' . , . . . . , , . , . . . , . . . , , . . . . . . . , . . , , . . . . . . . . . . . . . . . 17 Is the organization exempt under R&TC Section 23701 g?, , , , , , , , , . , ' , , ' , , , , , . , . . . . , , , . . , . . . , ' . . . . . . . , . . , ' , . . . . . . . . . . If 'Yes,' enter amount of gross receipts from nonmember sources. , ., $ 18 Did the organization file Form 100, Form 100S, lOOW, or Form 109 to report taxable income?,.,........"............. If 'Yes,' enter amount of total income reported, , . .. $ 1 2 3 Receipts 4 and Revenues (Enclose, but 5 do not staple, 6 any payment.) 7 8 9 Expenses 10 11 Gross sales or receipts from other sources. From Side 2, Part II, line 8 . . . , , , , , . . . , . ' , , , . . , . 1 Gross dues and assessments from members and affiliates. . . . . . . . . . . , , . . . ' . . . . . . . . . . ' , , . , . 2 Gross contributions, gifts, grants, and similar amounts received. See instructions. . . . , . . . . . . . , . . , . . . . . , . , , , , . 3 Total gross receipts for filing requirement test. Add line 1 through line 3 This line must be completed. If the result is less than $25,000, see General Instruction C, . 4 Cost of goods sold . . , , , , . , . . . , , . . , . , , , , , . , . . . . , . . ,. .,.. 5 Cost or other basis, and sales expenses of assets sold. . , 6 Total costs. Add line 5 and line 6 . . . . , , . , . . . . , , . . , . . , . . . , . , . , . . . . , , . . . . . , . . . . . , . . . . . . . . . . . 7 Total gross income. Subtract line 7 from line 4. . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . , , 8 Total expenses and disbursements. From Side 2, Part II, line 18 . . . . . . . , . . . . . . . . . . . . . . . . . . . . . 9 Excess of receipts over expenses and disbursements. Subtract line 9 from line 8 . . . . . . . . . . . . ,. 10 20,167. 177,435. 197,602. Filing fee $10 or $25. See General Instruction F......................................,.,.,. 11 197,602. 174,934. 22,668. 10. 10. DYes ~NO DYes DYes [Kl No [Kl No DYes [Kl No Daytime telephone 925-743-0438 19 The financial records are in care of. Linda Turnbull 94526 Please Sign Here Under penalties of perjury. I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true. correct. and complete, Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. President ~ Title ~ Signature of officer Date . 925-743-0438 Daytime telephone Check Paid preparer's SSN or PTIN ~~~~~d . P00139244 FEIN Paid Preparer's ~ Paid signature Preparer's Use Only Firm's name (or yours, if self. ~ employed) and address Date . 94-3334028 . Day time telephone (925) 924-1500 19905104051 CACA1112L 12/02/05 Form 199 C1 2005 Side 1 For Priva(:y Act Notice, get form FTB 1131. Teen Esteem 20-1598494 Part II Organizations with gross receipts of more than $25,000 and private foundations regardless of amount of gross receipts- complete Part 1/ or furnish substitute information. See Specific Line Instructions. 1 Gross sales or receipts from all business activities. See instructions. . . . . , , , . . , . . . . . , , , . , . . . . , . . 1 2 Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... .. 2 3 Dividends. . . . . . . . . . . . . . ' . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . ' . . . . . . . . . . . . . . . . . . . 3 Receipts 4 Gross rents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , , . . 4 from 5 Gross royalties. . , . . . , , , . , . . . . . , . , . , , . . . . . . . . . . . . . . . . . . . . . . , . . , . . . . . . . . . . . . . . . . . , . , . . . , . . . . 5 Other Sources 6 Gross amount received from sale of assets . . . . . . . . . . . . , . . , . . . . . . . . . , . , . . . . . . . . . . . . . , . . . . , , . . 6 7 Other income. Attach schedule................................. See. .S.ta.tement..1...,. 7 20,167. 8 Total gross sales or receipts from other sources. Add line 1 through line 7. Enter here and on Side 1, Part I, line 1. . . , . . , . . . . . . . . . . . . . . . . . . , . . . . . . . . . . .. . .. . . . . . . . . . . . . . 8 20,167. 9 Contributions, gifts, grants, and similar amounts paid. Attach schedule. , , , . . . , . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . 9 10 Disbursements to or for members. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . , . . . . . . . . , . . . . . . . 10 11 Compensation of officers, directors, and trustees. Attach schedule ..... .See. .Statement. 2. 11 50,000. Expenses 12 Other salaries and wages. . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . , . . . , , , . . . . . . . . . , . . , , , . . . . 12 26,210. and 13 Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . , . . . . . . . . , . , , . . . . . . . . . . . . , . , . . . . . . 13 Disburse., ments 14 Taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . , . . . . . . . . . , , . , . . . . . . . . . . . . , . 14 15,247. 15 Rents. . . . . . . . . . . , . . . . . . , . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . , . . . . , . , . , . . . . . . . . , . . . , , . 15 16 Depreciation and depletion. . . . . . . . . . . . . . . . . , . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . , . 16 412. 17 Other. Attach schedule. . . . . . . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S.ee, . S,tatement. ,3. . , . . 17 83,065. 18 Total expenses and disbursements. Add line 9 through line 17. Enter here and on Side 1, Part I, line 9. , . . , , . . . . . . . , . , , 18 174,934. Schedule L Balance Sheets BeginninQ of taxable year End of taxable year Assets (a) (b) (c) (d) 1 Cash, ... . ............. . ................. . 22,209. 41,814. 2 Net accounts receivable. . . . .... . .. . ... . 3 Net notes receivable. Attach schedule, . . , ...... . , . 4 Inventories. . . .........,. . ., . . . ........... . 5 Federal and state government obligations. . . . 6 Investments in other bonds. Attach schedule. . ...... . 7 Investments in stock. Attach schedule. . . . . ., . ...... . 8 Moritgage loans (number of loans. . . ) - 9 Other investments. Attach schedule. . , , . , . . . , 10a Depreciable assets. . . . . .. . ,. . ..... . . . .,. . 1,052. 1,052. b Less accumulated depreciation. . ..... . .... . 125. 927. 537. 515. 11 Land. ... . ..... . ..... . ... . .. . .. . ... . 12 Other assets. Attach schedule. ........ . .... . 13 Total assets. ..... . ...... . .. . .... . ., , 23,136. 42,329. Liabilities: and net worth 14 Accounts payable. ... . '. ' ,.... . ........ . 4,289. 814. 15 Contributions, gifts, or grants payable. . . . . . . . 16 Bonds and notes payable. Attach schedule. . ..... . . , 17 Mortgages payable. ..... . .... . ....... . 18 Other liabilities. Attach schedule. . . . . . ... . .. . 19 Capital stock or principle fund. . . . 18,847. 41,515. 20 Paid-in or capital surplus. Attach reconciliation . . ,. . 21 Retained earnings or income fund. . . , , ..... . 22 Total liabilities and net worth. . . . . . . . . . . , .., . 23,136. 42,329. Schedule M-' Reconciliation of income per books with income per return Do not complete this schedule if the amount on Schedule L, line 13, column (d), is less than $25,000 1 Net income per books. . . . . . . . . . . . . . . , . , . . 22, 668. 7 Income recorded on books this year 2 Federal income tax. . . . . . . . . . . . . . . . . . . . . . not included in this return. 3 Excess of capital losses over capital gains. . Attach schedule. . . . . . , . . . . . . . , . . . . . . . 4 Income not recorded on books this year. 8 Deductions in this return not charged Attach schedule. . . . . . . . . . . . . . . . . . . . . . . . . against book income this year. 5 Expenses recorded on books this year not deducted Attach schedule. . . . . . . . . . . . . . . , . . . . . . in this return. Attach schedule. . . . . . . . . . . . . . . . . . 9 T ota!. Add line 7 and line 8 . , . , , . . . . . , 6 Total. 10 Net income per return. Add line 1 through line 5. . . . . . . . . . .. . . . .. . 22,668. Subtract line 9 from line 6. . . . , . . . . . . . Side 2 Form 199 C1 2005 19905204051 22,668. CACA 1112L 12102105 201~5 Corporation Depreciation and Amortization CALIFORNIA FORM 3885 TAXABLE YEAR Attach to Form 100 or Form lOOW. Corporation name Calilomia corporation number Teen Esteem 2628003 Part I Election to Ex ense Certain Pro erty Under IRC Section 179 1 Maximum deduction under Section 179 for California. . . . . . . . . . , . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Total cost of Section 179 property placed in service. . . . . . . . . . . . . . . . . . .. . . . . . . . . . , , . .. . . ., . . . . , . . . , , , . , . , 2 3 Threshold cost of Section 179 property before reduction in limitation. . . . . . . . . . . , , . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 Dollar limitation for tax ear. Subtract line 4 from line 1. If zero or less, enter -0, . , . . . . . . . . . . . . . . , , . . . . . . . . . 5 6 (a) Description of property (b) Cost (business use onl ) (c) Elected cost $25,000 $200,000 7 Listed property (elected Section 179 cost),.,....,....,...,........., 7 8 Total elected cost of Section 179 property. Add amounts in column (c), lines 6 and 7. . . . . . . . . . . . . . . . . ' . . . . . . 8 9 Tentative deduction. Enter the smaller of line 5 or line 8, . . , . . . . . , . . . . . . . . . . , . , , . . . . . . . . . . . . . . . . . . . . . . . . . 9 10 Carryover of disallowed deduction from prior years. . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . , . . . . . . . . . . , . . , . . , , . .. 10 11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 . . . . . . . . . . . . . . 11 12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 . . . . . . . . . . . , . . . . . . . .. 12 13 Carryover of disallowed deduction to 2006. Add lines 9 and 10, less line 12. . , . . , , . . .. 13 P rt II D . t" dEl A d F E Oed U d R&TC S ct" 24356 a eprecla Ion an ectlon of d itional irst Year xpense uctlon n er e Ion (a) (b) (c) (d) (e) (f) (g) (h) 14 Description Date Cost or Depreciation Method of Life Depreciation for Additional first of property acquired other basis allowed or figuring or rate this year year allowable in deprecia- depreciation earlier years tion 15 Add the amounts in column (g) and column (h). The combined total of column (h) may not I exceed $2,000. See instructions for line 14, column (h), . , . , . . . . . . . ' , ' . . . . . . . . . . . ' . . . . . . . .. 15 Part III Summa 16 Total: If the corporation is electing: IRC Section 179 expense, add the amount on line 12 and line 15, column (g) or Additional first year depreciation under R & TC Section 24356, add the amounts on line 15, columns (g) and (h) or Depreciation (if no election is made), enter the amount from line 15, column (g) . , . , . . . . , ' , . . . . . . . . . . . , , . . 16 17 Total depreciation claimed for federal purposes from federal Form 4562, line 22. . . . ' . , . . . . . . . . . . . . . . . . . . . . . . . .. 17 18 Depreciation adjustment. If line 17 is greater than line 16, enter the difference here and on Form 100 or Form 100W, Side 1, line 6. If line 17 is less than line 16, enter the difference here and on Form 100 or Form 100W, Side 1, line 12. (If California depreciation amounts are used to determine net income before state adjustments on Form 100 or Form lOOW, no adjustment is necessary.), .,.........,....,....... 18 Part IV Amortization 19 (a) (b) (c) (d) (e) (f) (g) Description Date Cost or Amortization R&TC Period or Amortization of property acquired other basis allowed or allowable section percentage for this year in earlier years 20 Total. Add the amounts in column (g). . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , . . . . . . , . . . . . . . . . . , , , 20 21 Total amortization claimed for federal purposes from federal Form 4562, line 44. . . . , . . . . . . , , , , . . . . . . . . . . , , , 21 22 Amortization adjustment. If line 21 is greater than line 20, enter the difference here and on Form 100 or Form 100W, Side 1, line 6. If line 21 is less than line 20, enter the difference here and on Form 100 or Form 100W, Side 1, line 12. . . . . . . . . , , . . . . . . . . . . . . . , . . . . . , . . . . . , , . , . . . . . . . . . . , . . . . . . . . . . . , , . . . , . . . . . , . 22 CACA3501L 12/28105 388505104051 FTB 3885 2005 200S California Statements Page 1 Teen Esteem 20-1598494 Staltement 1 FOl1n 199, Part II, Line 7 Other Income Income from Special Events,...........,...,.,...............,...,.,.",.,.,.,........,.... $ Total $ 20,167. 20,167. Statement 2 Form 199, Part II, Line 11 Compensation of Officers, Directors, and Trustees Ti tle and Contri- Expense Average Hours Compen- bution to Account! Name and Address Per Week Devoted sation EBP & DC Other Linda Turnbull President $ 50,000. $ o. $ O. 85 Highbridge Ct. 35 Danville, CA 94526 Janyce Hoyt Secretary O. O. O. 85 Highbridge Ct. 10 Danville, CA 94526 Tim Barley Vice President O. O. O. 85 Highbridge Ct. 5 Danville, CA 94526 Becky Pine Director O. O. o. 85 Highbridge Ct. None Danville, CA 94526 Tom Mason Director O. o. O. 85 Highbridge Ct. None Danville, CA 94526 Rick Weisser Director O. O. o. 85 Highbridge Ct. None Danville, CA 94526 Janet Wilford Director O. O. O. 85 Highbridge Ct. None Danville, CA 94526 Total $ 50,000. $ o. $ o. Staitement 3 Form 199, Part II, Line 17 Other Expenses Accounting Fees.......................................................,............,............ $ Advertising. . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . , , . . . . . . . . . . , , , , , , . , . , . . , Bank Fees.................................,.,.......................... ........................... Conferences, Conventions, and Meetings........,.....................,."...,......... Educational Events.""....,.,.,."......."..,...............,................................ Insurance. , . , . . . . . . . . . . . . . , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . , Marketing Expense...,..................................,....,..............,.............".." 2,120. 393. 19. 2,575. 5,763. 4,143. 19,343. 20051 California Statements Page 2 Teen Esteem 20-1598494 Statement 3 (continued) Form 199, Part II, Line 17 Other Expenses Other Operating Expense..........,.....,........,.,.......,.........................."..". $ Payroll Service Fee.,........................."...".......,..........,....".,.......,.,.... Postage and Shipping.............,...................,...............,....................... Printing and Publications.........,......,.,..........""..."........,................... Professional Services...,..........................,...,."..,........."...,................ Speaker Expense........,........................................................................ SpE!cial Event Expenses.....,........."....."".,...."...".........,...................,.. Supplies. . . , . , , . . . . . . . , . , . . . . . . . . . . . . . , . . . , . . . . . . . . . . . . . . . , . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , , . . , , . . . Telephone, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . , . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , . Workers Compensation Insurance,........"..............................................., Total $ 1,908. 1,627. 380. 7,562. 9,095. 4,448. 20,167. 2,080. 836. 606. 83,065. IN MAIL TO: Registry of Charitable Trusts P.O. Box 903447 Sacramento, CA 94203-4470 Telephone: (916) 445-2021 WEBSITI~ ADDRESS: http://ag.ca.gov/charities/ State Charity Registration Number Teen Esteem Name of Organization e Court Danville, CA 94526 City or Town ANNUAL REGISTRATION RENEWAL FEE REPORT TO ATTORNEY GENERAL OF CALIFORNIA Sections 12586 and 12587, California Government Code 11 Cal. Code Regs. sections 301-307, 311 and 312 Failure to submit this report annually no later than four months and fifteen days after the end of the organization's accounting period may result in the loss of tax exemption and the assessment of a minimum tax of $800, plus interest, and/or fines or filing penalties as defined in Government Code Section 12586.1. IRS extensions will be honored. Check if: o Change of address o Amended report Corporate or Organization No. 2628003 Federal EmployerlD No. 20-1598494 ANNUAL REGISTRATION RENEWAL FEE SCHEDULE (11 Cat. Code Regs. sections 301-307, 311and 312) Make Check Payable to Attorney General's Registry of Charitable Trusts State ZIP Code Gross AI~nual Revenue Less than $25,000 Between $25,000 and $100,000 PART A - ACTIVITIES Fee Gross Annual Revenue o Between $100,001 and $250,000 $25 Between $250,001 and $1 million Fee Gross Annual Revenue $50 Between $1,000,001 and $10 million $75 Between $10,000,001 and $50 million Greater than $50 million $150 $225 $300 For your most recent full accounting period (beginning Gross annual revenue $ 197 , 602 . 7/01/05 ending Total assets $ 6/30/06) list: 42,329. PART Ia - STATEMENTS REGARDING ORGANIZATION DURING THE PERIOD OF THIS REPORT Fee Note: If you answer 'yes' to any of the questions below, you must attach a separate sheet providing an explanation and details for each 'yes' response. Please review RRF-l instructions for information required. Yes No 1 Duning this reporting period, were there any contracts, loans, leases or other financial transactions between the organization and any officer, director or trustee thereof either directly or with an entity in which any such officer, director or trustee had any financial interest? 2 Duri!ng this reporting period, was there any theft, embezzlement, diversion or misuse of the organization's charitable property or funds? 3 During this reporting period, did non-program expenditures exceed 50% of gross revenues? 4 During this reporting period, were any organization funds used to pay any penalty, fine or judgment? If you filed a Form 4720 with the Internal Revenue Service, attach a copy. 5 During this reporting period, were the services of a commercial fundraiser or fundraising counsel for charitable purposes used? If 'yes,' provide an attachment listing the name, address, and telephone number of the service provider. 6 During this reporting period, did the organization receive any governmental funding? If so, provide an attachment listing the name of the agency, mailing address, contact person, and telephone number. 7 During this reporting period, did the organization hold a raffle for charitable purposes? If 'yes,' provide an attachment indicating the number of raffles and the date(s) they occurred. 8 Does the organization conduct a vehicle donation program? If 'yes,' provide an attachment indicating whether the program is operated by the charity or whether the organization contracts with a commercial fundraiser for charitable purposes. 9 Did your organization have prepared an audited financial statement in accordance with generally accepted accounting principles for this reporting period? Organization's area code and telephone number 925 -7 4 3 - 0 4 3 8 Organization's e-mail address I declare under penalty of perjury that I have examined this report, including accompanying documents, and to the best of my knowledge and belief, it is true, correct and complete. Signature of authorized officer Linda Turnbull Printed Name President Title CAVA9801L 08116105 Date RRF-l (3-05) o Teen Esteem Board Resolution February 5, 2007 Whereas: Teen Esteem receives all of its revenue from the community through grants and citizen donations. Whereas: Teen Esteem provides services at no cost to the Dublin schools to provide information important to the health and decision making of area students. Whereas: Teen Esteem has been providing services in the Dublin schools for many years. Whereas: the City of Dublin (Dublin) is offering to support selected organizations proposing to provide services in the Dublin with funds. Whereas: Teen Esteem is in needs such funds to continue providing services. Therefore: The Teen Esteem Board unanimously approves the submittal to Dublin of the Request for Funds and the proper submittal of the Application for Funds for consideration in the selection of funding for Dublin's fiscal year 2007 - 2008. Tim Barley Pending Board Member Janyce Hoyt Pending ~l~r (--+---' " :;7 t ,_ --- / A V\. _~,.._r. Finance Committee Chair, Board Member, Acting President Tom Mason Becky Pine Pending Board Member Linda Turnbull Director of Teen Esteem, Board Member Rick Weisser Pending Board Member , ~ . E. ACORDTN CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYYYY) 2/5/2007 PRODUCER (510)273-8888 FAX: (510)273-8867 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Saylor & Hill Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1939 Harrison St. #900 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oakland CA 94612 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Nonorofits Insurance Teen Esteem INSURER B: P.O. Box 966 INSURER C: INSURER D: Danville CA 94526 INSURER E: 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, AGe REGA nc: LIMIT!': !':HOWI\I MAY HAVE BEEN RFDIlr.FD BY PAin f"1 "I"'" INSR ADD'L P8k~~:~8~r Pg~fll~~~~N ITR IN....n TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - ~ 3MERCIAL GENERAL LIABILITY ~~~~~H9E~~J.i~nce) $ 100,000 A f-- CLAIMS MADE W OCCUR 2007-18706-NPO 2/6/2007 2/6/2008 MED EXP (Anv one nerson) $ 10,000 f-- PERSONAL & ADV INJURY $ 1,000,000 f-- GENERAL AGGREGATE $ 2,000,000 ~'L AGGREr9 LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PRo-(=f X POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT l,OOO,OOOX I--- $ ANY AUTO (Ea accident) f-- A ALL OWNED AUTOS 2007-18706-NPO 2/6/2007 2/6/2008 BODILY INJURY I--- $ SCHEDULED AUTOS (Per person) f-- ~ HIRED AUTOS BODILY INJURY $ ~ NON-OWNED AUTOS (Per accident) f-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSlUMBRELLA LIABILITY "M'H "'U'IIR"'''''''E $ ==:J OCCUR D CLAIMS MADE AGGREGATE $ $ ~ DEDUCTIBLE $ RETENTION ~ $ WORKERS COMPENSA 110N AND I WCSTAT~" T OTH, EMPLOYERS' LIABILITY Tr\lw LIMIT ER ANY PROPRIETORlPARTNERlEXECUTIVE EL. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L DISEASE, POLICY LIMIT $ A OTHER Buss. Personal Prop CWBOO05896-00-18706 2/6/2007 2/6/2008 BPP Lim.i. t $5,000,000 A 0&0 2007-18706 DO 2/6/2007 2/6/2008 Lim.i. t $1,000,000 DESCRIPTION OF OPERA TIONSlLOCATIONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Proof of coverage Insured's Copy CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL * 30 DAYS WRITTEN NOTICE TO THE CER11FICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLlGA 110N OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ;~:;;Z:~~::~;~~;IVE ~~~~__~_ @ ACORD CORPORA nON 1988 CERTIFICATE HOLDER ACORD 25 (2001/08) ~ 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 (2001/08) INS025 (0108).088 Page 2 of2 FEB. 5.2007 NO, 3155 h.'10DM ).f. I POLICYHOLDER COpy STATE COMP.NSATION INSU"'jlNC. FUND P.O, sox 420807, SAN FRANCISCO,CA 94142,-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE OATE: 02-0&-2007 GROUP: 0004110I POL-ICY NUMBER; 0000327-2006 CERTIFICATE 10: 1 CERTIFICATE EXPIRES: 08-01-2007 08-01-200S/OB-0'~2007 CITY OF DUBLIN 100 CIVIC ,.LZ DUBLIN CA 84588-2658 HB This is to tertily tNt 11\/8 h,ve Issued a valid Workers' Compen,ation insurance policy in a form approved by the Cali forma I"surlnee Commissioner to the employer namlild below for the poliey period Indicated. This policy is not slJbiect to cancellatio,., by tl1e Fund except upon 10 days advlII1ce written notice to tile employer. We 1I\/i11 also give you 10 clays advance notil;:e sholJld tIlis POliCY be clnceUed prior to It$ hortnal expiration. This cenlflcate 01 insurance is not ,n insur,"ce policy and does not al\'lend. extend or alter the coverage ,fforded by the policy listed herein. Notwitnslandi"g any requirement. term or condition of InY co"tract or other document with respe<:t to II\/hich thll certificate of insuranCe mav blil i5$ued or to which it may perUln, the insurllllce afforded by \h' policy described herein is $\Ib ject to alt the terrllS, exclusions. and conditions. of llu<:h poliCY. 6:::""'5'""" EMPLOYER'S LIABILITY LIMIT ~ PRESiOENT INCLUDING DfFI:NSE COSTS: $1,000,000 PER OCCURRENCE. EMPLOYER nEN ESTEEM PO lOX IGI DANVILLE CA 84528 NB fAtv.a-o,' [ROA.SC] PRINTED 02-05-2007 p, 1/1 NB F City of Dublin Fiscal Year 2007-2008 Application for Funds ApPLICATION VERIFICATION I attest that the information contained in this FY 2007-2008 grant application is accurate and that the funds requested will not supplant any other monies secured by the organization. Attached is a resolution, letter, or other document providing 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 submitting the reimbursement request, but not later than August 30,2008. Failure to submit a report will result in ineligibility for future funding. Signatures: Executive Director 2 Ie::; /0 7 I Dafe ~'\<p/ ~~Z/?__--- Board President/Chairperson '10/07 Date SECTION 2 Page 11 of 16 Teen Esteem - Who We Are T E f N E ~ TEE MT'" · The goal of Teen Esteem is to Equip, Educate & Empower teens, parents, educators and the community on issues related to teens and adolescent health · Comprised of trained volunteer speakers · Reach over 10,000 teens in the tri-valley annually through classroom presentations and school assemblies · Provide parent education and support · Local non-profit founded in 1994 , info@teenesteem.com 925-828-3685 P.O. Box 966, Danville, CA 94526 .. TUN tSTH/f' Wake Up and Smell the Coffee! An early morning gathering offered periodically throughout the year when parents, educators and community members come together to become educated, equipped and empowered on issues related to teens and adolescent health. Friday December 2nd 7:30 a.m. - 9:00 a.m. San Ramon Marriott Talk to Your Teens About What They NEED to Hear, Not What They WANT to Hear! With Guest Speakers: Teens will join Tim Barley to share what they NEED and WANT to hear from the adults in their lives. Tim has worked with hundreds of youth for 17 years, has been a dynamic classroom speaker for seven years and has counseled San Ramon Valley Are District firefighters for four years. He is a fun, energetic, extreme, adventurous man who both teens and adults relate to. Come and listen as he shares his experiences! 1. Purchase individual tickets: _ @ $20 ea. = $ 2. Host a table for ten: $200.00 3. Contact Teen Esteem at 925-828-3685 or heiditeenesteem@yahoo.com Name: Phone: Address: Payment: Mail to P.O.Box 966, Danville, CA 94526 1. Cash 2. Check [payable to Teen Esteem] 3. Visa or MC # Exp: Name on card: Signature: [For a tax-deductible receipt] TH!E gytEW t.ElJUf DP Jl1(}1f <RJS7( qjP:J{)fo/IO'RS ~ fl. t.' ~ t~]. ...-(.')I'.~."", .~.\ ,.~.... \' ( ~../. , . (.,; '-'- jfn eye-Opening ana Informative iEvening Peaturing: Linda Turnbull, Director of Teen Esteem Dr. Rick Weisser, Adolescent Medicine Pleasanton Kaiser George Papageorge, MFT Joe Ianora, SRVHS Principal Karen Schneider, CWMS Assistant Principal SRVUSD students -Kids are experimenting with high-risk behaviors at younger ages -The media and Internet are having a strong impact on our children -Build on your current communication with your teen -Help raise the bar in teen personal decision making Charlotte Wood Parent Ed Night Date: Time: Thurs. Feb. 9 7:00- 9:00 p.m. Charlotte Wood Middle School Multi-purpose room 600 EI Capitan Dr., Danville RSVP Carol perry- cperry@srvusd.net High schoof and mUftf[e sc/ioo[ parents wefcome. p[ease attend regarc[[ess of your chiU's age. RESOURCES FOR COMPUTER ACCOUNTABILITY AND BLOCKINGIFILTERING SOFTWARE SAFE EYES: Parental control software provides internet filtering; controls instant messaging file sharing; provides controls for time spent online; creates logs of web sites visited, programs used and instant messaging chats; provides usage alerts instantly via email, text message or phone can when inappropriate websites are visited FAMILY CYBER ALERT: Parental control software records emails, chat, instant messaging, websites visited, all keystrokes, and screen snapshots and provides reporting to a designated location; blocks email, chats, instant messaging, and inappropriate websites (\ ,) X3W A TCH: Accountability software program saves all site names browsed that contain questionable material in a folder which is emaiIed monthly to a designated person KIDSW A TCH WEB FILTERING CONTROL: Blocks inappropriate internet websites or content; restricts game playing; manages your child's computer time; automatically logs off at bedtime (\\ ."e\\ . WISECHOICE.NET: Parental control software blocks inappropriate internet websites and content; provides addresses of all sites accessed; cannot be turned off or changed by the user at their computer; primary customer must call office to personally request removal NET NANNY: Parental control software blocks inappropriate internet websites; limits child's computer time; protects personal information SPECTOR PRO 6.0: Parental control/monitoring software that secretly records every detail of internet activity including MySpace, email, chat, instant messaging, websites visited and searched, and blog communications; warning system alerts the parent when a pc has been used in an inappropriate manner SPYGATORPRO: Secretly monitors all activity on your computer including all keystrokes, programs, and internet websites visited; can capture screenshots at given intervals; stores all activity in an encrypted log file that can be sent to a specified address C, PCPANDORA: Can run openly or secretly; monitors and records all emails, instant messaging, chats, keystrokes, web sites visited, and programs installed; blocks any sites you don't want accessed CYBERPATROL 7.6: Internet safety software monitors internet activity; blocks harmful sites and images; restricts chat and instant messaging; limits time online and access to certain programs; controls program downloads; filters personal information before it leaves your computer C. 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 P.O. Box 966, Danville, CA 94526 (925) 828-3685 TEEN ESTEEM HIGH SCHOOL OUTLINE DAY 1 (50-55 min total) I. OPENING A. Introduction B. Tradeoffs of Choices II. YOUTH CULTURE A. What it is like today B. Why Teens Take Risks III. RELATIONSHIPS (Part one) A. Ideal Relationship B. Tea Cup Analogy (Activity) DAY 2 III. RELATIONSHIPS (Part two) C. Fireplace Illustration D. Physical Progression Line E. Rape/Sexual Abuse F. Abusive Relationships IV. CONSEQUENCES OF RISKY BEHAVIOR A. Drugs & Alcohol (Activity) B. Pregnancy/STDs/Emotional Ramifications C. Starting Over V. TOOLS FOR MAKING HEALTHY CHOICES VI. CLOSING Copyright Teen Esteem 1994,2006 Revised December 5, 2006 1 I TEEN ESTEEM MIDDLE SCHOOL OUTLINE DAY 1 (40-45 min total) I. OPENING A. Introduction II. HORMONES A. Roller Coaster Analogy B. Think * Feel * Act (with Angelica Story Activity) III. CHOICES/GOALS A. Choices Teens Make B. Benefits and Consequences C. Building Trust with Parents IV. PREPARING FOR HIGH SCHOOL A. What to Expect DAY 2 (40-45 min total) V. DEVELOPING A POSITIVE SELF-IMAGE A. Self-Image (Activity) B. How the Media Influences Self Image C. Internet/My Space D. Pornography E. Rape and Sexual Abuse VI. POWER TOOLS AND HOW TO USE 'EM A. Differences Between Guys and Girls B. Burglar-Proofing Your House - Refusal Skills (Activity) C. Your Power Tools VII. CLOSING A. Your Future is Up to You Copyright Teen Esteem 1994,2006 Revised December 13, 2006 1