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Agenda Packet
PRC Meeting 03.03.22 Page 1 of 306 CITY OF CUPERTINO AGENDA Nos C U P E RTi N O PARKS AND RECREATION COMMISSION This will be a teleconference meeting without a physical location. Thursday, March 3, 2022 7:00 PM This meeting will be televised. TELECONFERENCE / PUBLIC PARTICIPATION INFORMATION TO HELP STOP THE SPREAD OF COVID-19 In accordance with Government Code 54953(e), this will be a teleconference meeting without a physical location to help stop the spread of COVID-19. Members of the public wishing to observe the meeting may do so in one of the following ways: 1) Tune to Comcast Channel 26 and AT&T U-Verse Channel 99 on your TV. 2) The meeting will also be streamed live on and online at www.Cupertino.org/youtube and www.Cupertino.org/webcast Members of the public wishing comment on an item on the agenda may do so in the following ways: 1) E-mail comments by 5:00 p.m. on Thursday, March 3 to the Commission at parksandrecreationcommission@cupertino.org. These e-mail comments will be received by the commission members before the meeting and posted to the City's website after the meeting. 2) E-mail comments during the times for public comment during the meeting to the Commission at parksandrecreationcommission@cupertino.org. The staff liaison will read the emails into the record, and display any attachments on the screen, for up to 3 minutes (subject to the Chair's discretion to shorten time for public comments). Members of the public that wish to share a document must email parksandrecreationcommission@cupertino.org prior to speaking. 3) Teleconferencing Instructions Members of the public may observe the teleconference meeting or provide oral public comments as follows: Page 1 1 PRC Meeting 03.03.22 Page 2 of 306 Parks and Recreation Commission Agenda March 3,2022 Oral public comments will be accepted during the teleconference meeting. Comments may be made during "oral communications" for matters not on the agenda, and during the public comment period for each agenda item. To address the Commission, click on the link below to register in advance and access the meeting: Online Please click the link below to join the webinar: https:Hcityofcupertino.zoom.us/webinar/register/WNj2XEahQYRtWFcGPvnOjegA Phone Dial 669-900-6833, enter Webinar ID: 935 8325 0039 (Type *9 to raise hand to speak) Unregistered participants will be called on by the last four digits of their phone number. Or an H.323/SIP room system: H.323: 162.255.37.11 (US West) 162.255.36.11 (US East) 213.19.144.110 (Amsterdam Netherlands) 213.244.140.110 (Germany) 103.122.166.55 (Australia Sydney) 103.122.167.55 (Australia Melbourne) 69.174.57.160 (Canada Toronto) 65.39.152.160 (Canada Vancouver) Meeting ID: 935 8325 0039 SIP: 93583250039@zoomcrc.com After registering, you will receive a confirmation email containing information about joining the webinar. Please read the following instructions carefully: 1. You can directly download the teleconference software or connect to the meeting in your internet browser. If you are using your browser, make sure you are using a current and up-to-date browser: Chrome 30+, Firefox 27+, Microsoft Edge 12+, Safari 7+. Certain functionality may be disabled in older browsers, including Internet Explorer. 2. You will be asked to enter an email address and a name, followed by an email with instructions on how to connect to the meeting. Your email address will not be disclosed to the public. If you wish to make an oral public comment but do not wish to provide your name,you may enter "Cupertino Resident" or similar designation. Page 2 2 PRC Meeting 03.03.22 Page 3 of 306 Parks and Recreation Commission Agenda March 3,2022 3. When the Chair calls for the item on which you wish to speak, click on "raise hand." Speakers will be notified shortly before they are called to speak. 4. When called,please limit your remarks to the time allotted and the specific agenda topic. In compliance with the Americans with Disabilities Act (ADA), anyone who is planning to attend this teleconference meeting who is visually or hearing impaired or has any disability that needs special assistance should call the City Clerk's Office at 408-777-3223, at least 48 hours in advance of the meeting to arrange for assistance. In addition, upon request, in advance, by a person with a disability, meeting agendas and writings distributed for the meeting that are public records will be made available in the appropriate alternative format. CALL TO ORDER ROLL CALL APPROVAL OF MINUTES 1. Subject: February 3, 2022 Parks and Recreation Commission Meeting Minutes Recommended Action: Review and approve the February 3, 2022 Parks and Recreation Commission meeting minutes. A-Draft Minutes POSTPONEMENTS ORAL COMMUNICATIONS This portion of the meeting is reserved for persons wishing to address the Commission on any matter within the jurisdiction of the Commission and not on the agenda. Speakers are limited to three (3) minutes. In most cases, State law will prohibit the Commission from making any decisions with respect to a matter not on the agenda. WRITTEN COMMUNICATIONS OLD BUSINESS NEW BUSINESS 2. Subject: Review Fiscal Year 2022-23 Community Funding Grant Applications Recommended Action: Review Fiscal Year 2022-23 Community Funding Grant applications. Page 3 3 PRC Meeting 03.03.22 Page 4 of 306 Parks and Recreation Commission Agenda March 3,2022 Staff Report A-Current Community Funding Policy B-Community Funding Applications Summary C-Community Funding Applications and Eligibility Criteria 3. Subject: Evaluation Process for the Fiscal Year 2022-23 Community Funding Grant Program Recommended Action: Review the evaluation process for the Fiscal Year 2022-23 Community Funding Grant Program. Staff Report A-Commissioner Community Funding Evaluation Form B-Evaluation Totals Form STAFF AND COMMISSION REPORTS 4. Subject: Monthly Update Reports Recommended Action: Receive monthly update reports from the Director of Parks and Recreation and commissioners. COMMISSIONER ATTENDANCE AT UPCOMING MEETINGS AND EVENTS FUTURE AGENDA SETTING ADJOURNMENT In compliance with the Americans with Disabilities Act (ADA), anyone who is planning to attend this teleconference meeting who is visually or hearing impaired or has any disability that needs special assistance should call the City Clerk's Office at 408-777-3223, at least 48 hours in advance of the meeting to arrange for assistance. In addition, upon request, in advance, by a person with a disability, meeting agendas and writings distributed for the meeting that are public records will be made available in the appropriate alternative format. Any writings or documents provided to a majority of the members after publication of the agenda will be made available for public inspection. Please contact the City Clerk's Office in City Hall located at 10300 Torre Avenue, Cupertino, California 95014, during normal business hours. IMPORTANT NOTICE: Please be advised that pursuant to Cupertino Municipal Code section 2.08.100 written communications sent to the Cupertino City Council, Commissioners or City staff concerning a matter on the agenda are included as supplemental material to the agendized item. These written communications are accessible to the public through the City's website and kept in packet archives. Do not include any personal or private information in written communications to the City that you do not wish to make public, as written communications are considered public records and will be made publicly available on the City website. Page 4 4 PRC Meeting 03.03.22 Page 5 of 306 Parks and Recreation Commission Agenda March 3,2022 Members of the public are entitled to address the members concerning any item that is described in the notice or agenda for this meeting, before or during consideration of that item. If you wish to address the members on any other item not on the agenda, you may do so during the public comment. Page 5 5 PRC Meeting 03.03.22 Page 6 of 306 CITY OF CUPERTINO CUPERTINO Agenda Item 22-10526 Agenda Date: 3/3/2022 Agenda #: 1. Subject: February 3, 2022 Parks and Recreation Commission Meeting Minutes Review and approve the February 3, 2022 Parks and Recreation Commission meeting minutes. CITY OF CUPERTINO Page 1 of 1 Printed on 3/2/2022 powered by LegistarTM 6 PRC Meeting 03.03.22 Page 7 of 306 CITY OF CITY OF CUPERTINO is PARKS AND RECREATION COMMISSION Teleconference Meeting CUPERTINO Thursday, February 3, 2022 7:00 PM DRAFT MINUTES CALL TO ORDER Chair Stanek called the meeting to order at 7:02 p.m. via remote teleconference. ROLL CALL Commissioners present: Carol Stanek, Xiangchen (Minna) Xu, Sashikala Begur, Gopal Kumarappan, Seema Swamy Commissioners absent: None Staff present: Joanne Magrini, Susan Michael, Kevin Khuu, Rachelle Sander, Sonya Lee, Daniel Mestizo Guest speakers: None CEREMONIAL MATTERS AND PRESENTATIONS 1. Subject: Chair and Vice Chair Selection Recommended Action: Conduct the selection of the Chair and Vice Chair. Commissioner Begur nominated Vice Chair Xu as Chair. Commissioner Kumarappan seconded. Motion carried unanimously. Vice Chair Xu nominated Commissioner Begur as Vice Chair. Commissioner Swamy seconded. Motion carried unanimously. 2. Subject: Presentation on Holiday Programs Recommended Action: Receive a presentation on holiday programs. Joanne Magrini, Director of Parks and Recreation, introduced Sonya Lee, Recreation Manager, to present on this item. Sonya reviewed the holiday programs hosted by the department in the winter, including Tree Lighting, Signing Santa, Santa Visits, Holiday Lights Cupertino, Holidays in Hawai i, and Seasons Greetings. 3. Subject: Capital Improvement Programs Update Recommended Action: Accept a presentation on the Capital Improvement Projects Update. 7 PRC Meeting 03.03.22 Page 8 of 306 Director Magrini introduced Susan Michael, Capital Improvement Projects Manager, to present on this item. Susan reviewed the current CIP projects and provided project statuses and reports on the Parks and Recreation related projects. Commissioner Kumarappan asked for an overarching map or overall plan that tracks all improvements recommended in the Parks and Recreation System Master Plan, for the community to understand what is being planned where and to ensure that the individual improvements complement each other. Chair Xu suggested adding this item as a future agenda item. Vice Chair Begur requested to see the design plan for the Memorial Park Ponds and timelines for the other projects. 4. Subject: Strategic Plan Update Recommended Action: Accept a presentation on the Strategic Plan Update. This item was postponed to the future meeting. APPROVAL OF MINUTES 5. Subject: December 2, 2021 Parks and Recreation Commission Meeting Minutes Recommended Action: Review and approve the December 2, 2021 Parks and Recreation Commission meeting minutes. Commissioner Stanek motioned to approve the minutes as submitted. Commissioner Kumarappan seconded. Motion passed with 4 yes and 1 abstain. 6. Subject: January 20, 2022 Parks and Recreation Commission Special Meeting Minutes Recommended Action: Review and approve the January 20, 2022 Parks and Recreation Commission special meeting minutes. Commissioner Stanek asked to correct the word "succeed" to "cede" under Old Business, Item 2. Commissioner Kumarappan motioned to approve the minutes, with the amendment above. Commissioner Stanek seconded. Motion passed with 3 yes and 2 abstain. POSTPONEMENTS None ORAL COMMUNICATIONS None 8 PRC Meeting 03.03.22 Page 9 of 306 WRITTEN COMMUNICATIONS None OLD BUSINESS None NEW BUSINESS 7. Subject: Update on the Fiscal Year 2021-2022 City Work Program Item Mental Health Support Recommended Action: Receive an update on the status of the Mental Health Support Fiscal Year 2021-2022 Work Program item and provide feedback. Director Magrini introduced Daniel Mestizo, Recreation Coordinator, to present on this item. Daniel provided an update to the Commission, covering the background, phases, and status of the project. Daniel also shared the City's mental health website. Commissioner Kumarappan and Commissioner Swamy encouraged staff to request help from the Commission to improve and build on this work program item. Chair Xu supported reaching out to other Commissions to expand the program. STAFF AND COMMISSION REPORTS 8. Subject: Monthly Update Reports. Recommended Action: Receive monthly update reports from the Director of Parks and Recreation and commissioners. Director Magrini provided the Director's update. Commissioner Stanek provided an update and had attended the Mayor's Meeting in January. Reported on the following: - Library Commission reported on the Library Expansion project and the Poet Laureate program. - Sustainability Commission is working on a Climate Action Plan and Single Use Plastics Ordinance for restaurants and other places that provide plastics. - Fine Arts Commission reported the emerging artist winners are on display at the Library. - Public Safety Commission reported on the consideration of License Plate Readers, outreach on catalytic converter thefts, and reviewing a gun ordinance. - Bicycle Pedestrian Commission reported on the Lawson Middle School bike ped options and the last phase of the McClellan Bike Lane to De Anza. - Mayor spoke about the State of the City Address. - Also met the new City Manager and City Attorney. 9 PRC Meeting 03.03.22 Page 10 of 306 COMMISSIONER ATTENDANCE AT UPCOMING MEETINGS AND EVENTS Commissioners to attend the upcoming Mayor's meetings as follows: - February 9: Commissioner Stanek - March 9: Vice Chair Begur - April 13: Commissioner Kumarappan FUTURE AGENDA SETTING Director Magrini commented that the Community Funding item will be agendized for the March meeting. ADJOURNMENT Chair Xu adjourned the meeting at 9:08 p.m. to the March 3, 2022 meeting at 7:00 p.m. Respectfully submitted, Kevin Khuu, Management Analyst Parks and Recreation Department Minutes approved at the regular meeting 10 PRC Meeting 03.03.22 Page 11 of 306 CITY OF CUPERTINO CUPERTINO Agenda Item 22-10527 Agenda Date: 3/3/2022 Agenda #: 2. Subject: Review Fiscal Year 2022-23 Community Funding Grant Applications Review Fiscal Year 2022-23 Community Funding Grant applications. CITY OF CUPERTINO Page 1 of 1 Printed on 3/2/2022 powered by LegistarTM 11 PRC Meeting 03.03.22 Page 12 of 306 CITY OF PARKS AND RECREATION DEPARTMENT QUINLAN COMMUNITY CENTER 10185 NORTH STELLING ROAD • CUPERTINO, CA 95014-5732 TELEPHONE: (408) 777-3120 • FAX: (408) 777-1305 CUPERTINO CUPERTINO.ORG PARKS AND RECREATION COMMISSION STAFF REPORT Meeting: March 3, 2022 Subject Review Fiscal Year 2022-2023 Community Funding Grant Applications. Recommended Action Review Fiscal Year 2022-2023 Community Funding Grant applications. Discussion The Community Funding Grant application process opened in January and closed on February 1, 2022. The City received 21 applications for the FY 2022-2023 Community Funding Grant Program application cycle. Staff reviewed all submitted applications for completeness and eligibility, determined by compliance with the Community Funding Policy (Attachment A). Staff concluded that 20 applications fully met eligibility requirements and one application is pending eligibility and required further consideration by the Commission to determine eligibility. A summary of the application project, funding requested, funding tier, new or returning applicant, and prior funding is provided (Attachment B). All submitted applications will be provided to the Commission for review, as well as staff's evaluation of each application's eligibility (Attachment C). Applicants have been notified of the Commission meeting and will have the opportunity to provide any clarification regarding Commissioner's questions. Sustainability Impact No sustainability impact. Fiscal Impact No fiscal impact associated with reviewing Community Funding applications and receiving staff's presentation. In April, the Commission will review application evaluations and provide a recommendation regarding funding to City Council for final approval. 12 PRC Meeting 03.03.22 Page 13 of 306 Prepared by: Rachelle Sander, Assistant Director of Parks and Recreation Reviewed and approved by: Joanne Magrini, Director of Parks and Recreation Attachments: A-Current Community Funding Policy B-Community Funding Applications Summary C-Community Funding Applications and Eligibility Criteria 13 PRC Meeting 03.03.22 Page 14 of 306 Fiscal Policies - Community Funding Grant Policy PURPOSE The City of Cupertino currently provides funding to local non-profit organizations in the areas of social services, fine arts and other programs for the general public. The policy provides a framework for the City's Community Funding Grant Program and guides the administration of the program and decision-making process. It also provides guidance on key aspects of the City's Community Funding Grant Program processes including: Eligibility, Evaluation Criteria, Restrictions/Guidelines, and Procedure. SCOPE All requests for funding must comply with this policy. POLICY The City has established the Community Funding Grant Program, subject to availability of funds,with a range of$70,000 to$90,000 in total funding available. Community Funding Grants shall not exceed$20,00 per applicant,per year. City Council will determine the organizations to be awarded funds through the Community Funding Grant Program. City Staff shall review applications for completeness and review the qualifications and accuracy based upon the eligibility criteria set forth below. In all cases, the City reserves the right to reject any and all applications in the event staff identifies a potential conflict of interest or the appearance of a conflict of interest.Submission of an application in no way obligates the City to award a grant and the City reserves the right to reject any or all applications, for any reason, at anytime. Eligibility To receive consideration for a Community Funding Grant, grant requests must: • Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the program/project/event. • Identify how the funds will be used to benefit the Cupertino community. • Be awarded only once per project • For specific needs,not ongoing, operational costs. • Have more than 75%of the requested funds allocated for direct service costs versus administrative costs. • Be complete and submitted by the application deadline. Evaluation Criteria • Impact on and benefit to the Cupertino community • Community need for the program/project/event • Alignment with City mission and values • Uniqueness of the program/project/event • Qualifications and experience of the organization and its members • Reasonable cost • Demonstrated effort to secure funding from other sources and/or establishing 14 PRC Meeting 03.03.22 Page 15 of 306 partnerships with other community or city organizations • Clarity, completeness, and accuracy of grant application • Past performance and compliance with requirements if a recurring applicant Applications will be sorted into two categories: • New applicants • Past recipients Applications in each category will be evaluated using a tiered structure based on the dollar amount requested for award as follows: • <$999.99 • $1,000.00-$4,999.99 • $5,000.00—$9,999.99 • $10,000.00-$20,000.00 Restrictions/Guidelines • An organization that is applying for multiple grants shall only submit one application. • Proceeds generated from the funded activity may only be used for the conducted activity. • If requested,recipients must provide full financial statements for the organization. • Admission to or participation in the event must be "free of charge"for Cupertino residents unless stated in the application and approved by Parks&Recreation Commission. • If an applicant makes a grant request directly to a member of the City Council,whether individually or as a group, the Council shall refer the applicant to the Parks and Recreation Department for a Grant application to be reviewed in accordance with this policy. • Grant recipients shall acknowledge the City contribution in formal promotional materials and efforts related to the funded activity. Any use of the City logo must be approved by the City's Communications Officer. Procedure 1. Applicants submit timely and complete grant applications by February 1. 2. City Staff reviews application for completeness and compliance eligibility. 3. Applications will then be forwarded to the Parks and Recreation Commission to be evaluated and sorted into the tiered funding structure. All applicants will be notified and invited to attend the Parks and Recreation Commission Meeting where their applications will be discussed. This meeting typically takes place in Spring. 4. City Council will make the final decision on grant amounts for each applicant as part of the budget adoption which typically happens in June. All applicants will be notified and invited to attend the City Council Meeting where their applications will be discussed. 5. Grant recipients shall submit a written report to the Parks and Recreation Department to show proof that the grant funds have been spent in the manner and for the purposes stated on the application,including information about the number of persons served and 15 PRC Meeting 03.03.22 Page 16 of 306 other results that benefit Cupertino. o Due by the 15f business day of July following the Fiscal Year in which grant funds are disbursed. o Failure to submit a written report by the July deadline could result in the loss of grant funding eligibility in the future. o Applicants will be expected to reimburse the City any funding awarded and not used for their program/project/event. 16 PRC Meeting 03.03.22 Page 17 of 306 Cupertino Residents Amount Status Project Name Served Requested Tier Eligibility Ne�Omniware Networks Peace Love Unity Youth Art Contest Exhibition 1,000 $2,000.00 Tier 2 Eligible Ne�Palisadoes Foundation Calico Challenge SF 1 $3,750.00 Tier 2 Eligible Ne�American Cancer Society-Relay for Life Relay for Life of Silicon Valley North 180 $6,000.00 Tier 3 Eligible Ne�STEMBoost Corporation STEMBoost Summer Workshop 4,588 $8,000.00 Tier 3 Eligible Ne�Youngzine Summer Youth Climate Steward Program 12 $6,000.00 Tier 3 Eligible Ne�Able 2 Shine Teens Club Events in 2022 2,000 $20,000.00 Tier 4 Pending Ne�Cupertino Educational Endowment Foundation Expansion of Teacher Grant Program 6,217 $109,325.00* Tier 4 Eligible Ne�Cupertino Union School District CUSD Summer Bridge 240 $20,000.00 Tier 4 Eligible Ne�Fremont Union School District Foundation Care Solace Partnership for Mental Health Services 7,000 $20,000.00 Tier 4 Eligible Ne Women SV Technical Support for Domestic Abuse Survivors 10 $20,000.00 Tier 4 Eligible *Maximum award$20,000 Cupertino Residents Amount Amount Status Applicant A& Project Name JAWServed Requested Tier Eligibility F,-FY Funded Funded ProjectBreathe California of the Bay Area Seniors Breathe Easy 2,500 $4,000.00 Tier 1 Eligible 2020-2021 $4,000 FY20-21 extended to FY21-22 due to COVID �.ong 2022 Tian Hong Cross Cultural Youth Art Contest(Love in my life) 100 $4,500.00 Tier 2 Eligible FY 2021-2022 $3,000 2021 Youth Art Contest(Nature and Me) l Foundation Healthy Cupertino Health Fair 50 $8,300.00 Tier 3 Eligible FY 2021-202.2 $7,400 Healthy Cupertino Health Fair Senior Services-Heart of the Valley COVID Car Kit 50 $6,160.46 Tier 3 Eligible FY 2019-2020 $7,000 FY19-20 extended to FY 20-21 due to COVID Returnin Chinese American Coalition for Compassionate Care Mindfully Facing Grief and Loss and Starting the Conversation 1,000 $13,000.00 Tier 4 Eligible FY 2021-2022 $12,000 Starting the Conversation and Mindful Self-Care Retumings Cupertino Bhubaneswar Sister City Initiative Bhubaneswar Sister City Event/Festival for Exchange&Immersion 2,000 $15,000.00 Tier 4 Eligible FY 2020-2021 $7,500 Festival and Exchanges Returningn Euphrat Museum of Art-De Anza College Euphrat Museum of Art exhibitions and events 11,500 $15,000.00 Tier 4 Eligible FY 2021-2022 $15,000 Euphrat Museum exhibitions and events 2021-2022 Retumingl Monta Vista High School Speech Boosters Inc Monta Vista Speech Program 4,464 $10,000.00 Tier 4 Eligible FY 2021-2022 $3,000 Monta Vista Speech Program Returningn Rotary Club of Cupertino Silicon Valley Fall Festival 500 $12,000.00 Tier 4 Eligible FY 2021-2022 $12,000 Cupertino Fall Festival Retumingl West Valley Community Services Gift of Hope 2022 300 $10,000.00 Tier 4 Eligible FY 2021-2022 $10,000 Gift of Holiday Hope Program Returning Silicon Valley Jewish Film Festival Silicon Valley Jewish Film Festival 5,000 $10,000.00 Tier 4 Eligible FY 2020-2021 $5,000 SV Jewish Film Festival Tiers TOTAL Community Funding Grants Requested $323,035.46 Tier 1 <$999.99 Tier 2 $1,000.00-$4,999.99 Community Funding Approved Funding Range-$70,000 to$90,000 Tier 3 $5,000.00-$9,999.99 Tier 4 $10,000.00-$20,000.00 17 PRC Meeting 03.03.22 Page 18 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO CONTACTSECTION 1 : Full Legal Organization Name: Qmnlware Networks Website:I www.omniwarenetworks_com Address: 656 Lytton Ave City: Palo Alto State: Galif Zip:194301 Phone: 16505398919 Organization President/Executive Director Name and Title: I Fengdi XU Email: omrliwarenetworks@gmail.com Phone: F6505398919 Contact Name and Title: (If different) Email: Phone: SECTION • • •' • 501(c)(3)?: ■ `es Year Established: 2�Q7 No {i f different than ab zle address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax IDJ 26-0319712 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 112000 Total#of Board Members: 2 Total#of staff:12 Total#of Volunteers:I 10 18 PRC Meeting 03.03.22 Page 19 of 306 Mission Statement: To strengthen relations and understanding among peoples of different regions and backgrounds; to promote people's knowledge and understanding of various cultures, values, arts and communities in a peaceful and enriching way. Brief Description of Organization and Serx ices Proz-ided: e are a sma micro nonprofit organEzation and have been serving local communities to encourage community diversity,understanding,cultural celebration and identity pride, and enhance community engagement and interpersonal connections.A few representative community activities in south bay are: 1.Active f Open now-"Peace Love Unity"Youth Art Contest in the face of mate crime and bias,Omniware Networks is selected by the County of Santa Clam's Division of Equity and Social Justice(DESJ)to organize a youth art contest of'Peace Love Unity'to increase the awareness of local students about the value of love and no hate,to encourage students to use artwork to express their feelings against hate crime,spread the love in our communities,and generate more impacts to students' families,and all the audience to the artworks created,exhibited in the local communities. The art contest is open now and witl conclude it in April 2022_The winning artworks will be displayed starting from late April in various local venues. We anticipate many children in Cupertino will participate in the art contest and their artworks will be exhibited- 2-COVID-19 impacts to disadvantaged communities and useful resources Findings of the recent report of"Economic Fallout From COVID-19 Continues to Hit Lower-Income Americans the Hardest"are shared and discussed via web meeting. Useful resources to help the disadvantaged communities which are adversely impacted by Covid-19 are also shared in the meeting. Many people in south bay including some from Cupertino participated in the meeting. Time and location:Oct 2021,virtual zoom meeting 3.Community Conversation on Understanding Diversity And Inclusion Community members are invited to share their thinking about diversity and inclusion at their organizations.You are invited to join us for an open and peaceful community conversation where we will share our process,model some of the tools community role models have been using,and open up a conversation_ Time and location:October 2020, East Palo Alto L brary 1 Virtual Zoom REQUESTSECTION 4: GRANT 1. Program/Project/EventNarne: "Peace Love unity" Youth Art Contest Exhibition 2. Date(s) and/or duration of program/project/event (if applicable): Exhibiting the winning artworks May -September 2022 3. Total program/project/event budget: S 15500 4. Requested Amount: 2000 Percent of total program/project/event budget: 36 % 5. What percentage of your organization's projected income does your funding request represent? 16 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in (year) ■ New program/project/event 19 PRC Meeting 03.03.22 Page 20 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost (ongoing operational cost) b) Materials/Equipment$ gQQ c) Entertainment$ d) Room/Venue Rental$ QQQ e) Other Professional Services such as I flyer design, printing arl 200 f) Other I I $ 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will be provided: The requested fund will be used 100% to pay for direct service cost of public exhibitions of youth artworks which will 1) enhance community understanding of and improving peace, love and unity, 2) show the value of peace, love and unity from youths' eyes and artworks to encourage community engagement, 3) provide an art education opportunity to the youth and the communities. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit ❑r impact the Cupertino community: 1.Youth in the city of Cupertino will have an opportunity to express their feelings and encourage peace love and unity in the city's communities via art- 2-Youth in the city will learn to be a resporrs bte member of the community to take care of each other and support each other via peace love and unity- 3-Youth in the city can win the contest and their artworks wil(be exhibited publicly. They will be recognized. It wilt enhance their pride, and community engagement and identity- 4- Some art teachers guiding the youth contestants are residents off or have art studios in the city. Their participation will uplift peace love unity of the city,and educate city youth of art. All the above are well aligned with the city's mission o#'encourage all members of the community to take responsibility for one another, and support the values of education'. 12. Who will be served by this rant? Exhibitions will be open to the public, so local communities and the general public will be served. a) Number of individuals total:15000 b) Number of Cupertino residents: 11 QOQ c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? The exhibitions wil[ be open to public. 20 PRC Meeting 03.03.22 Page 21 of 306 d) Will there be a charge or fee for the programlproject/event(if applicable)? none 13_ If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: none 14_ Describe any funding requested from other agencies organizations in regard to this program/project/event request_Indicate whether the funding was granted, denied, or is still pending: Omniware has received grant from the County of Santa Clara to support this project. 21 PRC Meeting 03.03.22 N Pa e 22 of 306 INTERNAL, REVENUE SERVICE DEPARTMENT OF THPTREASQRY P. O. BOX 2508 CINCINNATI, OH 45201 APR 7 2��3 Employer Identification Number: Date: 26-0319712 DLN: 17053180324022 OMNIWARE NETWORKS Contact Person: 24 211TH PL NE KIMBERLY TUCKER ID* 31554 SAMMAMISH, WA 98074 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170(b) (1) (A) (vi.) Form 990 Required: Yes Effective Date of Exemption: June 1, 2012 Contribution Deductibility: Yes Addendum Applies: Yes Dear Applicant: We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c) (3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2105 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. organizations exempt under section 501(c) (3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter. Please see enclosed Publication 4221-PC, Compliance Guide for 501(c) (3y Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 (DO/CG) �1. PRC Meeting 03.03 2-2 Page 23 o f 306 N ly, cl�aUreF V No On o, paV oz 9sd elnns i�atlQn� tettez PRC Meeting 03.03.22 Iq -3 Page 24 of 306 N OMNIWARE NETWORKS ADDENDUM Based on the information submitted with your application, we approves} your request for reinstatement under Notice 2011--44. Your effective date of exemption, as shown in the heading of this letter, is the postmark date of your application. Letter 947 (DO/M PRC Meeting 03.03.22 Page 25 of 306 2022 YOUTH ART CONTEST PE CE �. Use your artistic skills to spread � loge in our communities and raise awareness about hate crimes. Age groups: 5-8, 9-12, 13-17 Size: 14x17 inch paper Submitted by April 5, 2022 Prizes for gold, silver, and bronze winners )IUMoreinformation: www.omniwarenetworks.com ORGANIZED BY SANTA CLARA COUNTY, OMNIWARE NETWORKS,AND WORLD ASSOCIATION OFYOUNG ARTISTS Omnhvare Networks 25 PRC Meeting 03.03.22 Page 26 of 306 Omniware Networks (NEW) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the x program/project/event Identify how the funds will be used to benefit the Cupertino x community Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct service costs versus administrative costs x Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission W PRC Meeting 03.03.22 Page 27 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION l 408-777-3120 1 1NWW.CUPERTINO.ORG CUPERTINO SECTION • ■ Full Legal Organization Name: Paiisadoes Foundation Website:I www.palisadoes.org Address: PCB 518 City: Cupertino State: CA Zip:195015 Phone: 14082523335 Organization President/Executive Director Name and Title: I Peter Harrison Email:I peter@palisadoes.org Plione: 14082523335 Contact Name and Title: (If different) Email: Phone: SECTION ■ i •' • 501(c)(3)?: ■ `es Year Established: No {i f different thmi above address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax IDJ 81-1271871 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 129,900 Total#of Board Members: 3 Total#of staff:10 Total#of Volunteers: 5 27 PRC Meeting 03.03.22 Page 28 of 306 Mission Statement: The Palisadoes Foundation's mission is to provide equitable access to life opportunities for STEM students. Brief Description of Organization and Services Provided: The Palisadoes Foundation focuses on offering software engineering education internships to university students in under-served communities. This prepares them for the competitive realities of the working world. After five years of success in Jamaica with our Calico Challenge program, members of the Jamaican diaspora suggested we expand our service area to include North America. They saw similar needs in their under-served communities. Here BIPOC minorities of race experience similar disadvantages after receiving a STEM education. We are based in the San Francisco metropolitan area, where the digital divide in education is very visible. We feel that our experience in the developing world will be useful in aiding this community too. This is where we will start the next stage of our evolution. The Information and Communication Technology (ICT) sector is a dynamic, growing, and critical international industry. It can provide significant financial, developmental, and social opportunities. Our internship programs provide equitable access to critical experiences for local 1CT students in under-served communities. We make them globally competitive by providing a stipend to spend the summer working on open source code under a highly qualified mentor. REQUESTSECTION 4: GRANT 1. Program/Projec-t/EventName: Calico Challenge 5F 2. Date(s) and/or duration of program/project/event (if applicable): May through August 2022 3. Total progralnfproject/event budget: $111 ,250 4. Requested Amount: q3750 Percent of total program/project/event budget: 33 % 5. What percentage of your organization's projected income does your funding request represent? 13 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in (year) ■ New program/project/event 28 PRC Meeting 03.03.22 Page 29 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 0 (o)igohig operational cost.} b) Materials/Equipment$® c) Entertainment$D d) Room/Venue Rental$® e) other Professional Services such as I Mentor Thank You fl750 f) other IStudent Stipend Is 3DgD 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that"Rill beprovided: The Calico Challenge SF will provide mentored,paid internships for underserved university students to work on open-source code projects.Stipends are paid upon achieving predefined goals.These stipends ensure students work full time on one of our ongoing coding projects.We also provide a small gratuity for our quality mentors. This program cultivates globally competitive skills through its combination of 3 key aspects with the student's own talent and education_Collaborative open-source coding techniques;professional requirements; and a quality mentor combine to strengthen the student's preparation for the workforce. This concept is closely modeled on the Google Summer of Code(GSoC)initiative,a program that has proven to be a successful method of developing open-source code and young programmers.Google is aware of the Calico Challenge program and has actively expressed support.These simple, relatively inexpensive internships will create international opportunities for these students_This concept bridges a gap in experience that will bring new, creative minds into a global vocation.A vocation where the only limiter is an individual's ability to commit concept into useable code.Calico began with a focus on Jamaican students.In 2022,the program will be expanded to include students in the United States in under-served university communities.Our goal is to expand our ability to connect BIROC students in the US with the professional growth opportunities they are often denied. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit or impact the Cupertino community: Our program supports all of Cupertino's values. It utilizes community members to mentor the next generation, supporting their growth and volunteering their time. It helps support underserved students by providing opportunities focused on giving them valuable experience leading to future technological innovation. The project is a real example of how the community can come together to support the education in technology of their youth through innovation. 12. who will be served by tlus rant? 3 Cupertino/San Francisco area high school or university students a) Number of individuals total:13 b) Number Of Cupertino residents: 11 c) Will the program/project/event be available to the entire commm-dty/public or are there any eligibility criteria? The program will be open to underserved high school or university students in the San Francisco Bay who have a background in software coding. 29 PRC Meeting 03.03.22 Page 30 of 306 d) Will there be a charge or fee for the programlproject/event(if applicable)? No 13. If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: This is not applicable. 14. Describe any funding requested from other agencies organizations in regard to this program/projectlevent request.Indicate whether the funding was granted, denied, or is still pending: We are searching for more organizations which align with our mission in the US. The Sloan Foundation was applied to, but denied support to the Calico Challenge. 30 - PRC Meeting 03.03.22 Page 31 of 306 INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. Q. BOX 2508 CINCINNATI, OR 45201 F E f 2 0` Employer Identification Number: Date: 81-1271871 DLN: 26053436002296 THE PALISADOES FOUNDATION Contact Person: P❑ BOX 518 CUSTOMER SERVICE ID# 31954 CUPERTINO, CA 95015-0000 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 509(a) (2) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: January 14, 2016 Contribution Deductibility: Yes Addendum Applies: No Dear Applicant.- We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c) (3) . Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c) (3) are further classified as either public charities or private foundations. We determined you're a public Charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard) . If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c) (3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 5436 31 PRC Meeting 03.03.22 2- Page 32 of 306 THE PALISADOES FOUNDATION Sincerely, Jeffrey I. Cooper Director, Exempt organizations Rulings and Agreements Letter 5436 32 PRC Meeting 03.03.22 Page 33 of 306 January 27, 2022 >!> I palisadoes www.palisadoes.org P.O.Box 518 Cupertino,CA,95015 Leaders of the Cupertino Community, It is with great pleasure that I submit the enclosed proposal for support of the Palisadoes Foundation's 2022 Calico Challenge.The Calico Challenge provides software engineering students in underserved communities a mentored internship developing open-source software. We aim to provide the tools they need to be global contributors and entrepreneurs. Life started for us in 2016 when a group of expatriate Jamaicans wanted to assist development of new and existing information technologies for the island's social good. We knew academic and student leadership wanted greater practical exposure to the latest technology. In response, our pilot program for Jamaican universities was created with the goal of addressing the issues graduates would face when employed.After five years of success, members of the Jamaican diaspora suggested we expand our service area to include North America.They saw similar needs in their underserved communities. Here BIPOC minorities experience similar disadvantages after receiving a STEM education. We are actively planning for this expansion this coming summer. Like many non-profits,the 2020 pandemic challenged us and our students. We scaled back efforts, strategized, and developed a recovery plan to support our international growth and current program. In 2021, we took exploratory steps towards this goal by becoming a mentoring organization in the Google Summer of Code and the India-based GitHub Externship.Thanks to these opportunities and the hard work of past Calico participants, our Talawa app, a community management software, is in its final stages of development. The ultimate mission of our foundation is to provide equitable access to life opportunities for STEM students. The Calico Challenge gives students exposure to large scale, unique, and collaborative projects that will allow them to compete in the global marketplace. We believe our program supports all of Cupertino's values. It utilizes community members to mentor the next generation, supporting their growth and volunteering their time. We ask that you support the 2022 Calico Challenge with a generous donation of$3,750 US dollars.This will provide a Cupertino student with this mentored internship opportunity.These internships bridge the learning gap in open-source software and professional experiences.The Palisadoes Foundation is fully volunteer effort with minimal overhead expenses, ensuring funds are efficiently used for the students. The accompanying proposal provides more information on the Palisadoes Foundation and the 2022 Calico Challenge. Please do not hesitate to contact us should you need additional information.Thank you for your consideration. Best Regards, k-� Vo4v;-.�� Peter Harrison President,The Palisadoes Foundation www.palisadoes.org peter@palisadoes.org 33 PRC Meeting 03.03.22 Page 34 of 306 f' is I + 3 - J� l pia PAi ti _ paiisadoes The Palisadoes Foundation GRANT PROPOSAL Request to the Cupertino Community Funding Grant for2D22 Calico Challenge Support 34 PRC Meeting 03.03.22 Page 35 of 306 Table of Contents ExecutiveSummary...............................................................................................................................................3 WhatWe Do..........................................................................................................................................................4 TheCalico Challenge.........................................................................................................................................4 Calico Expands to the USA in 2022...............................................................................................................4 Expansion Preparation Activities in 2021 .....................................................................................................5 WhatWe Can Do Together...............................................................................................................................6 Statementof Need................................................................................................................................................7 Calicoin Detail ......................................................................................................................................................9 2022 Calico Challenge ......................................................................................................................................9 2022 Timeline for the Calico Challenge......................................................................................................10 Progress Evaluations for the Calico Challenge............................................................................................11 Tangible Results for the Calico Challenge...................................................................................................11 Our Software Projects' Highlight:The Talawa Mobile App ................................................................................12 OrganizationalInformation.................................................................................................................................13 Palisadoes Foundation Beginnings .................................................................................................................14 MeetOur Volunteers......................................................................................................................................15 Peter Harrison, President............................................................................................................................15 KG Charles-Harris, Secretary.......................................................................................................................15 Tennyson Williams,Treasurer....................................................................................................................16 The Palisadoes Foundation Team...............................................................................................................16 Conclusion...........................................................................................................................................................16 Palisadoes Foundation Budget...........................................................................................................................17 CalicoChallenge..............................................................................................................................................17 GeneralExpenses............................................................................................................................................18 2 � 35 PRC Meeting 03.03.22 Page 36 of 306 Executive Summary 4 ` �Lf 11 Y}7 Rih r f y k Figure 1:Jamaica Public Service Student Tour,2016 The Palisadoes Foundation provides equitable access to life opportunities for STEM students. We focus on offering software engineering education internships to university students in under-served communities.This prepares them for the competitive realities of the working world. Life started for us in 2016 when a group of expatriate Jamaicans wanted to assist development of new and existing information technologies for the island's social good. We knew academic and student leadership wanted greater practical exposure to the latest technology. In response, our pilot program for Jamaican universities was created with the goal of addressing the issues graduates would face when employed. After five years of success, members of the Jamaican diaspora suggested we expand our service area to include North America. They saw similar needs in their under-served communities. Here BIPOC minorities of race experience similar disadvantages after receiving a STEM education. We are based in the San Francisco metropolitan area, where the digital divide in education is very visible. We feel that our experience in the developing world will be useful in aiding this community too.This is where we will start the next stage of our evolution. 3 1 P a g e 36 PRC Meeting 03.03.22 Page 37 of 306 What We Do The Information and Communication Technology (ICT) sector is a dynamic, growing, and critical international industry. It can provide significant financial, developmental, and social opportunities.Our internship programs provide equitable access to critical experiences for local ICT students in under-served communities. We make them globally competitive. The Calico Challenge Our existing program is the annual Calico Challenge. It provides mentored, paid internships for underserved university students to work on open-source code projects. Stipends are paid upon achieving predefined goals. These stipends ensure students work full time on one of our ongoing coding projects.We also provide a small gratuity for our quality mentors. In 2022, the Calico Challenge will become an international program, supporting both US and Jamaican students. The success of this expanded program depends upon both the support of local companies and organizations,and international cooperation. 1 I ® We . . Rea � ra1 4t Figure 2:RealDecoy Donation, Calico Expands to the USA in 2022 For the past 6 years,we have been consistently sponsored by Jamaican IT companies,who believe in the need and value of Calico. Over 30 internships have been provided to Jamaica software engineering students.These students have gone on to join local Jamaican IT companies, global companies such as Apple and WordPress, and postgraduate studies in North America and Europe.As we expand the 2022 Calico Challenge, we hope to continue this momentum and bring it to under-served US students. 4 1 P a g e 37 PRC Meeting 03.03.22 Page 38 of 306 �4 L r Figure 3:University of Technology Students,2018 Expansion Preparation Activities in 2021 Like many non-profits, the 2020 pandemic hit us hard due to a lack of funding. We scaled back our efforts in Jamaica. We also began a strategy review to determine how to recover, learn, and plan our growth for international expansion. We decided to take exploratory steps towards this goal by becoming a mentoring organization in the 2021 Google Summer of Code and the India based GitHub Externship. We are growing our processes, volunteers, and software projects to meet the international standards we must consistently attain in future.This will help us create a robust Calico Challenge program to specifically meet the needs of US-based students in 2022. Google Github Externship Summer of Code Students-Industry Connect 5 1 P a g e 38 PRC Meeting 03.03.22 Page 39 of 306 What We Can Do Together •i V _ l' Figure 4:Palisadoes Silicon Valley Supporters,2019 We believe our program aligns with the city of Cupertino's mission to utilize the strengths of the community to grow and support its future generations through innovation. We have experience with students from around the world. We began with a specialization in cultivating software engineering talent from developing countries. This makes us uniquely positioned to successfully support under-served university communities in the United States.Together we can expose BIPOC students to the professional growth opportunities we often take for granted. This expands the American worker talent pool and will improve the communities where they live,work, and play. 6 1 P a g e 39 PRC Meeting 03.03.22 Page 40 of 306 Statement of Need Tow� b S Figure 5:Students Learning about Internship Opportunities through a Palisadoes Foundation Video Conference The Palisadoes Foundation works to bridge well-known opportunity and representation gaps. To understand how we could help IT students, we spoke with them, their professors, and IT businesses both in Jamaica and beyond. We found that exposure to collaborative, open-source coding was missing. It was felt this could be a bridge between university education and professional performance. Contributing effectively to open-source projects requires the programmer to structure their code in a way that allows multinational teams to use it and add to it easily.This skill set is taught in many university coursework programs, but often to a limited degree.We feel that it is best learned from real world, practical opportunities. In 2020, when we began exploring expansion opportunities, we decided to evaluate how our program could help underserved students in the US. 7 1 P a g e 40 PRC Meeting 03.03.22 Page 41 of 306 We started by looking at US STEM and race related data in the National Science Foundation's database. The NSF defines underrepresented minorities as Black American, African American, Hispanic, Latino, American Indian, or Alaska Native.The gaps we found are summarized in Figure 6. Percentage in US Percentage of Undergraduate Percentage of STEM Population (2014) STEM Degrees in US (2016) Occupations (2017) 32 79.6 Figure 6:Underrepresented Minorities in STEM The numbers demonstrate that equal representation diminishes as the minorities advance in the education and career process. Clearly, this group faces other, less tangible obstacles to entering the workforce. We believe these obstacles include a lack of experience and exposure, not by choice, but rather by factors related to race and/or socio-economic position. Our foundation works to ensure that these underserved students receive internship opportunities often unknown or denied to them.We believe in the value of exposure to new coding experiences and opportunities to form community and professional connection. Our talented students complete our internships feeling more confident and connected with an IT community and professionals who look like them. We hope our efforts increase the number of under-served minority Americans entering and remaining in the STEM workforce. It is essential that their creativity, perspective, and experience be represented in STEM products. Only then will these same products fully serve the needs of users who look like this part of the American community. 8 � 41 PRC Meeting 03.03.22 Page 42 of 306 Calico in Detail AGILE 4 i1I.'.. Figure 7:Student Visit,National Commercial Bank 2022 Calico Challenge The Calico Challenge is the Palisadoes Foundation's primary program. It offers underserved student- . ,allvV developers stipends to write software code for various Competitive open-source software projects. Developer This program cultivates globally competitive skills through its combination of 3 key aspects with the Palisadoes Foundation's Internship Program student's own talent and education. Collaborative open- source coding techniques; professional requirements; Qualli laborativ]e, Professional and a quality mentor combine to strengthen the Professionall 01 student's preparation for the workforce. Mentor pe,source code LRecluirements This concept is closely modeled on the Google Summer of Code(GSoC) initiative, a program that has proven to be a successful method of developing open-source code and young programmers. Google is aware of the Calico rPla�si o Z te. Challenge program and has actively expressed support. Talented IT These simple, relatively inexpensive internships will L University create international opportunities for these students. Student This concept bridges a gap in experience that will bring new, creative minds into a global vocation. A vocation Figure 7:How Calico Challenge Supports Student Growth 9 1 P a g e 42 PRC Meeting 03.03.22 Page 43 of 306 where the only limiter is an individual's ability to commit concept into useable code. Calico began with a focus on Jamaican students. In 2022,the program will be expanded to include students in the United States in under- served university communities.Our goal is to expand our ability to connect BIPOC students in the US with the professional growth opportunities they are often denied. Like many other non-profits,the Palisadoes Foundation lost significant funding support due to the global pandemic in 2020.As many organizations are still battling and recovering from the effects of this situation, finding enough funding to reliably execute a 2021 Calico Challenge was simply not possible. Instead,we became a mentor organization in the 2021 Google Summer of Code to expand our experience and network. We will use this valuable opportunity to become stronger and ready to expand in the US in 2022. 2022 Timeline for the Calico Challenge Preparation for the Calico Challenge begins in the fall, STIPEND VALUE PER EVALUATION gathering project ideas and mentors. In the new year,the focus becomes supporting students in developing their Final 55% applications and finalizing details. For Calico,the applicants are required to be enrolled in an Phase 1 accredited university, or college Computer Science or 45% Computer Engineering program. Their application addresses a proposed open-source project, a description for why the project is valuable to the open-source movement, and why they are the best individual to accomplish this project. Figure 11:Stipend Breakdown Per Phase Calico Challenge Milestones December End of Augti<st 2021 rilarch 2a2z May zo22 2022 MentarOrganization .StudentApplication Calico challe1w Kickoff Final Evaluation Fz Application Window window Presentatinns Meutor Orgaiuzatimis Accepted Pa-Heipants ldeutifi Notilaed Phase t Evaluation Fehrnaa.y April 2022 Eind of June 2o22 zozz Figure 8:Calico Challenge Milestones The Calico Challenge begins on May 23,2022, when the students begin their coding work.Completed code is required to be uploaded to the Calico 2022 website by August 26,2022. In addition,each participant prepares a final presentation. 101Pa e 43 PRC Meeting 03.03.22 Page 44 of 306 Progress Evaluations for the Calico Challenge The Palisadoes Foundation monitors progress through 2 evaluations. Students and mentors are asked to complete Phase 1(due mid-July 2022) and Final(due end of August 2022)evaluation forms.After each passed evaluation, students receive a specified stipend amount, as documented in Figure 11. The Palisadoes Foundation has a thorough method for arbitrating any disputes, and clear expectations of both the student and mentor are agreed upon ahead of initiation of the project. Tangible Results for the Calico Challenge ® The final results of the 2022 Calico Challenge will be: • The completion of one or more project tasks for their selected open-source program. • Mentor-approved open-source code which is easily usable and modifiable by other programmers. • An increased skill level in his/her coding skills and an enhanced his/her reputation on an international level for the student. • An increased understanding of professional aspects of collaboration and presentation • A new, positive relationship between the mentoring Joinand Collaboratewith your organization and student developers. Organizations The combination of these goals will help the 2022 Calico OrganizationEnter Challenge participants establish themselves globally as the budding innovative,talented professionals they are. Login � lign Up 130 Change language 111 Page 44 PRC Meeting 03.03.22 Page 45 of 306 Our Software Projects' Highlight: The Talawa Mobile App 9:27 ® oe6 rya 1,911 M ED Since 2015 we have been developing open-source software code in many areas. For the past three years we have been Explore Events q focusing on ways to help community organizations. Talawa was created to help community-based organizations My Events - ❑ Add Date collaborate with their membership.These organizations would include religious groups, non-profit charities,social groups, sports clubs and in limited cases, businesses. Though software applications exist for these types of organizations(eg. Breeze ChMS,The Realm)they assume UBER POOL ❑ 6/10/2021-6/1012021 their memberships are fully literate and have access to email. Q e,04PM-210PM QGotham We wanted to create a system that would work for countries Get anUber and i-yflorsomething else if > and communities with similar technology access and you need. public 83 10 education challenges as Jamaica. Talawa has three main components.A mobile application with social media features,a web-based portal to be used by the organization's administrative team, and finally an API providing access to data and features. Hello Edited ❑ 6n/2021-61112021 The Palisadoes Foundation wants to eventually host Talawa (), &45AM-9:00?M 9Pune as a cloud service to help finance its education outreach. This is a test event and the other one and the one in Front. Talawa's main features include: a private S&10 1.A user news feed 2. Event calendars with lightweight project management 3. Group chats + Event 4. Member notifications 5. Donation and subscription acceptance © Q 6. Service provider level multi-organization capability Home Events Po,- Chat Proi 7. Plugin support for administration services such as billing Talawa has over 60 software developers actively updating its code.The projects have been cloned 250 times by curious software developers trying to understand how the nuts and bolts work. 121 Page 45 PRC Meeting 03.03.22 Page 46 of 306 OPP.- } i 1�. Figure 10:Student testing our Talawa Mobile App Organizational Information Since 2016, the Palisadoes Foundation has been promoting equitable access to life opportunities for STEM education recipients. Our annual internship programs match university students with Information and Communications Technology(ICT) professionals as they collaborate on Open-Source software projects. We are a registered 501(c)(3) non-profit organization registered in California. 131 Page 46 PRC Meeting 03.03.22 Page 47 of 306 Palisadoes Foundation Beginnings G_ T " + 1 - 1 Y s k_, Figure 11:President Peter Harrison from the Palisadoes Foundation speaks to Jamaican students about the Calico Challenge program Our story begins in 2016, when a group of Jamaican technology professionals came together with a desire to assist underserved university students on STEM education paths. We began in Jamaica, where we spoke with academic and student leadership in ICT education to ask what gaps we could fill. With their responses in mind, we focused our mission on promoting equitable access to life opportunities for STEM education recipients. Calico Challenge History 2016 2017 2018 2019 2020 2021 The 3 Successes The 2018 Calico Major progress Significant First Google participants in included the Challenge was made on feature Summerof Code their finalyear increasing of the continued to ongoing,unique enhancements participation. of their degree stipend,variety develop projects, were made on The Talawa app program were all of projects and relationships and allowing them to Wawa.our open was completed, hired into mentors,and its supported be tested in real source software and enters Beta several time. organization testing. software successful Successful management engineering evacuation rate. candidates. application. positions. Figure 12:Calico Challenge History Our first program, the Calico Challenge, began in 2016, supporting the Jamaican ICT student community. In 2020, we realized that a similar gap existed for underserved students in our local San Francisco Bay area community.This realization inspired us to expand to the USA. Using the successful Calico Challenge as a model, we hope to do our part to fill opportunity gaps for underserved students in this area. 141 Page 47 PRC Meeting 03.03.22 Page 48 of 306 Meet Our Volunteers The Palisadoes Foundation's staff of volunteers includes the board president,treasurer,secretary,and several additional volunteers. Peter Harrison, President Peter is currently the Chief Technology Officer and a Co-Founder of Colovore. Colovore is a provider of high-density colocation solutions for companies operating high-performance IT hardware. Peter has built the core web infrastructure for several of Silicon Valley's - internet titans. Most recently, Peter worked at Google where he helped manage global data center demand and capacity planning; the Google Fiber program and its initial data center infrastructure rollout. Peter + previously lead the network team that was responsible for the initial design and deployment of Netflix's Internet video service. Peter obtained his Computer Engineering undergraduate and postgraduate diplomas from the University of West Indies in Jamaica. By chance, Peter was recruited to support Y2K issues in the US, and found himself on a unique path to success. He is proof that the quality of Jamaican college education is strong, but it took chance opportunities to help him establish his place in Silicon Valley. He wants to ensure that Jamaican programmers who share his work ethic don't have to wait for luck to develop their reputation in the growing world of Information Technology. KG Charles-Harris, Secretary KG is currently the Chief Executive Officer of Quarrio Corporation. Quarrio Corp. is a software company that uses artificial intelligence (AI) to make it easy for average business users to do advanced reporting and analytics. KG has founded, built, and sold three companies in the software, biotech and services and investment banking industries. He was named Global Entrepreneur of the Year by the United Nations and is a board member and advisor to several companies. KG grew up experiencing a variety of different cultures.When he moved to Jamaica from Sweden during his teenage years, it changed his life and he fell in love with the country. One of his goals is to provide college students in disadvantaged countries the ability to keep pace with cutting edge technologies.The Calico Project brings Jamaican computer science students the opportunity to experience real world open-source coding and collaboration on an international level. KG helps Palisadoes provide great students great opportunities,and teach them how to align themselves for future ones. 151 Page 48 PRC Meeting 03.03.22 Page 49 of 306 Tennyson Williams, Treasurer Tennyson is a Senior Technical Project Manager at Comcast. He has worked on projects for Google, PayPal, Cisco, and has also worked for Hewlett-Packard. He is passionate about the Palisadoes Foundation,and in particular the Calico Challenge, because it's one of the few programs that has a direct impact on the students. His forte is working on next generation technologies and products,which gives him great insight into what is required to stay current. He knows they are getting exposure to ' real world technology and will have the opportunity for their r � contribution to have direct impact to solve real world issues. He believes these are the things needed to raise the knowledge base of the Jamaican next generation of software developers such that they can compete with the rest of the world. The Palisadoes Foundation Team Palisadoes Foundation is also supported by a few volunteers and its Advisory Board. Each year we work together with our target communities to expand the •ve previously tried • contribute • program and aid the fundraising effort. The Palisadoes •• • " projects, •ut I always • Foundation team is passionate about their mission to • overwhelmed. had anyone bridge gaps in STEM barriers for underserved youth. We who was really "• in helping me are particularly excited about the potential of our current to getfamilior with the existing sustainable programs. We believe in exposing capable, codebase • • I was • • ' • my underserved university students to modern engineering own devices, . I stopped trying. collaboration techniques.We are confident this will enable since been • mostly]oneprogrammer, these new technology graduates to thrive in well-deserved but Calico has mode me realize roles and create increasingly diverse and creative fun being part of something bigger technologies. than me can • Calico Challenge Student Conclusion The Palisadoes Foundation is committed to creating access to critical educational and professional experiences for underserved software engineering students. We are continually learning from the community.We will continue to seek opportunities to remove racially-related barriers to success in the STEM industry. Our current efforts focus on removing the barrier to real-world experience during the student's university pursuits.We do this by providing real- world,collaborative, and paid coding internships. 16 Page 49 PRC Meeting 03.03.22 Page 50 of 306 Palisadoes Foundation Budget Calico Challenge The standard yearly Calico Challenge budget is $28,620 (US). The breakdown of these numbers is presented below. Item Item Explanation Cost Number (US Dollars) of Item Student Stipend This stipend will provide each Jamaican student $1500(JA) 10(JA) with the resources they need to focus their time $3000(SF) 3 (SF) on their Open-Source project and learning from their mentor, rather than finding an irrelevant summer job. Mentor Thank You When possible, the Calico Challenge prefers to $375(JA) 6 provide the volunteer mentors with a token thank $750(US) 3 you as they manage several students and provide a great deal of coaching and written feedback. Wire Transfers The Palisadoes Foundation will need to transfer $60 2 stipend funds to the Jamaica Computer Society for them to disburse the funds to the students. These transfers cost$30 each. Total Cost: $28,620 17 Page 50 PRC Meeting 03.03.22 Page 51 of 306 General Expenses General expenses for the Palisadoes Foundation cost about $200 each year. While it varies, our current overhead expenses focus on paying for email and social media services, and legal costs related to expansion. Item Item Explanation Cost Number (US Dollars) of Item MailChimp Subscription The Calico Challenge uses this service to $200 1 communicate updates to sponsors, participants, volunteers, and supporters. MailChimp provides additional email capabilities which greatly increases Calico's efficiencies. Legal Costs As we look to expand in to the US,we will require legal advice to ensure a successful expansion. Total Cost: $200 18 51 PRC Meeting 03.03.22 Page 52 of 306 Palisadoes Foundation (NEW) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the x program/project/event Identify how the funds will be used to benefit the Cupertino x community Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct service costs versus administrative costs x Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission Cif IV PRC Meeting 03.03.22 Page 53 of 306 FUNDINGCOMMUNITY ■ A APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO CONTACTSECTION 1 : Full Legal Organization Narne:1 Rebekah Adams Website:I Gwvw.relayforlife.org/SiliconValleyNorthCA Address] 747 Camden Ave B CitS.T: Campbell State: CA Zip:195008 Phone: 14086147213 Organization President/Executive Director Name and Title: I American Cancer Society, CEO Dr. Karen Knudse Email:I becki.adams@cancer.org Phone: 14086147213 Contact Name and Title: Becki Adams, Senior Development Manager (If different) Email:I becki.adams@cancer.org Phone: 4086147213 SECTION • • O • 501(c)(3)?: t `es Year Established: 1913 t, {i f different than above address information) Sponsor Name: Sponsor Address: Cit :I State: Zip: Phone: Federal Tax ID: 13-1788491 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 1577411000 Total# of Board Members:123 Total#of staff: 2545 Total#of Volunteers: 1000000 53 PRC Meeting 03.03.22 Page 54 of 306 Mission Statement: The American Cancer Society's mission is to save lives, celebrate lives, and lead the fight for a world without cancer. Brief Description of Organization and Services Provided: The American Cancer Society is a nationwide, community-based voluntary health organization dedicated to eliminating cancer as a major health problem. -We attack cancer from every angle. •Vile promote healthy lifestyles to help you prevent cancer. -We research cancer and its causes to find more answers and better treatments_ -We provide everything from emotional support and health equity, to the latest cancer information for those who have been touched by cancer. And we do it all 24 hours a day, 7 days a week. REQUESTSECTION 4: GRANT 1. Prograrn/Project/EventName: Relay for Life of Silicon Valley North 2. Date(s) and/or duration of program/project/event (if applicable): June 18, 2022 from 1 Oam - 1 Opm 3. Total program/project/event budget: S I 100,000 4. Requested Amount: sF6000 Percent of total program/project/event budget:®% 5. What percentage of your organization's projected income does your funding request represent? a dl 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 11999 (year) New program/project/event 54 PRC Meeting 03.03.22 Page 55 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 0 (o)igoing operational cost) b) Materials/Equipment$ 2500 c) Entertainment$ 500 d) Room/Venue Rental$ 200 e) other Professional Services such as f) other JPermits, Luminarla supplies, survivor recognition I $ 8'60 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will be provided: Grant will be used for: Covering the costs of equipment rentals, recognition items, luminaria products, entertainment (DJ), and venue reservation. Relay for life is a community event that raises awareness for cancer screenings, early detection, healthy eating, and lifestyles choices and provides local resources if they are fighting cancer. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit ❑r impact the Cupertino community: This event is designed bring the community together to honor/celebrate/recognize those affected by cancer. Relay for Life (RFL)takes place in over 4,500 communities worldwide and we are honored to host one for our Cupertino residents. So many Cupertino residents have suffered from cancer&RFL of Silicon Valley North gives them a place to remember& grieve in a supportive environment. We feel supporting this event will enhance the image of the city as a supportive place for residents who have been affected by cancer. It will also bring in other surrounding community citizens(like Milpitas and Sunnyvale),which could bring extra revenue to the city. The residents of Cupertino and surrounding communities benefit from Relay For Life directly by participating in a fun, educational and supportive event that focuses on celebrating the survivors and caregivers,remember those that were lost and Teaming about preventative care.The funds raised will ensure all patient services are free of charge to any person needing resources along their journey with cancer, including Cupertino resident who benefit from local hospitals that we support. 12. Who will be served by tlus rant? Cupertino and surrounding communities a) Number of individuals total:160257 b) Number of Cupertino residents: 1180 c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? Yes. It will be available to everyone. We will have both virtual and in-person events to allow everyone to participate (pending COVID regulations and ACS best practices at that time) Part A-The 60K represents the last recorded population of Cupertino. Part B - Represents the number of in-person participants a the last in person event (2019) 55 PRC Meeting 03.03.22 Page 56 of 306 d) Will there be a charge or fee for the programlproject/event(if applicable)? No 13. if your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: Not that I am aware of. 14. Describe any funding requested from other agencies organizations in regard to this program/projectlevent request.Indicate whether the funding was granted, denied, or is still pending: NIA 56 PRC Meeting 03.03.22 Page 57 of 306 Form W=9 Request for Taxpayer Give Form to the (Rev.October2018) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service ►Go to wwwJrs.gov/FormW9 for instructions and the latest information. 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. American Cancer Society, Inc. 2 Business name/disregarded entity name,if different from above a� 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to following seven boxes. certain entities,not individuals;see to a instructions on page 3): o [:1Individual/sole proprietor or ElC Corporation ElS Corporation ❑ Partnership ElTrust/estate ai c single-member LLC Exempt payee code(if any) 1 ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)► o Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting c LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code(if any) A S another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that IL °w is disregarded from the owner should check the appropriate box for the tax classification of its owner. y ❑✓ Other(see instructions)► Non-Profit, IRS 501 c $ (Applies to accounts maintained outside the U.S.) fn 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional) PO Box 111417 6 City,state,and ZIP code Campbell,CA 95011 7 List account number(s)here(optional) IMB Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number backup withholding.For individuals,this is generally your social security number(S However,for a —IE — resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN, later. or Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. 173 - 1 7 8 8 4 9 1 LiMM Certification Under penalties of perjury,I certify that: 1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3.1 am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends, ou are not re uired to sign the certification,but you must provide your correct TIN.See the instructions for Part 11,later. Sign Signature of Here U.S.person No. Date No- 7/6/21 General Instru •Form 1099-DIV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise .Form 1099-MISC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments .Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they were published,go to www.irs.gov/FormW9. •Form 1099-S(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest), 1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption .Form 1099-A(acquisition or abandonment of secured property) taxpayer identification number(ATIN),or employer identification number (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later. Cat.No.10231X Form W-9(Rev.10-2018) 57 PRC Meeting 03.03.22 Page 58 of 306 Form W-9(Rev.10-2018) Page 2 By signing the filled-out form,you: Example.Article 20 of the U.S.-China income tax treaty allows an 1.Certify that the TIN you are giving is correct(or you are waiting for a exemption from tax for scholarship income received by a Chinese number to be issued), student temporarily present in the United States.Under U.S.law,this student will become a resident alien for tax purposes if his or her stay in 2.Certify that you are not subject to backup withholding,or the United States exceeds 5 calendar years.However,paragraph 2 of 3.Claim exemption from backup withholding if you are a U.S.exempt the first Protocol to the U.S.-China treaty(dated April 30,1984)allows payee. If applicable,you are also certifying that as a U.S.person,your the provisions of Article 20 to continue to apply even after the Chinese allocable share of any partnership income from a U.S.trade or business student becomes a resident alien of the United States.A Chinese is not subject to the withholding tax on foreign partners'share of student who qualifies for this exception(under paragraph 2 of the first effectively connected income,and protocol)and is relying on this exception to claim an exemption from tax 4.Certify that FATCA code(s)entered on this form(if any)indicating on his or her scholarship or fellowship income would attach to Form that you are exempt from the FATCA reporting,is correct.See What is W-9 a statement that includes the information described above to FATCA reporting, later,for further information. support that exemption. Note:If you are a U.S.person and a requester gives you a form other If you are a nonresident alien or a foreign entity,give the requester the than Form W-9 to request your TIN,you must use the requester's form if appropriate completed Form W-8 or Form 8233. it is substantially similar to this Form W-9. Backup Withholding Definition of a U.S.person.For federal tax purposes,you are considered a U.S.person if you are: What is backup withholding?Persons making certain payments to you •An individual who is a U.S.citizen or U.S.resident alien; must under certain conditions withhold and pay to the IRS 24%of such payments.This is called"backup withholding." Payments that may be •A partnership,corporation,company,or association created or subject to backup withholding include interest,tax-exempt interest, organized in the United States or under the laws of the United States; dividends,broker and barter exchange transactions,rents,royalties, •An estate(other than a foreign estate);or nonemployee pay,payments made in settlement of payment card and •A domestic trust(as defined in Regulations section 301.7701-7). third party network transactions,and certain payments from fishing boat operators. Real estate transactions are not subject to backup Special rules for partnerships.Partnerships that conduct a trade or withholding. business in the United States are generally required to pay a withholding You will not be subject to backup withholding on payments you tax under section 1446 on any foreign partners'share of effectively receive if you give the requester your correct TIN,make the proper connected taxable income from such business.Further,in certain cases certifications,and report all your taxable interest and dividends on your where a Form W-9 has not been received,the rules under section 1446 tax return. require a partnership to presume that a partner is a foreign person,and pay the section 1446 withholding tax.Therefore,if you are a U.S.person Payments you receive will be subject to backup withholding if: that is a partner in a partnership conducting a trade or business in the 1.You do not furnish your TIN to the requester, United States,provide Form W-9 to the partnership to establish your 2.You do not certify your TIN when required(see the instructions for U.S.status and avoid section 1446 withholding on your share of Part II for details), partnership income. In the cases below,the following person must give Form W-9 to the 3.The IRS tells the requester that you furnished an incorrect TIN, partnership for purposes of establishing its U.S.status and avoiding 4.The IRS tells you that you are subject to backup withholding withholding on its allocable share of net income from the partnership because you did not report all your interest and dividends on your tax conducting a trade or business in the United States. return(for reportable interest and dividends only),or •In the case of a disregarded entity with a U.S.owner,the U.S.owner 5.You do not certify to the requester that you are not subject to of the disregarded entity and not the entity; backup withholding under 4 above(for reportable interest and dividend •In the case of a grantor trust with a U.S.grantor or other U.S.owner, accounts opened after 1983 only). generally,the U.S.grantor or other U.S.owner of the grantor trust and Certain payees and payments are exempt from backup withholding. not the trust;and See Exempt payee code, later,and the separate Instructions for the •In the case of a U.S.trust(other than a grantor trust),the U.S.trust Requester of Form W-9 for more information. (other than a grantor trust)and not the beneficiaries of the trust. Also see Special rules for partnerships,earlier. Foreign person.If you are a foreign person or the U.S.branch of a What is FATCA Reporting? foreign bank that has elected to be treated as a U.S.person,do not use Form W-9.Instead,use the appropriate Form W-8 or Form 8233(see The Foreign Account Tax Compliance Act(FATCA)requires a Pub.515,Withholding of Tax on Nonresident Aliens and Foreign participating foreign financial institution to report all United States Entities). account holders that are specified United States persons.Certain Nonresident alien who becomes a resident alien.Generally,only a payees are exempt from FATCA reporting.See Exemption from FATCA nonresident alien individual may use the terms of a tax treaty to reduce reporting code, later,and the Instructions for the Requester of Form or eliminate U.S.tax on certain types of income.However,most tax W-9 for more information. treaties contain a provision known as a"saving clause."Exceptions Updating Your Information specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise You must provide updated information to any person to whom you become a U.S.resident alien for tax purposes. claimed to be an exempt payee if you are no longer an exempt payee If you are a U.S.resident alien who is relying on an exception and anticipate receiving reportable payments in the future from this contained in the saving clause of a tax treaty to claim an exemption person. For example,you may need to provide updated information if from U.S.tax on certain types of income,you must attach a statement you are a C corporation that elects to be an S corporation,or if you no to Form W-9 that specifies the following five items. longer are tax exempt.In addition,you must furnish a new Form W-9 if 1.The treaty country.Generally,this must be the same treaty under the name or TIN changes for the account;for example,if the grantor of a which you claimed exemption from tax as a nonresident alien. grantor trust dies. 2.The treaty article addressing the income. Penalties 3.The article number(or location)in the tax treaty that contains the saving clause and its exceptions. Failure to furnish TIN.If you fail to furnish your correct TIN to a 4.The type and amount of income that qualifies for the exemption requester,you are subject to a penalty of$50 for each such failure from tax. unless your failure is due to reasonable cause and not to willful neglect. 5.Sufficient facts to justify the exemption from tax under the terms of Civil penalty for false information with respect to withholding.If you the treaty article. make a false statement with no reasonable basis that results in no backup withholding,you are subject to a$500 penalty. 58 PRC Meeting 03.03.22 Page 59 of 306 Form W-9(Rev.10-2018) Page 3 Criminal penalty for falsifying information.Willfully falsifying IF the entity/person on line 1 is THEN check the box for... certifications or affirmations may subject you to criminal penalties a(n)... including fines and/or imprisonment. Misuse of TINs.If the requester discloses or uses TINs in violation of • Corporation Corporation federal law,the requester may be subject to civil and criminal penalties. • Individual Individual/sole proprietor or single- * Sole proprietorship,or member LLC Specific Instructions • Single-member limited liability company(LLC)owned by an Line 1 individual and disregarded for U.S. You must enter one of the following on this line;do not leave this line federal tax purposes. blank.The name should match the name on your tax return. . LLC treated as a partnership for Limited liability company and enter If this Form W-9 is for a joint account(other than an account U.S.federal tax purposes, the appropriate tax classification. maintained by a foreign financial institution(FFI)),list first,and then • LLC that has filed Form 8832 or (P=Partnership;C=C corporation; circle,the name of the person or entity whose number you entered in 2553 to be taxed as a corporation, or S=S corporation) Part I of Form W-9. If you are providing Form W-9 to an FFI to document or a joint account,each holder of the account that is a U.S.person must . LLC that is disregarded as an provide a Form W-9. entity separate from its owner but a. Individual.Generally,enter the name shown on your tax return.If the owner is another LLC that is you have changed your last name without informing the Social Security not disregarded for U.S.federal tax Administration(SSA)of the name change,enter your first name,the last purposes. name as shown on your social security card,and your new last name. Note:ITIN applicant:Enter your individual name as it was entered on • Partnership Partnership your Form W-7 application,line 1a.This should also be the same as the • Trust/estate Trust/estate name you entered on the Form 1040/1040A/1040EZ you filed with your Line 4, Exemptions application. b. Sole proprietor or single-member LLC.Enter your individual If you are exempt from backup withholding and/or FATCA reporting, name as shown on your 1040/1040A/1040EZ on line 1.You may enter enter in the appropriate space on line 4 any code(s)that may apply to your business,trade,or"doing business as"(DBA)name on line 2. you. c. Partnership,LLC that is not a single-member LLC,C Exempt payee code. corporation,or S corporation.Enter the entity's name as shown on the • Generally,individuals(including sole proprietors)are not exempt from entity's tax return on line 1 and any business,trade,or DBA name on backup withholding. line 2. • Except as provided below,corporations are exempt from backup d. Other entities.Enter your name as shown on required U.S.federal withholding for certain payments,including interest and dividends. tax documents on line 1.This name should match the name shown on the . Corporations are not exempt from backup withholding for payments charter or other legal document creating the entity.You may enter any made in settlement of payment card or third party network transactions. business,trade,or DBA name on line 2. • Corporations are not exempt from backup withholding with respect to e. Disregarded entity.For U.S.federal tax purposes,an entity that is attorneys'fees or gross proceeds paid to attorneys,and corporations disregarded as an entity separate from its owner is treated as a that provide medical or health care services are not exempt with respect "disregarded entity." See Regulations section 301.7701-2(c)(2)(iii).Enter to payments reportable on Form 1099-MISC. the owner's name on line 1.The name of the entity entered on line 1 should never be a disregarded entity.The name on line 1 should be the The following codes identify payees that are exempt from backup name shown on the income tax return on which the income should be withholding.Enter the appropriate code in the space in line 4. reported. For example,if a foreign LLC that is treated as a disregarded 1—An organization exempt from tax under section 501(a),any IRA,or entity for U.S.federal tax purposes has a single owner that is a U.S. a custodial account under section 403(b)(7)if the account satisfies the person,the U.S.owner's name is required to be provided on line 1. If requirements of section 401(f)(2) the direct owner of the entity is also a disregarded entity,enter the first 2—The United States or any of its agencies or instrumentalities owner that is not disregarded for federal tax purposes.Enter the disregarded entity's name on line 2,"Business name/disregarded entity 3—A state,the District of Columbia,a U.S.commonwealth or name."If the owner of the disregarded entity is a foreign person,the possession,or any of their political subdivisions or instrumentalities owner must complete an appropriate Form W-8 instead of a Form W-9. 4—A foreign government or any of its political subdivisions,agencies, This is the case even if the foreign person has a U.S.TIN. or instrumentalities Line 2 5—A corporation If you have a business name,trade name,DBA name,or disregarded 6—A dealer in securities or commodities required to register in the entity name,you may enter it on line 2. United States,the District of Columbia,or a U.S.commonwealth or possession Line 3 7—A futures commission merchant registered with the Commodity Check the appropriate box on line 3 for the U.S.federal tax Futures Trading Commission classification of the person whose name is entered on line 1.Check only 8—A real estate investment trust one box on line 3. 9—An entity registered at all times during the tax year under the Investment Company Act of 1940 10—A common trust fund operated by a bank under section 584(a) 11—A financial institution 12—A middleman known in the investment community as a nominee or custodian 13—A trust exempt from tax under section 664 or described in section 4947 59 PRC Meeting 03.03.22 Page 60 of 306 Form W-9(Rev.10-2018) Page 4 The following chart shows types of payments that may be exempt M—A tax exempt trust under a section 403(b)plan or section 457(g) from backup withholding.The chart applies to the exempt payees listed plan above,1 through 13. Note:You may wish to consult with the financial institution requesting IF the payment is for... THEN the payment is exempt this form to determine whether the FATCA code and/or exempt payee for... code should be completed. Interest and dividend payments All exempt payees except Line 5 for 7 Enter your address(number,street,and apartment or suite number). Broker transactions Exempt payees 1 through 4 and 6 This is where the requester of this Form W-9 will mail your information through 11 and all C corporations. returns.If this address differs from the one the requester already has on S corporations must not enter an file,write NEW at the top.If a new address is provided,there is still a exempt payee code because they chance the old address will be used until the payor changes your are exempt only for sales of address in their records. noncovered securities acquired Line 6 prior to 2012. Barter exchange transactions and Exempt payees 1 through 4 Enter your city,state,and ZIP code. patronage dividends Part I. Taxpayer Identification Number (TIN) Payments over$600 required to be Generally,exempt payees Enter your TIN in the appropriate box.If you are a resident alien and reported and direct sales over 1 through 52 you do not have and are not eligible to get an SSN,your TIN is your IRS $5,0001 individual taxpayer identification number(ITIN). Enter it in the social security number box.If you do not have an ITIN,see How to get a TIN Payments made in settlement of Exempt payees 1 through 4 below. payment card or third party network If you are a sole proprietor and you have an EIN,you may enter either transactions your SSN or EIN. 1 See Form 1099-MISC,Miscellaneous Income,and its instructions. If you are a single-member LLC that is disregarded as an entity separate from its owner,enter the owner's SSN(or EIN,if the owner has z However,the following payments made to a corporation and one).Do not enter the disregarded entity's EIN. If the LLC is classified as reportable on Form 1099-MISC are not exempt from backup a corporation or partnership,enter the entity's EIN. withholding:medical and health care payments,attorneys'fees,gross Note:See What Name and Number To Give the Requester, later,for proceeds paid to an attorney reportable under section 6045(f),and payments for services paid by a federal executive agency. further clarification of name and TIN combinations. Exemption from FATCA reporting code.The following codes identify How to get a TIN.If you do not have a TIN,apply for one immediately. payees that are exempt from reporting under FATCA.These codes To apply for an SSN,get Form SS-5,Application for a Social Security apply to persons submitting this form for accounts maintained outside Card,from your local SSA office or get this form online at of the United States by certain foreign financial institutions.Therefore,if www.SSA.gov.You may also get this form by calling 1-800-772-1213. you are only submitting this form for an account you hold in the United Use Form W-7,Application for IRS Individual Taxpayer Identification States,you may leave this field blank.Consult with the person Number,to apply for an ITIN,or Form SS-4,Application for Employer requesting this form if you are uncertain if the financial institution is Identification Number,to apply for an EIN.You can apply for an EIN subject to these requirements.A requester may indicate that a code is online by accessing the IRS website at www.irs.gov/Businesses and not required by providing you with a Form W-9 with"Not Applicable"(or clicking on Employer Identification Number(EIN)under Starting a any similar indication)written or printed on the line for a FATCA Business.Go to www.irs.gov/Forms to view,download,or print Form exemption code. W-7 and/or Form SS-4. Or,you can go to www.irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 A—An organization exempt from tax under section 501(a)or any business days. individual retirement plan as defined in section 7701(a)(37) If you are asked to complete Form W-9 but do not have a TIN,apply B—The United States or any of its agencies or instrumentalities for a TIN and write"Applied For"in the space for the TIN,sign and date C—A state,the District of Columbia,a U.S.commonwealth or the form,and give it to the requester.For interest and dividend possession,or any of their political subdivisions or instrumentalities payments,and certain payments made with respect to readily tradable D—A corporation the stock of which is regularly traded on one or instruments,generally you will have 60 days to get a TIN and give it to more established securities markets,as described in Regulations the requester before you are subject to backup withholding on section 1.1472-1(c)(1)(i) payments.The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until E—A corporation that is a member of the same expanded affiliated you provide your TIN to the requester. group as a corporation described in Regulations section 1.1472-1(c)(1)(i) Note:Entering"Applied For"means that you have already applied for a F—A dealer in securities,commodities,or derivative financial TIN or that you intend to apply for one soon. instruments(including notional principal contracts,futures,forwards, and options)that is registered as such under the laws of the United Caution:A disregarded U.S.entity that has a foreign owner must use States or any state the appropriate Form W-8. G—A real estate investment trust Part 11. Certification H—A regulated investment company as defined in section 851 or an To establish to the withholding agent that you are a U.S.person,or entity registered at all times during the tax year under the Investment resident alien,sign Form W-9.You may be requested to sign by the Company Act of 1940 withholding agent even if item 1,4,or 5 below indicates otherwise. I—A common trust fund as defined in section 584(a) For a joint account,only the person whose TIN is shown in Part I J—A bank as defined in section 581 should sign(when required).In the case of a disregarded entity,the K—A broker person identified on line 1 must sign.Exempt payees,see Exempt payee L—A trust exempt from tax under section 664 or described in section code,earlier. 4947(a)(1) Signature requirements.Complete the certification as indicated in items 1 through 5 below. 60 PRC Meeting 03.03.22 Page 61 of 306 Form W-9(Rev.10-2018) Page rJ 1.Interest,dividend,and barter exchange accounts opened For this type of account: Give name and EIN of: before 1984 and broker accounts considered active during 1983. You must give your correct TIN,but you do not have to sign the 14.Account with the Department of The public entity Certification. Agriculture in the name of a public entity(such as a state or local 2.Interest,dividend,broker,and barter exchange accounts government,school district,or opened after 1983 and broker accounts considered inactive during prison)that receives agricultural 1983.You must sign the certification or backup withholding will apply.If program payments you are subject to backup withholding and you are merely providing your correct TIN to the requester,you must cross out item 2 in the 15.Grantor trust filing under the Form The trust certification before signing the form. 1041 Filing Method or the Optional 3.Real estate transactions.You must sign the certification.You may Form 1099 Filing Method 2(see cross out item 2 of the certification. Regulations section 1.671-4(b)(2)(i)(B)) 4.Other payments.You must give your correct TIN,but you do not List first and circle the name of the person whose number you furnish. have to sign the certification unless you have been notified that you If only one person on a joint account has an SSN,that person's number have previously given an incorrect TIN."Other payments"include must be furnished. payments made in the course of the requester's trade or business for 2 Circle the minor's name and furnish the minor's SSN. rents,royalties,goods(other than bills for merchandise),medical and health care services(including payments to corporations),payments to 3 You must show your individual name and you may also enter your a nonemployee for services,payments made in settlement of payment business or DBA name on the"Business name/disregarded entity" card and third party network transactions,payments to certain fishing name line.You may use either your SSN or EIN(if you have one),but the boat crew members and fishermen,and gross proceeds paid to IRS encourages you to use your SSN. attorneys(including payments to corporations). 'List first and circle the name of the trust,estate,or pension trust.(Do 5.Mortgage interest paid by you,acquisition or abandonment of not furnish the TIN of the personal representative or trustee unless the secured property,cancellation of debt,qualified tuition program legal entity itself is not designated in the account title.)Also see Special payments(under section 529),ABLE accounts(under section 529A), rules for partnerships, earlier. IRA,Coverdell ESA,Archer MSA or HSA contributions or *Note:The grantor also must provide a Form W-9 to trustee of trust. distributions,and pension distributions.You must give your correct Note:If no name is circled when more than one name is listed,the TIN,but you do not have to sign the certification. number will be considered to be that of the first name listed. What Name and Number To Give the Requester Secure Your Tax Records From Identity Theft For this type of account: Give name and SSN of: Identity theft occurs when someone uses your personal information 1.Individual The individual such as your name,SSN,or other identifying information,without your 2.Two or more individuals Qoint The actual owner of the account or,if permission,to commit fraud or other crimes.An identity thief may use account)other than an account combined funds,the first individual on your SSN to get a job or may file a tax return using your SSN to receive maintained by an FFI the account' a refund. 3.Two or more U.S.persons Each holder of the account To reduce your risk: (joint account maintained by an FFI) •Protect your SSN, 4.Custodial account of a minor The minor' •Ensure your employer is protecting your SSN,and (Uniform Gift to Minors Act) •Be careful when choosing a tax preparer. 5.a.The usual revocable savings trust The grantor-trustee' If your tax records are affected by identity theft and you receive a (grantor is also trustee) notice from the IRS,respond right away to the name and phone number b.So-called trust account that is not The actual owner printed on the IRS notice or letter. a legal or valid trust under state law If your tax records are not currently affected by identity theft but you 6.Sole proprietorship or disregarded The owner3 think you are at risk due to a lost or stolen purse or wallet,questionable entity owned by an individual credit card activity or credit report,contact the IRS Identity Theft Hotline 7.Grantor trust filing under Optional The grantor* at 1-800-908-4490 or submit Form 14039. Form 1099 Filing Method 1 (see For more information,see Pub.5027,Identity Theft Information for Regulations section 1.671-4(b)(2)(i) Taxpayers. (A)) Victims of identity theft who are experiencing economic harm or a For this type of account: Give name and EIN of: systemic problem,or are seeking help in resolving tax problems that 8.Disregarded entity not owned by an The owner have not been resolved through normal channels,may be eligible for individual Taxpayer Advocate Service(TAS)assistance.You can reach TAS by 9.A valid trust,estate,or pension trust Legal entity° calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059. 10.Corporation or LLC electing The corporation Protect yourself from suspicious emails or phishing schemes. corporate status on Form 8832 or Phishing is the creation and use of email and websites designed to Form 2553 mimic legitimate business emails and websites.The most common act 11.Association,club,religious, The organization is sending an email to a user falsely claiming to be an established charitable,educational,or other tax- legitimate enterprise in an attempt to scam the user into surrendering exempt organization private information that will be used for identity theft. 12.Partnership or multi-member LLC The partnership 13.A broker or registered nominee The broker or nominee 61 PRC Meeting 03.03.22 Page 62 of 306 Form W-9(Rev.10-2018) Page 6 The IRS does not initiate contacts with taxpayers via emails.Also,the privacy Act Notice IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers,passwords,or similar secret access Section 6109 of the Internal Revenue Code requires you to provide your information for their credit card,bank,or other financial accounts. correct TIN to persons(including federal agencies)who are required to If you receive an unsolicited email claiming to be from the IRS, file information returns with the IRS to report interest,dividends,or forward this message to phishing@irs.gov.You may also report misuse certain other income paid to you;mortgage interest you paid;the of the IRS name,logo,or other IRS property to the Treasury Inspector acquisition or abandonment of secured property;the cancellation of General for Tax Administration(TIGTA)at 1-800-366-4484.You can debt;n contributions you made to i IRA,Archer the for to The forward suspicious emails to the Federal Trade Commission at person collecting this form uses the information o the form to file spam@uce.gov or report them at www.ftc.gov/complaint.You can information returns with the IRS,reporting the above information. contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT(877-438-4338). Routine uses of this information include giving it to the Department of If you have been the victim of identity theft,see www.ldentityTheft.gov Justice for civil and criminal litigation and to cities,states,the District of and Pub.5027. Columbia,and U.S.commonwealths and possessions for use in administering their laws.The information also may be disclosed to other Visit www.irs.gov11dentityTheft to learn more about identity theft and countries under a treaty,to federal and state agencies to enforce civil how to reduce your risk. and criminal laws,or to federal law enforcement and intelligence agencies to combat terrorism.You must provide your TIN whether or not you are required to file a tax return.Under section 3406,payers must generally withhold a percentage of taxable interest,dividend,and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information. 62 PRC Meeting 03.03.22 AMERICAN CANCER SOCIETY, INC Page 63 of 306 2021 Plan (in thousands) REVENUE 2021 Events & Peer to Peer 139,519 Relationships 239,405 Marketing 13 8,73 3 Merchandise,Memberships&In-Kind 28,368 TOTAL ONGOING OPERATIONS 544,025 Nan-Recuiring (Gov Grants & Campaigns) 13,991 TOTAL OPERATIONS 558,016 Investment, Exchange & Other 19,395 TOTAL REVENUE 577,411 EXPENSES Salaries, Benefits &Taxes 240,721 Professional Fees 48,272 Grants and Awards 108,590 Education and Marketing 59,647 Direct Assistance to Patients 4,451 Travel 4,371 Postage and Shipping 12,559 Meetings and Conferences 2,594 Community and Hope Lodge Facilities 30,989 Technology 31,277 Telecommunications 4,552 Depreciation and Amortization 14,671 Miscellaneous 7,986 TOTAL EXPENSES 570,679 63 PRC Meeting 03.03.22 Page 64 of 306 American Cancer Society Relay for Life (NEW) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the X program/project/event Identify how the funds will be used to benefit the Cupertino X community Be awarded only once per project X For specific needs,not on going,operational costs X Have more than 75%of the requested funds allocated for direct X service costs versus administrative costs Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission PRC Meeting 03.03.22 Page 65 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION l 408-777-3120 1 1NWW.CUPERTINO.ORG CUPERTINO CONTACTSECTION 1 : Full Legal Organization Name: StemBoost Corporation Website:I https:llwww.stemboost.org/ Address: City: Cupertino State: CA Zip:195014 Phone: Organization President/Executive Director Name and Title: I Queenlee FOG, Board Director Email:I queenleefoo a@gmai1.com Phone: Contact Name and Title: (If different) Email: Phone: SECTIONNON-PROFIT •' • 501(c)(3)?: ■ `es Year Established: No {i f different thmi above address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax IDJ 82-274 1 857 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 112,000 Total#of Board Members: 3 Total#of staff: 27 Total#of Volunteers: 30 65 PRC Meeting 03.03.22 Page 66 of 306 Mission Statement: STEMBoost is a 501(c) non-profit organization founded in 2017 by a group of STEM savvy high school students to educate elementary and middle school students in the field of STEM so that they can gain a better understanding of the field and perhaps even seek a career in STEM. STEMBoost continues to support the Kennedy Science Olympiad team, the national champion in 2019 and 2021 (2020 was canceled), to ensure performance from year to year and maintain continuity between teams by conducting Science Olympiad Invitationals, assembling materials, knowledge, and experience for the Kennedy Science Olympiad teams. STEMBoost also fundralses for both the Kennedy Science Olympiad team activities as well as STEMBoost activities to enhance STEM interests in younger students residing in Cupertino and beyond. Brief Description of Organization and Services Provided: Our team consists of oun ers,officers and boardof directors-Our five co-founders are alumni of on a Vista HighSchool and have moved on to colleges including Stanford,UCLA,Georgia Institute of Technology,and Occidental College.They have kept contributing to STEMBoost by offering their expert advice to current officers,even being hands-on sometimes_Currently,we have 22 officers,all of wham are Monta Vista High School students and alumni of the Kennedy Middle School Science Olympiad team.This team has won first place in Santa Clara County,Northern California, and the National Science Olympiad competitions for the past two consecutive seasons,and has been recognized by the Cupertino Union School District(https.7hvww.cusdkB-orglPagel6241).All of our officers also serve as instructors to mentor younger students on STEM related topics.We have three adult board of directors who are responsible for electing president of the organization.The vice presidents appointed by the president are in charge of departments of operations,marketing, multimedia and communications.Out program manager is the liaison between different departments. STEMBoost provides three major services to enhance STEM interests and improve pertormance of younger students in STEM.First,we have been offering mu#tiple workshop series during school year since 2018_The topics of the workshops wilt cover physics,chemistry,biology,math,computer science,earth science and engineering.In addition,the depth of knowledge the workshops cover will vary depending on the topics so that both beginner and advanced students can find topics that interest them. For example,will,Depending on the topic,each workshop spans 2-4 weeks with one or multiple 60-90 minute in person or online sessions_Syllabus and instructor's background is provided before registration to help students select the right workshop that fits their interest. For example,a total of 31 workshops were offered during the 4th annual workshop series in 2021 summer by STEMBoost instructors who collectively volunteered 117 hours.Second,STEMBoost supports six Kennedy Middle Schoof Science Olympiad teams by mentoring team members for specific events they compete on_STEMBoost also helps teams competing in Science Olympiad Division B from all over the country to improve their performance by inviting them to annual STEMBoost invitational toumament.In particular,72 teams from 10 states have registered to compete in the third annual STEMBoost invitational,which will be held on 1122I2022. Teams can take this opportunity to perfect their devices and get a feet for the difficulty level of tests and labs,as well as prepare members to compete in regional,state or national tournaments_ Finally,STEMBoost supports focused projects such as cyber security and robotics.The Cyber Squad focuses on both basic cyber security skill training and contributions to solving real wortd cyber security related challenges though holding weekN meetings and attending security related competitions throughout the year.The robotics group creates and maintains robotics teams to compete in FLL(FIRST LEGO League)and FTC(FIRST Tech Challenge)programs_ REQUESTSECTION 4: GRANT 1. Program/Project/EventName: STEMBoost Summer Worshop 2. Date(s) and/or duration of program/project/event (if applicable): 2022 Summer June-Aug 3. Total program/project/event budget: S 18,000 4. Requested Amount: q8,000 Percent of total program/project/event budget: QO % 5. What percentage of your organization's projected income does your funding request represent? 60 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 12017 (year) New program/project/event 66 PRC Meeting 03.03.22 Page 67 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 0 (o)ioohi operational cost.} b) Materials/Equipment S 50❑ c) Entertainment$0 d) Room/Venue Rental$ 5500 e) other Professional Services such as f) other I Insurance $2000 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will be provided: The requested fund will support a series of in-person summer workshops offered from June to August in 2022. The majority of the fund will be used to pay facility rental. Additional expenses include materials such as handouts, facility services and utilities.The topics of the workshops will cover physics, chemistry, biology, math, computer science, earth science and engineering. In addition, the depth of knowledge the workshops cover will vary depending on the topics so that both beginner and advanced students can find subjects that interest them. For example, while Fundamentals of Physics will explore kinematics in 1 and 2 dimensions,along with force and other common topics, Rptation and Stellar Collapse will focus on investigation of stellar collapse using the principles of rotational physics.As described above, each workshop will span 2-4 weeks with one or multiple 60-90 minute sessions and syllabus and instructor's background will be provided before registration to help students select the right workshop that fits their interest. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit ❑r impact the Cupertino community: Our proposed program aligns to City mission and values perfectly, which is to provide exceptional service, encourage all members of the community to take responsibility for one another, and support the values of education, innovation and collaboration. Our program not only enhances the exposure of middle school students to STEM, but also help them build a unique interest in STEM related topics. In addition, by offering these workshops in summer, we can effectively prevent summer learning loss. The new skills and knowledge acquired will reinforce confidence of the students and help them thrive in the coming school year. 12. Who will be served by tlus rant? Middle school students in City of Cupertino a) Number of individuals total:14588 b) Number of Cupertino residents: 14588 c) Will the program/project/event be available to the entire commuruty/public or are there an- eligibility criteria? The programlproject/event will be available to the entire community/public. 67 PRC Meeting 03.03.22 Page 68 of 306 d) Will there be a charge or fee for the programlproject/evelit(if applicable)? The registration fee for the workshop varies from year to year. In some cases, we offer free registration to students who experience financial difficulties. 13. If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: We have never received financial or in-kind support from City of Cupertino. 14. Describe any funding requested from other agencies organizations in regard to this program/projectlevent request.Indicate whether the fimding was granted, denied, or is still pending: We don't have any funding requested from other agencies/organizations in regard to this program. 68 INTERNAL REVENUE. SERVICE DEPARTMENTPbi�n ' �Y P_ 0. BOX 2508 Page 69 of 06 CINCINNATI, 6H 45201 Employer Identification Number: Dace: N N 16 2017 $2-2'74#18 a'7 DLN= 26053703006167 STEMSOUST CORPORATION Contact Person: CUSTOMER SERVICE 1D#1 31954 Contact Telephone Number: {877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 509{a) {2) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption- August 30, 201.7 Contribution Deductibility: Yes Addendum Applies. No Dear Applicant: We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 541(c) (3) . Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522_ This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c) (3) are further classified as either public charities or private foundations. we determined you're a public charity under the IRC Section listed at the top of this letter. if we indicated at the top of this letter that you're required to file Farm 990/990-EZ/990-N, our records show you're required to file an annual information return (Foray 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard) . If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked- If we indicated at the tap of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, g❑ to www.irs.gov/charities. Enter 04221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c) (3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 69 _Z_ PRC Meeting 03.03.22 STEMBOOST CORPORATION Page 70 of 306 Sincerely, Director, Exempt Organizations Rulings and Agreements Letter 947 70 PRC Meeting 03.03.22 Page 71 of 306 STEMBoost Corporation (NEW) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the X program/project/event Identify how the funds will be used to benefit the Cupertino X community Be awarded only once per project X For specific needs,not on going,operational costs X Have more than 75%of the requested funds allocated for direct X service costs versus administrative costs Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved x Registration Fee(amount not specified)for workshop. by Parks and Recreation Commission y PRC Meeting 03.03.22 Page 72 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION i 408-777-3120 I WWW.CUPERTINO.ORG CUPERTINO CONTACTSECTION 1 : Full Legal Organization Name: Dee pa Go alakrishnan Website:I www.youngzine.org Address: City: Cupertino State: CA Zip:195014 Phone: Organization President/Executive Director Name and Title: I Younpne Inc Email:I deepa@youngzlne.org Phone: Contact Name and Title: (If different) Email:I deepa@youngzine.org Phone: SECTION • • •' • 501(c)(3)?: t�le: Year Established:{i f different than r baue address information) Sponsor Name:1youngzine Sponsor Address: City.: Cu p e rti n a state: CA Zip: 5014 Phone: Federal Tax ID: 900850890 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 1175,000 Total#of Board Members: 6 Total#of staff:12 Total#of Volunteers: 15 72 PRC Meeting 03.03.22 Page 73 of 306 Mission Statement: Youngzine's mission is to teach young people about the environment and our changing climate, and empower them to create a future that is just and sustainable. Brief Description of Organization and Services Provided: Youngzine is an educational non-profit that builds students' literacy in the areas of climate, environment, and sustainability. Over the past decade, Youngzine's online news platform has grown into a trusted and age-appropriate resource for teachers and students. Our news articles explain the current global issues, report on the latest scientific findings, and highlight innovative solutions to mitigate and adapt to climate change. Our news articles are written by high school students, some local, who are guided and mentored by our editorial team. Youngzine is used by teachers in over 1,000 classrooms across the U.S and our content partnerships with Gale and ProQuest continue to expand our reach. We have also developed comprehensive core content and lesson plans on Climate Literacy,together with a climate scientist at Stanford University. Our content explores all aspects of the issue from the basics of weather and climate to the underlying science and ecosystem impacts, and the solutions and actions that contribute to a sustainable future. This content,which was launched in Fall 2021, is currently being piloted in several K-12 classrooms. In December 2021, we presented our climate literacy content at the Environmental Teacher Fellowship Program in San Mateo. We will be at the upcoming SXSW Edu conference in Austin in March, 2022 to present a 90-minute workshop to teachers on integrating climate change in their classrooms. We are now looking to work with students directly and empower them from knowledge to action, and would like to run our inaugural Youth Climate Steward Program in our home city of Cupertino. REQUESTSECTION 4: GRANT 1. Program/Project/EventName: summer Youth Climate Steward Program 2. Date(s) and/or duration of program/project/event (if applicable): Three Weeks; 9-4 pm; Dates TBD I Total program/project/event budget: $ 9200 4. Requested Amount: 6000 Percent of total program/project/event budget: % 5. What percentage of NTour organization's projected income does your funding request represent? 46 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in I (year) ■ New program/project/event 73 PRC Meeting 03.03.22 Page 74 of 306 S_ Please provide a line item breakdown of bow the funds will be used in the categories below. If a category is not applicable, put$0: a) .Staffing cost (ongoing operational cost) b) Materials/Equipment$� c) Entertainment$ d) RoomJVenue Rental$� e) Other Professional Services such as Consultant for Summer fl 6000 f) Other I I $ 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will beprovided: The funds YnM be used to develop and run a three-week online Youth Climate Steward program for local high school students in Summer 2022,based on our content. The goal of the program is to help studerds develop a broad and systems4evel understanding of climate change and how it relates to sustainability.We will start with the science and evidence behind our changing climate,including tow scientists record,model,and predict changes in the environment.Then we will examine the impacts of climate change on ditkNent ecosystems,emphasizing their interconnectedness with each other and with human society.Finally,we will delve into the different sectors that exacerbate greenhouse gas emissions(i.e.energy,agriculture,transportation, infrastructure,etc-)and discuss multidisciplinary solutions needed for citizens and governments to mitigate and adapt over the next few decades.Key topics to discuss and weigh include environmental justice,conservation perspectives,role of technology and policy,and tradeoffs and the stakeholders involved in implementing these solutions- The program will combine lectures and slides,pre-reading and analysis of relevant excerpts,and breakout discussions where participants will interact in small groups to share their perspectives and questions.We also plan to Ming guest speakers working on climate change and sustainaMRty from industry,academia,and governments to share their knowledge and experience. The program will include a capstone project,where students develop a local research project or idea that addresses austainability in their community.Through the project,they will apply what they have learned about climate change and understand how different political,economic,and social forces shape solutions from the ground up.The projectwilf culminate in a final TEQ-tMe pre: n[alron that shows the participants understanding of the issue and tier passion for sustadnability advocacy. The funding would be used to pay for staff to co-develop the weekly content and lesson plans,as well as run the program,provide edu utbonad materials,and nversee logistics on a daily basis. 11. Explain how the request aligns to City mission and values.Describe how fiinds will be used to benefit or impact the Cupertino community: The city of Cupertino upholds education as a core value and has always encouraged and supported holistic education opportunities for our students.Cupertino is also a leader in focal sustainabifity efforts in the Bay Neil,C alffomia,with several green initiatives including habitat conservation,energy�lficient buildings,Mke lanes,and the establishment of She Cupertino Green team. Youngwie's summer program embodies and aligns itself with these values,looking to equip Cupertino's youth with the knowledge and skills to comprehend an issue as complex as the ckmate crisis. We are especially motivated to connect our content to local rues that students can relate to and potentially contribute towards,through our program's capstone project.overall,environment and sustainablity education will allow students to make informed choices in their homes,schools,and communities,advocate for local sdutions,build civic engagement,and thrive and innovate in a green economy. Funding our summer program will directly benefit the Cupertino community as our first cohort of Climate Stewards will be selected Tram local schools,and at least T5%of our cohort will be from the city of Cupertino.For the final project,students will research issues or develop ideas for solutions on topics such as food security,water conservation,reducing pollution or waste management that can be meaningfully implemented in the Cupertino community. While the program iself will be conducted virtually,we are considering hosting final presentations in person,where the students are able to present their projects in a TEDaike setting to a panel of peers and mentors from the Cupertino community.We would be glad to have Cupertino officials attend this event.We also plan to advise and guide students aierthe program ends,encouraging them to follow through on their projects,and implement their ideas in their schools and commurtities by providing potential resasrces,opportunities,and access through Youngzine's platform. 12. Who will be served by this rant? FR—igF_s_cF6ol Students as well as rising 9th graders.We are looking for students from multiple disciplines , Humanities)who are interested in learning about sustainability and climate change, and taking action. a) Number of individuals total:120 b) Number of Cupertino residents: 112 c) Will the program/project/eventbe available to the entire community/public or are there any eligibility criteria? The program is intended for high school students, including rising freshmen. 75% of our inaugural cohort will be selected from Cupertino schools. Students will need to submit an application to be considered for the program. 74 PRC Meeting 03.03.22 Page 75 of 306 d) Will there be a charge or fee for the prograniiproject/event(if applicable)? Yes, there will be a discounted fee for the program. 13_ If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: NO. Not Applicable. 14_ Describe any funding requested from other agencies organizations in regard to this program/project/event request_Indicate whether the funding was granted, denied, or is still pending: NONE. Not Applicable 75 PRC Meeting 03.03.22 Page 76 of 306 INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREAS'ORX P. O. BOX 2508 CINCINNATI, OH 45201 Employer Identification Number: Date: j A UJO nLW.0850890 �` 1705332532701.2 YOUNG71NE INC Contact Person: JOHN J KOESTER ID# 31364 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 170(b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: June 11, 2012 Contribution Deductibility: Yes Addendum Applies: No Dear Applicant: We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501 (c) (3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501 (c) (3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter. Please see enclosed Publication 4221-PC, Compliance Guide for 501 (c) (3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 (DO/CG) 76 _ PRC Meeting 03.03.22 -2- Page 77 of 306 YOUNGZINE INC Sincerely, �~ -- Holly O. Paz Director, Exempt Organizations Rulings and Agreements Enclosure: Publication 4221-PC Letter 947 (DO/CG) 77 PRC Meeting 03.03.22 Page 78 of 306 Deepa Gopalakrishnan Founder, Youngzine 10386 Avenida Ln Cupertino, CA 95014 Dear Cupertino Grant Committee Members, Thank you for considering Youngzine for the grant opportunity from Parks and Rec, Cupertino. I wanted to clarify that the IRS letter for 501c3 certification was granted when the organization was incorporated in San Jose. In 2015, the organization address was moved to Cupertino and since then, that is the official address on IRS records. I have tried many times to amend the original letter but was informed that is not possible. Hence, I am including additional images from the IRS website that show the location of the organization as well as the 990N. I hope this helps clarify the address. Thank you. r File Ray Refunds Credits&Deductions Forms&Instructions Homo>Tait EXernpt Organization Sea rsh>Ycungtine Inc. r Sack to Search Results Youngzine Inc. EIN:90.08508901 Cupertino,CA,United States Other Names Determination Letter e A faVOra h le determination letter i5 issued by the IRS it an organization meets the requi remen%For tax-Exempt status under the Code section the organization appii ed. Final teeters Final Letter 90-0850890 YOUNG21NEINC 11122012 OUR 78 PRC Meeting 03.03.22 Page 79 of 306 Form 990-N (e-Postcard)o Organizations who have filed a 990-N(e-Postcard)annual electronic notice.Most small organizations that receive less than$50,000 fall into this category. Tax Year 2020 Form 990-N(e-Postcard) Tax Period: Mailing Address: Gross receipts not greater than: 2020(01/01/2020-12/31/2020) 10386 Avenida Lane $50,000 Cupertino,CA95014 EIN: United States 90-0850890 Principal Officer's Name and Address: organization has terminated: Deepa Gopal No Legal Name(doing Business as): Voungzine Inc 10386 Avenida Lane Cupertino,CA 95014 Website LIRL: United States www.youngzine.org Tax Year 2019 Form 990-N(e-Postcard) Tax Year 2018 Form 990-N(e-Postcard) Tax Year 2017 Form 990-14(e-Postcard) Tax Year 2016 Form 990-N(e-Postcard) Tax Year 2015 Form 990-N(e-Postcard) 79 PRC Meeting 03.03.22 Page 80 of 306 Youngzine (New) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the X program/project/event Identify how the funds will be used to benefit the Cupertino X community Be awarded only once per project X For specific needs,not on going,operational costs X Have more than 75%of the requested funds allocated for direct X service costs versus administrative costs Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application 12e.Proceeds generated from the funded activity may only be used for the conducted activity INA admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved x Registration Fee(amount not specified)for program. by Parks and Recreation Commission Go O PRC Meeting 03.03.22 Page 81 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION l 408-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTION 1 : CONTACT INFORMATION Full Legal Organization Name: Lilian Chen Website:I able2shine_org Address: City: Fremont State: CA Zip:194539 Phone: Organization President/Executive Director Name and Title: I Ping Lilo Email: pingluo@able2shine.com Phone: Contact Name and Title: (If different) Email: Phone: SECTIONNON-PROFIT •' • 501(c)(3)?: ■ `es Year Established: No {i f different thmi above address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax ID: h11A (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 150000 Total#of Board Members: 13 Total#of staff:15 Total#of Volunteers: 500 81 PRC Meeting 03.03.22 Page 82 of 306 Mission Statement: Able2Shine Shine4Love Teens' Club mission is to serve the community and help develop soft skills for teenagers through leadership opportunities, problem-solving, project and time management, teamwork, and communication skills. Brief Description of Organization and Services Provided: Our teens are split into committees to carry out projects that serve our local community. Past projects include fundraising for local organizations, free 1-on-1 tutoring, nursing home performances, cross-cultural shows, Asian American History Month activities, COVID-19 memorial tree planting, donation drives, etc. REQUESTSECTION 4: GRANT 1. Program/Project/EventName: Teens Club Events in 2022 2. Date(s) and/or duration of program/project/event (if applicable): 2022 3. Total program/project/event budget: S 150000 4. Requested Amount: 20000 Percent of total program/project/event budget: 4Q % 5. What percentage of your organization's projected income does your funding request represent? 50 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 12017 (year) New program/project/event 82 PRC Meeting 03.03.22 Page 83 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 9000 (ongoing operational cost) b) Materials/Equipment$ 5000 c) Entertainment$ 1000 d) Room/Venue Rental$ 5000 e) Other Professional Services such as f) Other I $ 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that'Will be provided: The requested funds will be used for various projects,including but not limited to the ffoilowing: Crass-Cultural Show(several times a year):The purpose of Cross-Cultural shows are to celebrate various cultures and bring together members of the community. Performances include dancing,singing,acting,and more.Our Teens Club members help to pfan and execute the Cross-Cultural show,which includes booking a venue,renting sound equipment,organizing performances,reaching out to local organizations,and promoting the event.These shows are held several times a year and have hundreds of audience members in attendance per show. Aft fundraisers(several times a year):Many of our Teens Club members are extremely passionate about art and love to create art projects for the community.In the past,we have had unique fundraisers such as our mason jar fundraiser,where students painted mason jars and sold them at the local farmer's market,and donated ail the proceeds to a local non-profit organization.Requested funds will be used to purchase art supplies for the fundraisers or for other community projects. Other projects that requested funds would be used for include staffing costs,COVID-19 memorial tree planting(purchase of trees and supplies),nursing horse performances and activities(sound system,props,craft kits,etc_), and other projects that our teens would like to plan for our community. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit or impact the Cupertino community: These events and projects directly impact the Cupertino community by engaging individual members through our cultural shows and programming. Our teens also volunteer at community organizations on a weekly basis to serve wherever needed. Specifically, our group hopes to represent and advocate for the Asian-American community, especially inspiring younger students to get more involved. 12. who will be served by tlus rant? Members ot the local Cupertino community will be served by this grant through oca community projects an cultural shows.Additionally, our teens volunteer at local community organizations every weekend, so our teens also give back to local organizations. a) Number of individuals total:15000 b) Number of Cupertino residents: 12000 c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? Yes, all Teens Club events are available to the entire community. 83 PRC Meeting 03.03.22 Page 84 of 306 d) Will there be a charge or fee for the programlproject/event(if applicable)? There are no charge or fees for Teens Club events. 13_ If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: NIA 14_ Describe any funding requested from other agencies organizations in regard to this program/project/event request_Indicate whether the funding was granted, denied, or is still pending: Still researching other funding, still in progress. 84 PRC Meeting 03.03.22 Page 85 of 306 IRS DEPARTMENT OF THE TREASURY INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 05-20-2016 Employer Identification Number: 81-2697003 Form: SS-4 Number of this notice: CP 575 A ABLE 2 SHINE FOUNDATION For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 81-2697003. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 1120 03/15/2017 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year) , see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue) . Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. IMPORTANT INFORMATION FOR S CORPORATION ELECTION: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation. 85 PRC Meeting 03.03.22 Page 86 of 306 (IRS USE ONLY) 575A 05-20-2016 ABLE B 9999999999 SS-4 If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945, CT-1, or 1042) , excise taxes (Form 720) , or income taxes (Form 1120) , you will receive a Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System (EFTPS) . A Personal Identification Number (PIN) for EFTPS will also be sent to you under separate cover. Please activate the PIN once you receive it, even if you have requested the services of a tax professional or representative. For more information about EFTPS, refer to Publication 966, Electronic Choices to Pay All Your Federal Taxes. If you need to make a deposit immediately, you will need to make arrangements with your Financial Institution to complete a wire transfer. The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized e-file Providers, such as Reporting Agents (payroll service providers) are available to assist you. Visit the IRS Web site at www.irs.gov for a list of companies that offer IRS e-file for business products and services. The list provides addresses, telephone numbers, and links to their Web sites. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. IMPORTANT REMINDERS: * Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax-related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Your name control associated with this EIN is ABLE. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. 86 PRC Meeting 03.03.22 Page 87 of 306 (IRS USE ONLY) 575A 05-20-2016 ABLE B 9999999999 SS-4 Keep this part for your records. CP 575 A (Rev. 7-2007) ---------------------------------------------------------------------------------------------- Return this part with any correspondence so we may identify your account. Please CP 575 A correct any errors in your name or address. 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 05-20-2016 ( ) - EMPLOYER IDENTIFICATION NUMBER: 81-2697003 FORM: SS-4 NOBOD INTERNAL REVENUE SERVICE ABLE 2 SHINE FOUNDATION CINCINNATI OH 45999-0023 87 PRC Meeting 03.03.22 Page 88 of 306 Able 2 Shine (NEW) Eligibility Checklist (staff use only) Eligibility YES NO Notes. Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the x program/project/event Identify how the funds will be used to benefit the Cupertino x community Be awarded only once per project x For specific needs,not on going,operational costs x $9,000 Staffing/$11,000 non-operational Have more than 75%of the requested funds allocated for direct s x $9,000 Staffing/$11,000 non-operational service costs versus administrative costs Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission Go 00 PRC Meeting 03.03.22 Page 89 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTIONCONTACT Full Legal Organization Name: cU ertino Educational Endowment Foundation Website:I https://ceefcares_org/ Address] 10301 Vista Drive City: Cupertino State: CA Zip:195014 Phone: 14082523000 Organization President/Executive Director Name and Title: I Karen Rizkalla Email: krizkalla@gmaii.com Phone: 14082302766 Contact Name and Title: Karen Rizkafla- CEEF Director (If different) Email: Phone: SECTION ! • •' • 501(c)(3)?: ■ `es Year Established: No {i f different than above address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax IDJ 77-0073617 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 179,900 Total#of Board Members: 10 Total#of staff:10 Total#of Volunteers:8 89 PRC Meeting 03.03.22 Page 90 of 306 Mission Statement: Together. We fund excellence in Cupertino Union School District schools. Brief Description of Organization and Services Provided: Led by a volunteer board of community leaders, our mission is to raise and leverage private support to provide stable, sustainable funding that ensures ongoing excellence and enriches the educational program for all students in the Cupertino Union School District. We help CUSD continue to set the standard of quality for public education by supplementing public funds with private philanthropy. REQUESTSECTION 4: GRANT 1. Program/Projec-t/EventName: Expansion of Teacher Grant Program 2. Date(s) and/or duration of program/project/event (if applicable): 1011512021-6130/2022 3. Total program/project/event budget: S 1210,000 4. Requested Amount: q upto 109 325 Percent of total program/project/event budget: 52 % 5. What percentage of your organization's projected income does your funding request represent? 437 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 12021 (year) New program/project/event 90 PRC Meeting 03.03.22 Page 91 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 0 (ongoing operational cost) b) Materials/Equipment$ c) Entertainment$0 d) Room/Venue Rental$® e) Other Professional Services such as 0 f) Other 10 $ 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the sei-vices that will beprovided: With the requested funds, we aim to extend the teacher grant program to include nurses.These funds will be used to purchase hearing equipment, specifically: a hearing screener and up to 9 audiometers. As of right now,the hearing equipment being used in the CUSD schools is outdated and antiquated. A hearing screener would help nursing staff care for young preschool and special needs students. This device can also be used for all students in the CUSD district.This device is placed in a child's ear and provides an analysis of the child's hearing. This serves as a replacement to hearing tests that require students to raise their hands when they hear sounds. These two classes of students have difficulty following instructions and so this would allow more accurate hearing screens to be conducted. Only one singular device would be needed as this device can be shared between schools. The next item is an audiometer. 9 CUSD schools are in need of audiometers, but any number provided up to 9 would be extremely impactful and allow the nursing staff to conduct hearing screens efficiently and accurately. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit ❑r impact the Cupertino community: This request aligns to the City mission and values because with improved hearing equipment in elementary school students, the quality of education for all students within CUSD students will be improved. The service provided within schools will be exceptional, and the students of CUSD will receive the highest quality, most accurate, and most inclusive hearing test. 12. Who will be served by this rant? The students of the Cupertino Union School District. a) Number of individuals total:113815 b) Number of Cupertino residents: 16217 c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? The program will only be available to the students that are enrolled in the CUSD elementary schools. 91 PRC Meeting 03.03.22 Page 92 of 306 d) Will there be a charge or fee for the prograni/project/event(if applicable)? There will be no charge or fee. 13. If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: Cupertino City Parks and Recreation - during the hosting of one our 5k fundraisers: "CEEF Run for Great Schools and Fun Run," (2019)the grant helped offset city costs that were associated with hosting that event. 14_ Describe any funding requested from other agencies/organizations in regard to this program/project/event request.Indicate whether the funding was granted, denied, or is still pending: Other funding for this program includes funds from our own Cupertino Educational Endowment Foundation fund and individual donations from parents and community members. 92 Internal Revenue Service DCPAPAg 5fVA- easury District Director Page 93 0 306 P O Box 36001 STOP SF-4-4-46 SAN FBANCISCO, CA 94102 Employer Identification Number: 77-0073617 Dace: AUG. 27 , 1987 Case N=ber: 957223009 CUPERT1140 EDUCATIONAL ENDOWMENT Contact Person: FOUNDATION PATRICE WHkNG Contact Telephone ,Iu:aber: (415) 556-0223 Our Letter Dated: May 15, 1987 Caveat Applies : NO Dear Applicant: This modifies our Letter of the above date in which we stated that you would be treated as ec. organization which is not a privatQ foundation until the expiration of your advance ruling period. Based on the information you submitted, we have deterained that you are not a private foundation within the meaning of section 509(a ) of the Internal Revenue Code, because you are an org2nization of the type described in section 509(a )(1 ) and 170(b)(1 )(A)(vi). Your exempt status under section 501(c )(3) of the code is still, in effect. Grantors and contributors may rely on this determination until the Internal Revenue Service publishes a notice to the Contrary. However, a grantor or a contributor may not rely on this determination if he or she was in part responsible for, or was aware of , tine act or failure to act that resulted in your loss of section 509(a)(1 ) status , or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from classification as a section 509(a )(1 ) organization. Because this letter could help resolve any questions about your private {oundatic n status, please keep is in your permanent, records. If the heading of this letter indicates that a caveat applies, the caveat below or on the enclosure is au integral part or this letter. If you have any questions , please contact the person Whose name ead telephone number are shown above. sincerely yours, Frederick C. Nielsen District Director letter i05[3(CG ) 93 1/31122.?_14 PM Mail-Rebecca Liu-Outlook PRC Meeting 03.03.22 Page 94 of 306 Search i11 Delete 8 Archive & Junky PHOTOS AND RESULTS FROM 5K RUN FOR GREAT 00 SCHOOLS AND FUN RUN YOU DID IT ! THANK YOU TO THE MORE THAN 999 RUNNERS WHO PARTICIPATED IN THE 5TH ANNUAL CEEF 5K RUN FOR GREAT SCHOOLS AND FUN RUN! Congratulations to our winners and all runners! Results can be found here. Photos from the race can be found here. Proceeds benefit all 17,940 CUSD Students hgs:lloutlook.office.eomluiaWinbox/idlAAQkAD]iaY`_'QxYag4LTkDZjELND1j�11aNTlkLTc3I'TM3MzlhNmltnZQAQAHQuu1Mo47dNoj5H7olc8co b3D 1194 PRC Meeting 03.03.22 Page 95 of 306 6th annual CEEF Run for Great Schools 5K and Fun Run Saturday, September 26,2020 Event Description: 611,annual CEEF Run for Great Schools 5K and Fun Run raises much-needed funds for the Cupertino Union School District to support our excellent schools.SK is for all ages. Fun Run is for ages 6 and below. Post-run festival with food trucks,vendor booths and awards presentation! 2 U 19 Event Financial Report: INCOME Actuals 2019 Sponsorships & Donations 26100 On line ticket sales 30825 Offline Ticket Sales 630 Donations $2,000 Total Income 59555 Marketing/PR Description Design 767 Printing 682 Social Media Marketing 100 Shirts 10211 Total Description Runner's Mind 2820 Zach Lee Production 2514 DJ 500 Santa Clara County Sheriff 0 95 PRC Meeting 03.03.22 Page 96 of 306 Cupertino Department of Public Works 0 City of Cupertino 0 United Site Services (Porta Potties) 1184 Medals 663 Fun Run Medals 53 Fun Run Bibs 61 Sanction/Insurance 1802 Water Food 171 Stripe transfer fee Coffee carts and bagels for schools 1000 Other supplies 42 Event Expenses Total Marketing and Event Expenses Total 22570 Description Credit card fees on registration payments 174 Total Expenditures with credit card fees NET 51K RUN PROCEEDS 36811 96 PRC Meeting 03.03.22 Page 97 of 306 Cupertino Educational Endowment Foundation (NEW) Eligibility Checklist (staff use only) Eli ib ility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the program/project/event x Identify how the funds will be used to benefit the Cupertino community x Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct service costs versus administrative x costs Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only submit one application NA Proceeds generated from the funded activity may only be used for the conducted activity NA admission to or participation in the event must be"free of charge"to Cupertino residents unless NA stated in the application and approved by Parks and Recreation Commission 4 PRC Meeting 03.03.22 Page 98 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTION • INFORMATION Full Legal Organization Name: Allison Liner Website:I cusdk8.org Address] 1309 South Mary Avenue, Suite 150 city:j Sunnyvale State: Calif Zip:194087 Phone: 14082523000 Organization President/Executive Director Name and Title: I Stacy Yao, Superintendent,Cupertino Anion School Distric Email:Iyao stacy@cusdk8.org I Phone: 14082523000 Contact Name and Title: Allison Liner, Assoc. Superintendent Ed. Services (If different) Email: liner_allison cusdk8.crg Phone: 4082523000 SECTION ! • O • 501(c)(3)?: 'es Year Established: �Io {i f different than above address information) Sponsor Name:Icupertino Union School District Sponsor Address:11309 South Mary Avenue City.. Sunnyvale State: Califamia Zip: 4087 Phone: 14082523000 Federal Tax ID: 77-0025265 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: Icupertino Total# of Board Members: 5 Total#of staff:11400 Total#of Volunteers: 1500 98 PRC Meeting 03.03.22 Page 99 of 306 Mission Statement: The mission of the Cupertino Union School District is to provide a child-centered environment that cultivates character, fosters academic excellence, and embraces diversity. District families, communities, and staff join as partners to develop creative, exemplary learners with the skills and enthusiasm to contribute to a constantly changing global society. Brief Description of Organization and Services Provided: The Cupertino Union School District is a vibrant learning community comprised of approximately 1,400 employees (FTE) serving just over 14,000 students in 19 elementary schools, one K-8 school, and five middle schools throughout the city of Cupertino and parts of the cities of Sunnyvale, San Jose, Saratoga, Los Altos, and Santa Clara. REQUESTSECTION 4: GRANT 1. Program/Project/EventName: CUS❑ Summer Bridge 2. Date(s) and/or duration of program/project/event (if applicable): June 23 - July 21, 2022 3. Total prograin/project/event budget: $1$200,000 4. Requested Amount: 2O OOO Percent of total program/project/event budget: 1 Q % 5. What percentage of your organization's projected income does your funding request represent? 1 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in (year) ■ New program/project/event 99 PRC Meeting 03.03.22 Page 100 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost (a�rgniil.g operational cost) b) Materials/Equipment$� c) Entertainment$ d) Room/Venue Rental$� e) other Professional Services such as f) other lExtended Learning Da - STEAM Summer Cam $20000 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will be provided: From June 23-July 21, CUSD plans to offer a summer learning/enrichment program for 240 students entering grades 1-6.The Summer Bridge program will include lessons in reading/math provided on campus by CUSD teachers. This portion of the program will be funded by CUSD ($128,000). In the afternoon, students will participate in a STEAM summer camp (Science, Technology, Engineering, Arts, Mathematics). The STEAM summer camp will cost$16/per student for 20 days. Grant funds will be used to fund $20,000 towards the$72,000 cost of the summer camp program. CUSD will fund$52,000 of this cost. Students will participate in activities and games designed to support skill development, creativity and problem solving, a sense of belonging, physical fitness, and positive citizenship skills. Meals will be provided with federal funds. This program was developed in response to the impacts of the COVID-19 pandemic on student learning and well-being. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit or impact the Cupertino community: The City of Cupertino's mission statement includes its commitment to encouraging all members of the community to take responsibility for one another and support the values of education, innovation and collaboration. In our response to the COVID-19 pandemic, we have an opportunity to create an inter-agency web of support for our most vulnerable families. These funds will allow us to offer an enriching, engaging and meaningful summer program for our kids with highest needs. In addition, this program will provide support to our families by ensuring that children have safe, no- cost enrichment and childcare this summer. Let's work together to help our kids and families thrive so that our community can continue to be strong. 12. Who will be served by tlus rant? 240 students who are pertorming 13wow gra a Havel in reading and/or math will be served at the Sedgwick campus.In addroon,efig)ble students for the STEAM summer camp will fall into one or more of the following state eligibility requirements: English Learner, Foster Youth,Low Income.We also plan to offer fee-based enrollment for any student in these grades who wants to enroll. a) Number of individuals total:1240 b) Number of Cupertino residents: 1240 c) Will the program/project/event be available to the entire commm-dty/public or are there any eligibility criteria? The program will be available to students who are: Entering grades 1-6 in the fall of 2022, performing below grade level in reading and/or math, residents of Cupertino, and who meet one or more of the following state eligibility requirements: English Learner, Foster Youth, Low Income. 100 PRC Meeting 03.03.22 Page 101 of 306 d) Will there be a charge or fee for the prograni/project/event(if applicable)? There will be no charge for students who meet eligibility criteria listed above 13. If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: We value our long-standing relationship with the City of Cupertino. We partner for programs such as Safe Routes to School, the McClellan Ranch Creeks Program and support for our Community Engagement Office in reaching out to families. 14_ Describe any funding requested from other agencies/organizations in regard to this program/project/event request.Indicate whether the funding was granted, denied, or is still pending: The state provides expanded learning program funding at approximately $5/per student for each day. We will use these funds as part of the district contribution. 101 PRC Meeting 03.03.22 Superintendent of306 Board of Education Lori Cunningham Sylvia Leong .ferry Liu Satheesh Madhathil Cupertino Union School District Phyllis Vogel 10301 Vista Drive • Cupertino, California 95014-2091 - (408)252-3000 • Fax(408)253-7845 VERIFICATION OF TAX EXEMPT STATUS Name of Organization: Cupertino Union School District Street Address: 10301 Vista Drive City, State, Zip: Cupertino, CA 95014 Organization Tax Status: Tax Exempt Governinent Agency Public School District Federal Tax Employer ID#: 77-0025265 Gifts to public schools are deductible under Internal Revenue (IRS) Code Section 170 (c) which authorizes a deduction for charitable contributions to a "State, a possession of the United States, or any political subdivision of any of the foregoing ... but only if the contribution or gift is made for exclusively public purposes." Please direct any questions to Chris Jew, Chief Business Officer, at (408) 252-3000 ext. 61323. Thank you! Equal Opportunity Employer 102 PRC Meeting 03.03.22 Page 103 of 306 Cupertino Union School District Summer Bridge (NEW) Eligibility Checklist (staff use only) EligibilitX YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the x Public Schools are considered non-profit organizations by the IRS and program/project/event 501(c)(3)status is not required. Identify how the funds will be used to benefit the Cupertino community x Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct service costs versus administrative costs x Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only submit one NA application Proceeds generated from the funded activity may only be used for the NA conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved by Parks NA and Recreation Commission 3 0 W PRC Meeting 03.03.22 Page 104 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTION 1 : CONTACT INFORMATION Full Legal Organization Name: Fremont Union High School Foundation Website:I fuhsfoundation.org Address] 589 West Fremont Avenue City: Sunnyvale State: CA Zip:194087 Phone: 14086008986 Organization President/Executive Director Name and Title: I Man isha Ana rkat Email:I manarkat@gmai1.com Phone: 14085987982 Contact Name and Title: Ashish Garg (If different) Email:I ashish75garg@gmaii.com Phone: 4086008986 SECTION • • O • 501(c)(3)?: ■ `es Year Established: No {i f different than above address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax JDJ 94-2907804 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 1500000 Total#of Board Members: 1$ Total#of staff:10 Total#of Volunteers: 50 104 PRC Meeting 03.03.22 Page 105 of 306 Mission Statement: Our mission is to raise funds and develop resources to support educational programs that benefit every student in the FUHS District. Brief Description of Organization and Services Provided: The Foundation is an independent 501(c)(3) nonprofit organization whose mission is to raise funds to support programs across the District. Our focus areas are: Academic Enrichment, College and Career Readiness, and Student Support. REQUESTSECTION 4: GRANT 1. Program/Projec-t/EventName: CARE SOLACE PARTNERSHIP FOR MENTAL HEALTH SERV 2. Date(s) and/or duration of program/project/event (if applicable): 2022 3. Total program/project/event budget: S 140000 4. Requested Amount: 20000 Percent of total program/project/event budget: 50 % 5. What percentage of your organization's projected income does your funding request represent? 4 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 12020 (year) New program/project/event 105 PRC Meeting 03.03.22 Page 106 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 0 (on gohig operational cost.) b) Materials/Equipment$® c) Entertainment$0 d) Room/'Venue Rental$® e) other Professional Services such as 0 f) other lFremont School District $20000 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the sei-vices that will be provided: Fremont school district which caters to five high schools located in the City of Cupertino and Sunnyvale has 10,000+ student_ Schools are understaffed, overwhelmed and ill-equipped to connect students, staff and their families to community-based care. We believe that the existing mental health care system is not able to support students and their families at the time of their need. As such school leaders want to provide an environment where students and staff are safe and healthy. For the 2021-2022 school year, the District is partnering with Care Solace, an online resource to assist individuals in finding local mental health related programs and counseling services. The Foundation is proud to support this important program. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit ❑r impact the Cupertino community: As explained in the item 10 above the request of the fund for Care Solace Program aligns with the mission of the City of Cupertino to provide exceptional service, encourage all members of the community to take responsibility for one another, and support the values of education, innovation and collaboration. 12. Who will be served by tlus rant? + students, their families and staff members of five high schools (Fremont High, Cupertino High, Homestead High, Manta Vista and Lynbrook)located in the City of Cupertino and Sunnyvale will be benefitted by this program. a) Number of individuals total:110000 b) Number of Cupertino residents: 17000 c) Will the program/project/event be available to the entire commuruty/public or are there any eligibility criteria? Yes 106 PRC Meeting 03.03.22 Page 107 of 306 d) Will there be a charge or fee for the program1project/event(if applicable)? No 13_ if your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: We received financial grant from the City of Sunnyvale (Sunnyvale Cares grant) in August, 2020. We are thankful to the City for the support to out student community. 14_ Describe any funding requested from other agencies/organizations in regard to this program/project/event request_Indicate whether the funding was granted, denied, or is still pending: No 107 PRC Meeting 03.03.22 Page 108 of 306 INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY Date: U �',P9a6 EIN: 94-2907804 Accounting Period Ending: June 30 Form 990 Required: Yes Fremont Union High Schools Foundation Person to Contact: Taxpayer 589 W. Fremont Avenue Service Representative Sunnyvale, CA 94087 Contact Telephone Number: (800 ) 424-1040 Dear Applicant: Based on the information supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from Federal income tax under section 501(c) (3 ) of the Internal Revenue Code. We have further determined that you are not a private foundation within the meaning of section 509(a) of the Code, because you are an organization described in section 509(a) ( 1 ) and 170 (b) ( 1 ) (A) (vi) . If your sources of support, or your purposes, character, or method of operation change, please let us know so we can consider the effect of the change on your exempt status and foundation status. Also, you should inform us of all changes in your name or address. As of January 1, 1984 , you are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA) . Since you are not a private foundation, you are not subject to the excise taxes under Chapter 42 of the Code. However, you are not auto- matically exempt from other Federal excise taxes. If you have any questions about excise, employment, or other Federal taxes, please let us know. Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. The box checked in the heading of this letter shows whether you must file Form 990, Return of Organization Exempt from Income Tax. If Yes is checked, you are required to file Form 990 only if your gross receipts each year are normally more than $25,000 . If a return is required, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. The law imposes a penalty of $10 a day, up to a maximum of $5, 000, when a return is filed late, unless there is reasonable cause for the delay. 108 PRC Meeting 03.03.22 Page 109 of 306 INTERNAL REVENUE SERVICE ❑EPARTMENT OF THE TREASURY You are not required to file Federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code. If you are subject to this tax, you must file an income tax return on Form 990-T,Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your present or proposed activities are unrelated trade or business as defined in section 513 of the Code. You need an employer identification number even if you have no employees . If an employer identification number was not entered on your application, a number will be assigned t❑ you and you will be advised of it. Please use that number on all returns you file and in all correspon- dence with the Internal Revenue Service. Because this letter could help resolve any questions about your exempt status and foundation status, you should keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter. Sincerely yours, 4 .. District Director 109 PRC Meeting 03.03.22 Page 110 of 306 �dZJYESTEgD L ti N 4 �� Fremont Union High Schools � 3. itt ���� Foundation l � � y 2020-2021 Annual Report ISO FREMONT UNION HIGH SCHOOLS F O U N D A T l o I From the Board The Board of Directors of the Many of you stepped up to proud that as an all-volunteer Fremont Union High Schools Foun- support our students and com- organization, 94� of every dation is so grateful for the suc- munity. We came very close to dollar spent went to Students, cessful completion of the 2020- our fundraising goal, even Teachers & Schools. 2021 academic year. Schools were without our annual Spring allowed to reopen and seniors had Fundraiser. We're especially in-person graduation ceremonies. Rita Allen N&hil Chinta Brad Loos Sanusi Tandun Manisha Anarkat Benaifer Dastoor Yifan Mao Hung Wei Barathi Balakrishnan Ashish Garg Loy Oppus-Mae Kelly Wissmar Parth Bharwad Kelly !Gang Roy Rocklin Liyan Zhao Polly Bove, Superintendent About Us The Foundation is an independent 501(c)(3) nonprofit organization whose mission is to raise funds to support programs across the District. Our focus areas are: Aca- demic Enrichment, College and Career Readiness, and Student Support. Each year, approximately, 60-70%of our funding comes from parent donations. Thank you for supporting ALL students. Bryan Emmert, Principal at Fremont HS, asks you to support the Foundation. https://vimeo.com/636562728 110 PRC Meeting 03.03.22 Page III of 306 Fremont Union High Schools Foundation 2020-2021 Annual Report Page 2 A Message from Superintendent Polly Bove Over the last several ished over the past year Care Solace, an online decades, the FUHS Foun- and a half of the pan- resource that assists stu- dation has supported demic. The Foundation dents and families in lo- �, supplemental opportuni- has continued to raise cating mental health and i ties for the students of critical funds for our stu- counseling services. The FUHSD, enhancing the dents and programs, services provided by exemplary educational particularly in the areas Care Solace have been experience that is of Student Support, Aca- critical to our families as offered at all five of our demic Enrichment, and they have navigated the comprehensive high College and Career effects of the pandemic, schools. These addition- Readiness. As an all- and the support of the al opportunities have volunteer organization, Foundation has allowed allowed students to the Foundation has us to continue providing more fully explore their worked diligently to en- this valuable resource to passions in a variety of sure that more dollars our school community. interest areas. The en- are flowing directly to On behalf of the entire thusiasm and dedication students in our music, district, I want to thank displayed by the Foun- theater, athletics,jour- the Foundation for their dation Board is truly re- nalism, FBLA, robotics continued efforts to sup- markable, and we are and STEM programs, port our teachers and especially appreciative while also supporting staff and ensure that of their tireless work, critical student services every student has the which has not dimin- like our partnership with best possible foundation for success in the future. What We Fund We work closely with the District to allocate funds for services and programs. We're proud to support these programs and more. ACADEMIC ENRICHMENT • Science, Technology, Engineering and Math (STEM) classes at all five schools • Direct Grants to Teachers for equipment and innovative programs • Robotics equipment and competition entry fees • Journalism Support for school newspapers • District-Wide Art Show to showcase our students' talents in the visual arts • Choral Festival to showcase our students' talents in the performing arts • AVID—a college readiness system for Advancement Via Individual Determination • Teacher Summer Work Teams—curriculum collaboration 111 PRC Meeting 03.03.22 Page 112 of 306 Fremont Union High Schools Foundation 2020-2021 Annual Report Page 3 STUDENT SUPPORT • Schoology—online stud entjparent/teacher communication tool • Teacher preparation for distance learning • Parent Resource Network— resources to support parents and students, parent education programs • Mental health services for students COLLEGE AND CAREER READINESS • Naviance—platform for college and career readiness, for all students when they enter high school • Resume writing and mock interview workshops • Annual job fair How Your donations Made a difference In 2020-2021 • We touch every student in the District with support for Schoology and Navi- ance. • Almost$30,000 was awarded to teachers via the Foundation's Teacher Grants rF program for supplies, innovative ways to address distance learning, and help- ing families in need. ■ Parent Resource Network offered 4 parent/student education events on topics ranging from mental health,to college admissions, to racism. Manta Vista STEM teacher Kavita Gupta • Six $1,000 scholarships were awarded to a student in each high school, plus talks about how support the District-level Educational Options Program. from the Foundation ad- • We supported many District-wide programs, such as STEM, Robotics,Arts, vances her students oppor- Journalism, FBLA, and guest speakers for staff development. tunities. • Our Managed Scholarships program distributed $19,600 to 20 FUHSD stu- https:/fvimeo.com/638073 097 dents. Teacher Grants The past year was challenging and we did our best to help our teachers and students overcome the challeng- es of remote learning via teacher grants. In 2020-21, we awarded $27,665 in grants which funded athletic, ceramics, and science equipment and supplies for distance learning. Art supplies, including pens, brushes, and paint sets, allowed many of ourtalented students to continue their creativity at home. Last year, we also supplied a unique one-time award of gift cards that went directly to families in need during the holidays. We received many heartfelt notes from art students who received art supplies to create projects at home. Dear Foundation Donors, I'm an art student of Ms. Hage`s from Lynbrook High School. This is my first time experimenting with all sorts of new tools, instruments, and techniques in this class. i want to thank you so much for providing us with such amazing resources for the school year. It has definitely been difficult getting used to this style of learning in the 2020-2021 school year. This definitely made a large contribution i►1 making our learning experiences, lessons, and overall hobbies much better. it was extremely fun to create projects with these instruments as it's still something new to me. Once again, thank you so much! 112 PRC Meeting 03.03.22 Page 113 of 306 Fremont Union High Schools Foundation 2020-2021 Annual Report Page 4 Foundation Scholars Every year, the Foundation awards $1,000 scholarships to students at each school. These students are selected by school staff based on having overcome significant obstacles with courage and grace. This 2020-2021 awardees were: Anushka Kelkar- Lynbrook Evelyn Solis Cabrera - Homestead Winter Bloom - Monta Vista Audrey Su - Fremont Heather Kuhl - Cupertino Zelli Duke - Educational Options (not pictured) r -r 1 Legacy Giving We received a very generous bequest from the estate of Jane French, a 1953 Fremont High gradu- ate. Jane and Dick French, became high school sweethearts and went on to get married and reside in Sunnyvale until they both passed away. Substantial donations also came in honoring Captain Pat- rick Klokow, a Homestead High alumnus and proud marine, and Harry Bettencourt, a teacher, princi- pal, and long-time supporter of the Foundation. These donations kicked off our Legacy Giving pro- gram and propelled our Endowment to a $1-million milestone, which allows us to disburse money each year to further the Foundation's mission, helping students today and for years to come. If you'd like more information about Legacy Giving, please contact us at info@fuhsfoundation.org. 113 PRC Meeting 03.03.22 Page 114 of 306 Fremont Union High Schools Foundation 2020-2021 Annual Report Page 5 Financials For 2020 - 2021 school year, our total income was $927,349, as beneficiary of a legacy gift. Total expenses were $404,876, which includes our legacy giving, endowment, and managed scholarship programs. Our standard Operating Income and Expenses are shown below. Fundraising Event 2% Companies, Realtors, Community Donors 13% 2020-21 ■ Operating Income $394,411 Foundation Scholarships 2a/4 zoz0-z1 Operating CharitableGivingto Disbursements Schools 84% $380,968 940 of every dollar spent went to Students, Teachers & Schools 114 PRC Meeting 03.03.22 Page 115 of 306 Fremont Union High Schools Foundation 2020-2021 Annual Report Page 6 Thank you to our Real Estate Partners for Education! Visionaries Circle k 11 AL $l 0,000 and up ,. MAx c kehecca U Ltn t405)720.6800 reb@ccal inhomL-s.com ka\ 8REO15Z5887 t Sothebys h TERNAW)NAq Pf.AL1' Maria Segal Keily Kang i4061891-2086 (650)937-9375 '• mana. al ram ss� com ke�kdlyk4nghpmeuvm .�'. r CALRE Ol i59681 WEE W WS —— y 114TERO M I COMPASS Champions Circe Cynthia C he ung Maggie L1 $1 T 0oo (65U}533735t {925i5345138 V maggieliRE®gmail.com rymhia.998ad�gmalL�om DRE 1947✓)04 G LWE w]ga93 LOSNESS GROUP ® COMPASS Gr4gvryStaphan: KevinChiao-Nei bang _ (498)805.2101 08)472-4121 gregVFZE 14412�p.cem hellq�keireakyXom - pRC g1d41238 C A flee Ol v17191 O". "` CADRE 01925245 LIAe11 Patrons Circle $500 kwVALLEY kwSIUCON C� �. KELLERWi L IAMS. KELLERW ILL IAI.15 Q COMPASS Sari D)&w k'_ .A 11 / gFaL EST•iE Shirieyfranrt TaresaSouvig6er 6avL-ClarkTeam VanjiEDong Nn11MICM [4w2w-1R39 I408i 515-3484 59081 7385833 I5501867-1248 IR31}774-d651 SfQnL*kw40M rer fouwWgmsiUmm pC,0eaRarpav@C1arkxom ranpedon9fgR131lxom daniwil00 q*Wdanl CA nlr[02076W CA PRE 01974664 M 01018204 CA ORE 429765�6 {�oM m vazlo 1 115 PRC Meeting 03.03.22 Pa e 116 of 306 Fremont Union High Schools Foundation 2020-2021 Annual Report Page 7 Thank you to our Business and Community Supporters! Visionaries Circle $1 v,vvv and up Estate of Jane P. French Leaders Circle BLACH $5rvvv CONSTRUCTION Innovators Circle Lozano 5v0r SCImiSthan C7a5tALIC:ti0H+94W+iE3.INC" 13onnie and Dave Stearns Puz ol FLEA and David Josephine ine Lucey COLLErE PREP Donatd &Greenie nexcoRegeprep.cam Ven Champions an Bur Circle Ar.upma Roy /�/� ��® Q•- Mercy lose $1 ,V00 DANNIS VVOLIVER KELLEY e�meri Altnn,ws ai k+w QUATTROCCHI KWCK UCEay,nkCHITECTsl David Fong and Family PARTHEX TECH,INC. H E Jim and Sharon Walker FURS❑Board of Trustees CUPERTINO Patrons AUTOCAR� INC. Superintendent Polly Boye ■ Circle SOIVITI�VrgFlcnrrNnNp SrI L Hung Wei andTa-Wei Chien "c $5vv c-rrvor SAN osE <T- CIANIAL OP SILK-'ON VALLEY Yuiiersowyms 5iliconValley BOSTON PRIVATE WEALTH - TRUST a FIRIVATE OANKING 116 PRC Meeting 03.03.22 Page 117 of 306 Page 8 The Foundation is honored to serve this wonderful community. We strive to make a difference in the educational experience of all students. Stay informed with our monthly newsletter by signing up on the home page of our website. We appreciate your support. �h C4 rot FREMONT UNION HIGH SCHOOLS • U N D A T 1 • Expanding Opportunities to Explore, Discover, and Learn 589 West Fremont Avenue Sunnyvale, CA 94087 (408) 773-1218 info@fuhsfoundation.org fuhsfoundation.org Tax ID: 94-2907804 117 PRC Meeting 03.03.22 Page 118 of 306 Fremont Union School District High School Foundation(NEW)Eligibility Checklist(staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced x members capable of implementing and managing the program/project/event Identify how the funds will be used to benefit the Cupertino community x Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct service costs versus administrative costs x Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only submit one application NA Proceeds generated from the funded activity may only be used for the conducted activity NA admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved by Parks and Recreation NA Commission 3 00 PRC Meeting 03.03.22 Page 119 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION l 448-777-3120 l WWW.CUPERTINO.ORG CUPERTINO SECTION • INFORMATION Full Legal Organization Name: Womensv Website:I www.womensv.org Address: P❑ Box 3982 City: Los Altos State: CA Zip:194024 Phone: 833-966-3678 Organization President/Executive Director Name and Title: I Ruth Darlene, Founder& Executive Director Emaid ruth@womensv.org Phone: 650-996-2200 Contact Name and Title: Rebecca Hull, Grant Writer (If different) Email:I rebeccaIevy@live.com Phone: 831-331-3478 SECTIONNON-PROFIT •R • 501(c)(3)?: ■ `es Year Established: t, {i f different than ab zle address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax ID: nla -womensv is not fiscally sponsored. (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 1507800 Total# of Board Members: 7 Total#of staff:13 Total#of Volunteers: 30 119 PRC Meeting 03.03.22 Page 120 of 306 Mission Statement: WomenSV's mission is to empower survivors, train providers and educate the community to break the cycle of covert:abuse and coercive control in Intimate partner relationships. Our vision is a world in which every woman and child can exercise their fundamental human right to live in peace, safety and freedom in their own home. Brief Description of Organization and Services Provided: Not @I I abuse is physical.A perpetrator can exert control by trackinghis parlinerswhereabouts,isolating r from extended amr members and Mends,c ng access finances, threatening to take the children away from her and attacking or undermining her accomplishments and capabilities.While WomenSV addresses physical and sexual violence--in fad about 35%of our survivors have experienced non-fatal strarigulation-our specific area of focus is coercive control,including emotional,financial,legal and technological abuse. WomenSV was founded in 2011 by current Executive Director Ruth Darlene in order to fill a gap in services for victims of domestic abuse.We support an often-overlooked population: survivors involved with a powerful and sophisticated abuser who engages in coercive control,including emotional,financial,legal and technological abuse and other more covert tactics to cantrol,manipulate,threaten,isolate and ultimatelyentrap an intimate partner. WomenSV is one of the only agencies in the country that focuses on serving survivors of coercive control and covert abuse. Research reveals that in abusive relationships,coercive control is among the top three lethality risks,along with gun ownership and ending the relationship_Recognizing this danger,the state of California incorporated coercive control legislation into Family Code 6320 in January of 2021,acknowledging coercive control as a safety risk to domestic violence victims and making it grounds for a restraining order in family court. In the past 10 years we have served over 1,000 survivors.In 2021-22,we anticipate serving 220 survivors,primarily from Santa Clara County. WomenSV provides three main services- 1 Purvivor Support-WomenSV helps victims of domestic violence find the means to address domestic abuse more safely and effectively and build healthier lives for themselves and their children_Services offered include a domestic abuse helpline,one-on-one intake sessions and ongoing follow-up meetings,weekly support groups,connections to resources(e.g.,financial planning,personal counseling,private investigators,etc.)and client accompaniment to court and the police station,CQVID restrictions permitting,to provide informal,peer support so that clients do not have to face their abuser alone. 2)Public Education-Public education and media outreach are key components of WomenSV's mission. Raising awareness in the general population helps to ensure that victims of covert abuse and coercive control are believed and supported.Social services are currently lacking for abuse victims in middle to upper income areas due to the misperception that domestic violence doesn't happen in more affluent areas,or,if it does,then they should have the fi nancial means to take care of any personal issues themselves.However,most of our survivors are expenenci rig extreme financial abuse and many are facing crippling debt and even homelessness. WomenSV provides presentations to service groups such as Rotary,Kiwanis,Junior League,community centers,schools(e g.,Harker Academy and KeN lah High School),religious organizations,and city councils.In addition,WomenSV aims to expand its outreach and education efforts to middle school and high school age youth_ t is critical to reach this age group given that education is the best strategy to prevent intimate partner violence,and instances of such abuse have been increasing among teenslyoung adults. 3}Professional Traini rgs-WomenSV offers trainings to service providers(e.g.,mental health,legal,medical and law enforcement professionals),who encounter domestic abuse survivors in their fields.Through our workshops,we educate providers and suggest strategies to help provide more effective care for the survivors they serve. • GRANT 1_ Program/Project/Event Name: ITechnicai Support for Domestic Abuse Survivors 2_ Date(s) and/or duration of program/project/event(if applicable): We anticipate the project will be completed within 12 months 3. Total program/project/event budget: $140,000 4. Requested Amount:q20,OOO Percent of total program/project/event budget: % 5_ What percentage of your organization's projected income does your funding request represent? 4 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in (year) New program/project/event 120 PRC Meeting 03.03.22 Page 121 of 306 S_ Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 0 (ongoing operational cost) b) Materials/Equipment$ 7 5D0 c) Entertainment$❑ d) RoomJVenue Rental$® e) other Professional Services such as Website Development 10,005 f) other I Educational videos for website 2n500 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. 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Explain how the request aligns to City mission and values.Describe how funds will be used to benefit or impact the Cupertino community: Gar request is aligned with the aty's rr ssion to encourage all members of the community to take responsibility For one another.W omenSV provides critical support to domestic abuse survivors.Domestic violence and intimate partner violence is a public health epidemic in the United States: :About 1 in 4 women have experienced sexual violence,physical violence,andlor stalking by an intimate partner during their lifetime_ In homes where violence between partners occurs,there is a 45%to 60%chance of co-occurring child abuse,a rate 15 times higher than the average- -Children witness fib%to 80%of domestic assaults_Exposure to domestic violence has been classified as one of several adverse childhood experiences(ACES),which contribute to poor quality of lie,premature death,and risk factors for many of the most common causes of death in the United States. The pandemic has intensified the domestic violence crisis with women trapped with their abuser 24f7 during shelter-in-place and families experiencing an increase in stressors such as unempkxyment and financial i nstability.A statement released by the White House on t V24I21,the International Day for the Elimination of Violence Against Women,states,`Around the world,including in the United States,reports of domestic violence have increased during the pandemic,exacerbating a deeply entrenched human rights crisis,and women in public life continue to experience threats,attacks,and fears of reprisal,both online and in daily life.' As described above,funding from the City of Cupertino will give victims of domestic abuse the tools necessary to address domestic abuse,particularly technological abuse more safely and effectively and build healthier lives for themselves and their children. 12. Who will be served b this rant? W-9V crept t an InMal Vft3M s dm WUi each wtxnan we serve.13—d w brie msp—s lion women m-Ed Last year •IDmr seed mal 1"—a17am a III&pants, •v3x M.Inad en d allolglW saes •Twc a Ta Had m anew w mated amecc b na�etaa wms a) Number of individuals total:1216 b) Number of Cupertino residents: 110 c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? Waf ntPm4an is anal.M.I.any wolnai who seeksou-1—YM Ter kng b—IdWal an*Wd 1ea5l s .1—,,etaNW9nng.Wang reUloMrp Tat is ra"adned foray"m she dmoses 3uNwrs VpIc*W W .EV Na Mesta.watla ..M a bl's-M rig onS-. Atey parts NfonrenSVafoau is earadon altloueacR Pa tlesalnedaxrve,we edualefiem Hy lnlagbpmsaAaJom blheo nnlyadtl H gsmservke pmNdas.Tneee tonal seMces pna'A]eameau of pnneadr-salloe pmvl6els mra dle [d us td assl9ace anc,m we W nnme—nmul4y Mucadar,Mae pepm Fes slot!m Jmmjh wartu'ynonM. In adcMn,WaneRSV P.V*m I—d a&a mrwme tier meta DvHls My am d3e_Is d n Ilk Me,.V.--let Wb peuple aao55 me many.vrpn,1V FmW wd Enearaxe 0recW raM Pali—hm been lealued In wea aeon prllm and m 13 news realms,, dnq Haas w61e6t as tle Nenl Tn3xw,the Wall S4 4. al,G M I g Anwi"ad brie TGday aJgw.l aso w[IR aaWmrW appeal pevbbx3 ly n a bcal rnwpaper,Mkln Has a tl�w IWt A mcx 16,9W�m. Some ample medal reach ma m Yfmlensva er mating one ane atldes sm.nec .g namnal eiq w on the Megyn Icely Today suF antl Good Wn ng Anlexa In M16,Nbme15V Has seen a sfaamyy nncmase In cab Mm Uane Ylc��e uNws amna Te Gantry mdengt rsupport 121 PRC Meeting 03.03.22 Page 122 of 306 d) Will there be a charge or fee for the prograni/project/event(if applicable)? WomenSV does not charge for these services because we believe it is everyone's right to be free and safe in their own home, and no one should have to pay for that right.The other reason we do not charge is that so many of our survivors have experienced extreme financial abuse at the hands of a powerful partner who has seized total control of the joint assets. We must therefore rely on grants and donations to sustain our services. 13. If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: Last year we received a generous donation from Mayor Darcy Paul's discretionary fund. 14_ Describe any funding requested from other agencies/organizations in regard to this program/project/event request.Indicate whether the funding was granted, denied, or is stilt pending: We have received funding in support of the project from Los Altos Rotary ($2,500). We have a proposal pending in support of the project to Urgent Action Fund for Women's Rights ($8,000) 122 PRC Meeting203.03.22 INTERNAL, REVENUE SERVICE DEPARTMENT OF W14'RE R6Y P. O. BOX 2508 CINCINNATI, OH 45201 Employer Identification Number; Date: APR L 7 2017 81-5015102 DLN: 17053060371007 WDMENSV Contact Person: JULIE CHEN ID## 31251 Contact Tele hone Number: Accounting Period Ending: December 31 Public Charity Status; 170(b) (1) (A) (Vi) Form 990/990-EZf990-N Required: Yes Effective Date of Exemption: August 1, 2016 Contribution Deductibility: Yes Addendum Applies: No Dear Applicant: We're pleased to tell you we determined you're exempt from federal income tax under Internal. Revenue Cade (IRC) Section 501(c) (3) . Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions an your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c) (3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZf990-N, our records show you're required to file an annual inf❑rmaticn return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard) . If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter- For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search Year to view Publication 4221-PC, compliance Guide for 501 (c) {3) public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 123 _2_ PRC Meeting 03.03.22 Page 124 of 306 WOMENSV We sent a copy of this letter to your representative as indicated in your power of attorney. sincerely, Director, Exempt organizations Rulings and Agreements Letter 947 124 PRC Meeting 03.03.22 Page 125 of 306 WomenSV Links to Articles WomenSV was featured on the front page of the San Jose Mercury News on 12/31/20 as part of their Wish Book series htlps://wishbook.mergLiMews.com/2020/women WomenSV Founder&Executive Director Ruth Darlene wrote a 7 part series on domestic violence and coercive control for the Los Altos Town Crier. Links to the series (which ran between 1 l/11/20— 12/23/20) are below: Part 1 https://www.losaltosonline.com/news/sections/community/177-features/63 517-invisible-abuse-coercive- control-violates-right-to-live-in-peace Part 2 https://www.losaltosonline.com/news/sections/community/177-features/63 553-confronting-domestic- violence-new-state-legislation-addresses-coercive-control Part 3 https://www.losaltosonline.com/news/sections/community/177-features/63 580-confronting-domestic- violence-the-tactics-of-covert-abusers Part 4 http s://www.lo salto sonline.com/news/sections/community/177-features/63 63 6-confronting-domestic- violence-the-impacts-of-coercive-control Part 5 https://www.losaltosonline.com/news/sections/community/177-features/63677-confronting-domestic- violence-subtle-forms-of-abuse-wear-victims-down Part 6 https://www.losaltosonline.com/news/sections/community/177-features/63710-confronting-domestic- violence-education-proves-best-form-of-protection Part 7 https://www.losaltosonline.com/news/sections/community/177-features/63731-reco ng izing-the-warning- signs-of-coercive-control 125 PRC Meeting 03.03.22 Page 126 of 306 Women SV(NEW)Eligibility Checklist(staff use only Elieih ty YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable o implementing and managing the program/project/event x moons-- Identify how the funds will be used to benefit the Cupertino communityx Be awarded only once per projec x For specific needs,not on going,operational cost: x Have more than 75%of the requested funds allocated for direct service costs versus administrativ x costs Be complete and submitted by the application deadlin x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only submit one applicatic NA Proceeds generated from the funded activity may only be used for the conducted activi NA admission to or participation in the event must be"free of charge"to Cupertino residents unle stated in the application and approved by Parks and Recreation Commission NA 3 N PRC Meeting 03.03.22 Page 127 of 306 FUNDINGCOMMUNITY ■ A APPLICATION PARKS AND RECREATION 1 408-777-3120 l WWW.CUPERTINO.ORG CUPERTINO SECTIONCONTACT Full Legal Organization Name: Breathe California of the Bay Area Website:I vwwv.lungsrus.org Address] 1469 Park Avenue City: San Jose State: Calif Zip:195126 Phone: Organization President/Executive Director Name and Title: I Margo Sldener, CEO Email: mango@lungsrus.org Phone: Contact Name and Title: Margo Sldener, CEO (If different) Emaid rnargo@lungsrLis.org Phone: SECTIONNON-PROFIT O ! 501(c)(3)?: t�le: Year Established:{i f different than abozle address information) Sponsor Name:Hoes not apply Sponsor Address: City:I State: Zip: Phone: Federal Tax IDJ 94-1156307 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 11,000,000 Total#of Board Members:113 Total#of staff:112 Total#of Volunteers:26D 127 PRC Meeting 03.03.22 Page 128 of 306 Mission Statement: Mission: As the local clean air and healthy lungs leader, Breathe California of the Bay Area fights lung disease in all its forms and works with its communities to promote lung health_ Mission: As the local clean air and healthy lungs leader, Breathe California of the Bay Area fights lung disease in all its forms and works with its communities to promote lung health. Breathe California's key roles have been to: fight lung disease such as TB, asthma, influenza, and COPD; establish tobacco-free communities; and achieve healthy air quality. Brief Description of Organization and Services Provided: Breathe California of the Bay Area is a 111-year-old grassroots, community-based, voluntary 501(c)3 non-profit that is committed to achieving clean air and healthy lungs. It was founded in 1911 in San Jose to fight tuberculosis and incorporated in 1948. With a greatly expanded mission, the agency now works in four core areas: clean air; tobacco control; lung disease prevention/patient support; and community health promotion. CCVID-19, vaping (e-cigarette use) among teens, and hazardous air quality caused by wildfires are emerging health threats that it is currently addressing. Because lung disease is more prevalent in disadvantaged communities, the agency focuses on vulnerable populations, especially those with health disparities and inequities. REQUESTSECTION 4: GRANT 1. Program/Project/Event Name: seniors Breathe Easy 2. Date(s) and/or duration of program/project/event (if applicable): July 1, 2022-June 30, 2023 3. Total prograin/projectlevent budget: S 175,000 4. Requested Amount: 4000 Percent of total program/project/event budget: % 5. What percentage of your organization's projected income does your funding request represent? 1 °�,o 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 11911 (year) New program/project/event 128 PRC Meeting 03.03.22 Page 129 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 250 (ongoing operational cost) b) Materials/Equipment$ 1 600 c) Entertainment$0 d) Room/Venue Rental$ 300 e) other Professional Services such as health educator project 1,800 f) other Istaff travel to deliver services 50 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will be provided: Project goals: to increase seniors' understanding of health risks, especially for COVID; improve access to prevention services; increase safety in seniors' homes; and increase knowledge of caregivers serving seniors. Objectives: to support wellness programs for 300 seniors at senior centers/other community locations/virtually in Cupertino and to serve 2,000 - 3,000 Cupertino residents with lung health and air quality education. Senior services: 1) Health education on a variety of senior topics; 2) Training for care providers; 3) Breathing exercises; 4) Health screenings; 5) Smoking cessation help, 6) Home visits for assessment of respiratory &fall hazards; and 7) respiratory therapy equipment provision. (ALL DEPENDING ON COVID GUIDELINES) 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit or impact the Cupertino community: Breathe California's Seniors Breathe Easy program uses a cost-effective service delivery model that serves senior adults where they gather (and virtually), collaborating with many other community groups, and delivers vital, up-to-date health information, screening, and equipment to improve health management and quality of life, including an innovative home assessment program. Thus, Breathe California supports Cupertino's mission to provide exceptional service, encourage all members of the community to take responsibility for one another, and support the values of education, innovation and collaboration. It also supports Cupertino's General Plan focus on public health and safety. 12. Who will be served by tlus rant? Seniors in the Uty of upertino will receive focused direct services, and all Cupertino residents will have access to information/referral and health education resources via our participation in community events or by phone, computer, website, or email. a) Number of individuals total:12500 b) Number of Cupertino residents: 12500 c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? Focused services will be available specifically for seniors,and information and referral serwes,general health education,and patient services will be available to all Cupertino residents. Due to COVID-19,we have been pivoting our programs to distance- leaming and vistual assistance,so programs will be available for horse-bound seniors,as well. All the above programs are available through telephone,computer,and tablet now,even the home assessments,except for health screenings which require special equipment. 129 PRC Meeting 03.03.22 Page 130 of 306 d) Will there be a charge or fee for the program/project/event(if applicable)? NO 13. If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: DOES NOT APPLY 14. Describe any funding requested from other agencies/organizations in regard to this program/project/event request.Indicate whether the funding was granted, denied, or is still pending: Funding for the Seniors Breathe Easy program is provided by the El Camino Healthcare District ($25,000). ECHD has granted funds for this program each year since 2016, and we anticipate that their support will continue. The City of San Jose also provides funding for Seniors Breathe Easy services within its jurisdiction, it has supported the program since 2010, and the current contract is through 2022. The National Heart, Lung, and Blood Institute provides funding currently of$50,000 for which we will reapply. And other funders provide educational materials. This grant will allow us to better serve Cupertino residents, specifically. 130 PRC Meeting 03.03.22 Page 131 of 306 Internal Revenue Service ❑epartment of the Treasury P.O. Box 2508 Cincinnati, OH 45201 ❑ate: April 13, 2006 Person to Contact: Barb Herald ID #31-02637 BREATHE CALIFORNIA OF THE BAY AREA Toll Free Telephone Number: 1469 PARK AVE 877-829-5500 SAN JOSS CA 95126 Employer Identification Number: 94-1156307 Dear Sir or Madam; This is in response to your request of February 1, 2006, regarding your tax-exempt status. We have updated our records to reflect the name change as indicated above. Our records indicate that a determination fetter was issued in February 1948 recognized you as exempt from Federal income tax. Our records further indicate that you are currently exempt under section 501(c)(3) of the Internal Revenue Code. Our records also indicate you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section 509(a)(1) and 170(b)(1)(A)(vi). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises. transfers, or gifts t❑ you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. If you have any questions. please call us at the telephone number shown in the heading of this letter. Sincerely, V�+'f Cln Westcott Man ger, Exempt Organizations Determinations 131 PRC Meeting 03.03.22 BREATHE Page 132 of 306 CALIFORNIA BENEFITS BEYOND r RETIREMENT (BERET): It is nearer _ too I ate to quit smoking. STEP-BY-STEP DAY-BY-DAY GUIDE TO QUIT SMOKING THAT WORKS FOR YOU OR A FRIEND Join us to learn more! IRW FREE Step r - r : : ' workbook • help • r • r stop smoking Cupertino Healthcarea and Wellness Center Date: - 29 2021 Time: 01:30 • i Please - a • a 132 PRC Meeting 03.03.22 Page 133 of 306 Breathe California of the Say Area report for July 1, 2020 through December 31, 2021 (Extension) a. Please provide a line-item breakdown of how the Community Funding Grant was used last year in the categories below. If a category is not applicable, put $0: a. Admin Staff $ 250 b. Materials/Equipment $ 781 c. Environment $ 30 d. Room/Venue Rental $ 120 e. Other professional Services $ 2,761 i. Please specify f. Other expenses $ 58 i. Please specify: travel $ 4,000 TOTAL b. Who was served by the grant last year? g. Number of individuals total 1,894 h. Number of Cupertino Residents 1,894 i. Particular Community Groups i. Please specify: focus on seniors, but most were general Cupertino residents this year. j. Was the program/project/event available to the entire community/public or was their eligibility criteria? Yes k. Was there a charge or fee for the program/project/event? No b. Was the program/project/event successful? More successful than we thought considering the pandemic. We did not meet our goal for number of people reached, reaching 1,874 of the 3,000 we had hoped to serve, but we worked harder than ever to let people know we were still there to serve. We spent a lot less on travel to deliver services but needed to spend much more on staffing than usual, as it was staff and not volunteers handling phone and website duties as we sheltered. While most of our Cupertino partners were closed to the public, we worked with long-time partners to reach their senior clients (Chateau Cupertino, Cupertino Healthcare and Wellness Center, Villa Sienna). Please indicate how success was measured. We measured success by how we were able to connect with Cupertino residents during this difficult time and how we were able to serve their lung health needs despite most of our community partners being closed for most of the time. Cupertino residents participated in our on-line presentations and the 2-hour World COPD Day webinar event that included yoga breathing, COPD jeopardy game, and practical instruction on using inhalers and spacers, along with a 133 PRC Meeting 03.03.22 Page 134 of 306 talk from one of the COPD experts at the National Heart, Lung, and Blood Institute. They picked up health education materials at senior centers that they visited one-at-a-time when they reopened, and they were able to connect with us by phone and email to arrange other services such as getting respiratory therapy equipment or asking about air pollution. We sent much more by old-fashioned snail mail this year, including information on getting COVID vaccinations, and fliers to physicians and clinics in Cupertino to promote our curbside and on- line health education offerings for their patients. Finally, there was the Silicon Valley Fall Festival, our first big in-person health fair in Cupertino since the pandemic, a very busy event that reminded us of life before COVID. We are set to provide services with or without COVID now and into the future. Seniors are the most vulnerable population for COVID, and we will do all that we can to reach them. c. Please indicate any addition funding received last year from other sources and provide your financial statement if available. : $50,000 from National Heart, Lung, and Blood Institute; $25,000 from El Camino Hospital District. 134 PRC Meeting 03.03.22 Page 135 of 306 Breathe California of the Bay Area (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the x program/project/event Identify how the funds will be used to benefit the Cupertino x community Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct service costs versus administrative costs x Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission 3 W PRC Meeting 03.03.22 Page 136 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTION 1 : CONTACT INFORMATION Full Legal Organization Nance: Tian Hong Foundation Website:I Gwvw.tianhongfoundation.org Address: 10330 5 Stelling Rd City: Cupertino State: CA Zip:195014 Phone: 16503364458 Organization President/Executive Director Name and Title: I Zuxin Li Email: tom.ii a@gmail_com Phone: 16502658853 Contact Name and Title: Susan Shi CFO & COO (If different) Email:I susanshi111 gmail.com Phone: 6503364458 SECTION • • O • 501(c)(3)?: ■ `es Year Established: 2011 ale {i f different than abode address information) Sponsor Name: Susan Shi sponsor Address: 10330 S Stelling Rd City.: CUPERTINO State: CA Zip: 5014 Phone: 16503364458 Federal Tax ID: 45-3858621 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 120000 Total# of Board Members: 2 Total#of staff:12 Total#of Volunteers:0 136 PRC Meeting 03.03.22 Page 137 of 306 Mission Statement: Our mission is to facilitate cross cultural communication, education, and arts & cultural exchange. Our programs aim to improve public health, happiness, and appreciation of arts from various cultural backgrounds and support the young art community in pursuing their dreams via art. Brief Description of Organization and Services Provided: Host free public seminars on cross cultural art appreciation; Sponsor and co-manage cultural dance performance shows and provide free tickets to multi-cultural audience; Host annual cross cultural youth art contest; Produce free content promoting positive thinking and poetic approach to life, with highlights on happiness, cultural heritage and arts appreciation. REQUESTSECTION 4: GRANT 1. Program/Project/EventName: 2022 Tian Hong Cross Cultural Youth Art Contest (Love in my lif 2. Date(s) and/or duration of program/project/event (if applicable): Apr- Dec 3. Total programfprojectlevent budget: S 112,650 4. Requested Amount: q4500 Percent of total program/project/event budget: 3 % 5. What percentage of your organization's projected income does your funding request represent? 20 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 12018 (year) New program/project/event 137 PRC Meeting 03.03.22 Page 138 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 0 (o)igohig operational:cost.} b) Materials/Equipment$® c) Entertainment$0 d) Room/Venue Rental$® e) other Professional Services such as f) other Icash awards for contest winners $4500 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that'Will be provided: With the success in 2020 with unprecedented number of contestants and winners in the contest with main theme of'Love, Hope and Collective Humanity,we have completed another successful year in 2021 with main theme"Nature and Me". The number of contestants have increased by 40%YoY,and we have distributed>$7500 in actuall cash awards. With the sponsorship from the City of Cupertino,we have especially seen active engagement from the Cupertino local community, even though the news came in a little late in the process(we launched annual contest every April,but funding from the City was approved and announced in July,which was only a few weeks before artworks were due for submission). We believe the experience in 2021 will help us further expand the program and deepen influence in the community.In our holiday party hosted on Dec 18th, 2021 in Cupertino Quinlan community center, we have active participation from local Cupertino residents, who have given us great support and good advice to move forward. We believe the collaboration between Tian Hong and the City of Cupertino has gone well in promoting our objectives,and wish to continue this in the year of 2022. As our program has grown quickly YoY,our funding need also grows, hence,we are requesting 2022 funding to be$4,500,which is approximately. 35%of the total funding needed for this program in 2022. Detailed expense breakdown can be provided as per request. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit ❑r impact the Cupertino community: Promoting a multi-cultural inclusive community in the City of Cupertino emphasizing education, youth engagement in art and greater love among the society. The funds will be 100% utilized to distribute cash awards to art contest winners, which are carefully selected from two age groups (age 4-12 and 13 -21). Tian Hong will fund the remaining cash award needs and other funding needs, including room rental, free art materials,judge panel fees, video production fees, etc. From the feedback we have received, young artist and parents appreciate the opportunity greatly to participate in the contest and become part of the cross cultural youth art community. Check out our website page for more information: https:I/www.tianhongfoundation.org/annual-cross-cultural-youth-art-contest 12. Who will be served by tlus rant? Young artists with age from 4-21 who submit their original artworks to reflect the annual theme of the contest, as well as general community with whom the content of the artworks will be shared. a) Number of individuals total:1200 b) Number of Cupertino residents: 110o c) Will the program/project/event be available to the entire commm-dty/public or are there any eligibility criteria? Any artists with age from 4-21. 138 PRC Meeting 03.03.22 Page 139 of 306 d) Will there be a charge or fee for the programlproject/event(if applicable)? no charge, free participation. 13_ If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: nla 14_ Describe any funding requested from other agencies organizations in regard to this program/projectlevent request_Indicate whether the finding was granted, denied, or is still pending: NIA 139 PRC Meeting 03.03.22 Page 140 of 306 Ir l IRS DEPART�T OF THE TREASURY INTERNAL REVENUE SERVICE r,.. CINCINNATI OH 45999-0023 Date of this notice: 11-22-2011 Employer Identification Number: 45-3858621 Form: SS-4 Number of this notice: CP 575 E TIAN HANG FOUNDATION 10330 S STELLING RD CUPERTINO, CA 95014 For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 45-3858621. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Assigning an EIN does not grant tax-exempt status to non-profit organizations. Publication 557, Tax Exempt Status for Your Organization, has details on the application process, as well as information on returns you may need to file. To apply for foimal recognition of tax-exempt status, most organizations will need to complete either Form 1023, Application for Recognition of Exemption Under Section 501(c) (3) of the Internal Revenue Code, or Form 1024, Application for Recognition of Exemption Under Section 501(a) . Submit the completed form, all applicable attachments, and the required user fee to: Internal Revenue Service PO Box 12192 Covington, KY 41012-0192 The Pension Protection Act of 2006 contains numerous changes to the tax law provisions affecting tax-exempt organizations, including an annual electronic notification requirement (Form 990-N) for organizations not required to file an annual information return (Form 990 or Form 990-EZ) . Additionally, if you are required to file an annual information return, you may be required to file it electronically. Please refer to the Charities & Non-Profits page at www.irs.gov for the most current information on your filing requirements and on provisions of the Pension Protection Act of 2006 that may affect you. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (Try/TDD 1-800-829-4059) or visit your local IRS office_ 140 PRC Meeting 03.03.22 Page 141 of 306 Tian Hong Cross Cultural Youth Art Contest Year 202O Year 2021 Year 2022 Annual Budget Actual Actual Plan Love,hope and collective Nature and Love in my Main Theme humanity Me life #of participants 97 138[11 200 #of artworks submitted 131 186 300 #of awards distributed 40 63 84 -award reception 1 holiday party venue rental* $0 $300 $300 -misc operating cost{annual calendar,art materials,postage,etc.} $0 $516 $700 -advertisement $265 $975 $1,000 -awards(cash&gift card)-see detailed break dowry $3,700 $7,597 $9,450 -compensation and gifts for judge panel $299 $704 $1,200 Total Budget Need 1 $4,2641 $10,0921 $12,650 City of Cupertino funding rant $4 $3,000 $4,30g Tian Hong foundation funding $4,264 $7,092 $8,150 City of Cupertino funding 96 0096 29.7% 35.6% Cuperino Quinlan community center Tian Hon Annual Cross Cultural Youth Art Contest Year 2020"Love,Hope and Collective Cash awards for winners Humanity" Year 2021"Nature and Me" 2022"My love in life" #of Award per #of Award per #of Award per Age group: 4-12 contestants contestant Total amount contestants contestant Total amount contestants contestant Total amount Istplace 2 $300 $600 3 $300 $900 3 $300 $900 2nd place 2 $150 $300 5 $150 $750 5 $150 $750 3rd place 6 $50 $300 8 $50 $400 8 $50 $400 encouragement 10 $20 $200 12 $20 $240 20 $20 $400 $1,400 $2,290 $2,450 Age group: 13-21 1st place 2 $500 $1,000 3 $500 $1,500 3 $500 $1,500 2nd place 2 $250 $500 5 $250 $1,250 5 $250 $1,250 3rd place 6 $100 $600 8 $100 $800 8 $100 $800 encouragement 10 $20 $200 13 $20 $260 20 $20 $400 $2,300 $3,810 $3,950 Special awards -most creative award 1 $250 $250 2 $250 $500 -most unique cultural influence award 1 $250 $250 2 $250 $500 -best theme award 1 $250 $250 2 $250 $500 -best artistic technique award 1 $250 $250 2 $250 $500 -City of Cupertino special awards 2 $250 $500 4 $250 $1,000 misc Paypay transaction fees&timing of payment 3 $50 adjustment Total -Award budget 40 $3 700 63 $7 597 84 $9 450 141 PRC Meeting 03.03.22 Page 142 of 306 Tian Hong 2021 Cross Cultural Youth Art Contest Nature and Idle Awards Announcement Aug 28th, 2021 142 PRC Meeting 03.03.22 Summary Page 143 of 306 • We have seen 40% increase from last year in number of contestants and artworks submitted ■ We are greatly impressed by the deep passion, creative thinking and artistic talents demonstrated in all the artworks depicting this year's main theme - Nature and Me. ■ Congratulations to all the award winners and bravo to everyone who participated in the contest! • Young artists, have fun, express yourself via arts, and enjoy your artistic journey! 143 PRC Meeting 03.03.22 Age Group 4- 12 — 1 s L Place Award Page 144 of 306 Name Age Artwork Name Location Veda Samhitha Lanka 11 1 am Nature Sunnyvale, CA Artist statement: "Nature, Nature 1 rise from the waves; My eyes full of love-filled 4? �.; rays . , 144 PRC Meeting 03.03.22 Age Group 4- 12 - 1 st Place Award Page 145 of 306 Name Age Artwork Name Location Anvitha Bakshi 11 Bonded by breath Sunnyvale, CA .i y T Artist statement: `My connection with nature began as i took my first breath." : R ll9l1d9Nlr 145 �'+ Award PRC Meeting 03.03.22 ❑■ ■ge Group 4- 12 - 1 st PIaLie Page 146 of 306 Name Age Artwork Name Location Rayini Kariyawasam 9 Nature and Me Sri Lanka Artist statement: "l grow because nature giving me fresh fruits and i vegetables. " Gy' 146 PRC Meeting 03.03.22 Page 147 of 30E� Age Group 4- 12 - 2nd Place Awards Name Age Artwork Name Location Arissa Lau 8 Earth Daly City, CA Ashley Avidan 12 A gift from my horse Las Altos, CA Vikram Snyder II In peace with nature Dublin, CA t " - 8 u N P 147 PRC Meeting 03.03.22 Page 148 of 306 Age Group 4- 12 - 2nd Place Awards Name Age s Artwork Name Location Lingfei Coco Truong 11 A drop of water Walnut, CA Tharuli Sehansa 8 Me and my friends in the village Sri Lanka 148 1 PRC Meeting 03.03.22 Age Group 4-12 - 3rd Place Awards Page 141 of 301 BU19IV— Name Age Artwork Name Location Christabelle Zheng G Love our Earth, do our part San Jose, CA Tei Jin 7 The little hummingbird in my yard San Jose, CA Ahaanya Karthikeyan 7 Nature needs our help Irvine, CA Savidya Keerthisinghe 9 Nature and Me Sri Lanka •. �` tit �. 3 A' ,r a 149 Age rou 4 1 3rd PIace Awards Meeting 0 of3.' '� � � � Page 150 of 30Name Age Artwork Dame Location 01 Ashley Avidan 12 My dogs new friend Los Altos, CA Allsa IIPc 11 Me at Japanese Garden San Diego, CA Jonathan Cheung 9 The beautiful colors of nature Cupertino, CA Navya Saini 9 1 am nature and Nature is me Cupertino, CA F_ ' 7flF�1n1� tt r' 150 PRC Meeting 03.03.22 City of Cupertino Special Award Page 151of306 �gxxpk�• Name Age Artwork Name Location 5hania Amjadi 10 The story of a seed Cupertino, CA C� Artist statement: "When there is ' another seed for you to plant, you plant it. When you planted it, you created nature." t :i r1 151 PRC Meeting 03.03.22 Age Group 4- 12 - Encouragement Awards of 306 WX9rr- Name Age Artwork Name Location Gabby Giusti 11 Free in the rain Redwood City, CA Christopher Nakata 8 Nature farm Saratoga, CA Ciara Wilson 10 Mother Earth San Jose, CA Jiabao Jasper Truong 7 California condor Walnut, CA Joyce Cheung 12 Yosemite valley in a wheelchair Cupertino, CA Christopher Nakata 8 Air balloon adventure Saratoga, CA Carissa Cheang 9 Underwater dream San .lose, CA Sanuli Sehansa 8 My garden is my playhouse Sri Lanka Uthuli Wickramaarachchi 7 Nature and Me Sri Lanka Aiendri Guha 8 Freedom under the blue moon Folsom, CA Dayami Wickramaarachchi 11 Nature and Me Sri Lanka Minduni Dinma Pahathkumbura 7 Love the nature and love the world Sri Lanka 152 PRC Meetini 03.03.22 Age Group 4- 12 - Bravo, thank you all for your participate, flow Name Age Artwork Name Name Age Artwork Name Name Age Artwork Name Abraham Pramanik 9 My first canoe riding Geetarth B Bhuyan 6.5 Day and night Sanaya Liyanagama 11 Nature and Me Adam Li 11 Living in harmony Geetarth B Bhuyan 6.5 Rainbow in a meadow Sassen Amarathunga 11 Nature and Me Ahaanya Karthikeyan 7 Respect nature Gehansa Jayawardena 6 1 love nature and nature loves me Sean Ethan Diep 12 Endangered mindoro bleeding hearts Aiendri Guha 8 Bountiful nature and serene me Grace Ann 7 The morning glory Sehansa Karwilakanda 8 Nature and Me Aken Atapattu 10 Nature and Me Alisa Ilic 11 Sunset Lake Hannah Lee 7 Happy swimming! Senuli Senarath 7 Nature and Me 1 Jiabao JasperTruong 7 Sunflower girl Senuli Senarath 7 Nature and Me 2 Angelina Pramanik 7 My favorite fall activity Jordyn Wong 8 Under the water Sinadi Samaraweera 7 My life with nature Anuki Thesara Peiris 9 Nature and Me Anuthi Atapattu 12 Nature and Me Lincoln Gius i 10 Eating panda Srinidhi Annepu 12 My view of nature Arissa Lau 8 Crane Lincoln Gius 1 14 Bird in a bucket Srinidhi Annepu 12 My dream visit in nature Audrey Yin 12 Flower forest Lingfei CooaTruang 11 Meet grunion Suhaansie Watada 9 Magical Nature __.—.—___— Sumedh Watada 6 Walk in the trail Audrey Yin 12:SunsetLeld Methuki Anandasiri 7 Nature and Me Tanisi Ramachandran 11 Nature and us Aven Nagata 7 Save the ocean Nayra Gupta 6 Nature bubbles Tanuli Kannangara 6 Nature and Me Carissa Cheang 9 Mother Earth Nayra Gupta 6 Nature is beautiful Tej Jin 7 Beautiful garden ChenuliAmarathunga 5 Nature and Me Nehansa Rathnayaka 11 Nature and Me Thanya Sri Mamilla 7 Seasons of life Daniel I(ung Thanya Sri Mamiiia 7 Nature and Me 4 Four seasons Noah Joo 7 Fishing — Thumandi Jayasinghe 8 Nature and Me DineliNadugala 11 Coexistence Olivia Zhang 12 Calamity Vefhmi Senanayake 10 Nature and Me Dutya VYjesekera 7 Nature and Me R.Ranawaka 6 Nature and Me Vosandi Vidanapathirana 8 1 let nature make me feel like a fairy Elina Yin 12 The Growth Elina Yin 12 The Pathway Ranuki Peiris 5 Nature and Me Yasandi Wijenayake 7 My nature dream Ethan Sea 6 I'll save the earth green Ravindi Jayathilaka 10 Nature and Me Zi Jie Luo 11 The horse in field Evan Jac) 4 1 like com Ravindi Jayathilaka 6 Nature and Me Zi Jie Luo 11 Dino worlds Gabby Giusti 11 Falling nature at peace Riley Wong 11 My nature roots 153 PRC Meeting 03.03.22 Page Age Group 13-21 - 1 st Place Award & Most Creative15 306 A)kard Name Age Artwork Name Location Sara Fang 17 Sunny-side up Fremont, CA Artist statement: `In my work, 1 aim to present an opinion on my observations of how our society interacts with nature. This is explored � ' through the exploitation of natural resources � A Y, � '"'�� �. =• through cryptocurrency ..." F 1 � J 17 8 lam' Cro -- 154 PRC Meeting 03.03.22 Age G rou p 3-21 - 1 st Place Award Page 155of306 Name Age Artwork Name Location Roy Kim 17 Delicate gift Irvine, CA r _ 5 • � k `- Artist statement: "l wanted to express my personal experience with the Coronavirus. The feeling of stagnation, stuffiness, and melancholy may have been felt by many others because they were unable to socialize with friends, get a job, get ,. groceries, or even take a walk outside.. " i r lu I!9?lHM - 155 PRC Meeting 03.03.22 Age Group 3-21 - 1 st Place Award Page 156 of 306 Name Age Artwork Name Location Romy Chung /18 La Vie En Rose Palo Alto, CA j^l Ir r�,� Artist statement: "Nature is like mother to us, in that no matter hew far we stray away or how much we squander the gifts it � provides, it is always delighted to have us back. i 1 F f h I!9?l9Qklr- ' '► t 156 PRC Meeting 03.03.22 Age Group 3-21 - 2nd Place Award & Best Theme1kkard Name Age —M Artwork Name Location Gabriella Say 18 Marine biome destruction Ladera Ranch, CA • 4 Artist statement: "Thousand pieces of trash E are being dumped and thrown into the ocean. It is said over 7 million seabirds and �-- over 900 gag sea mammals are killed every y year due to ocean pollution. This piece is a statement about how pollution is affecting ' our global community & how people need to take better care of our environment." 4 - 157 PRC Meeting 03.03.22 Page 158 of 306 Age Group 13-21 - 2nd Place Award & Best Artistic Technique Award Name Age Artwork Name =40A Location Iris Ding 16 Iris in irises San Diego, CA , Artist statement. "my connection to nature can be represented by my name. Iris. iris flowers are symbolic of rigor, hoe love and wisdom - values 1 want to ... ,, incorporate into my life. ' MIE4kfr Age Group �'+ Awardo&age PRC Meeting 03.03.2 13-21 - 2nd Place 159of30 Name AgeAV M Artwork Name A Location 1W Aroshi Ghosh 17 Gaea San Jose, CA Roy Kim 17 Unusual new coming Irvine, CA Cindy Zhou 17 Magnified 1 San Ramon, CA EMS I mango s - 159 PRC Meeting 03.03.22 Age Group 13-21 - 3rd Place Awards Page 160 of 306 41101W19117- Name Age Artwork Name Location Helen Ngo 17 Broken breath Fremont, CA Chloe Wang 17 Future by us Irvine, CA Paul U 18 Nature vs everybody Cupertino, CA Alexandra Novoa 20 Air for free San Jose, CA u J 41 -=a 160 PRC Meeting 03.03.22 Age Group 13-21 - 3rd Place Awards3age 161 of 306 � Name Age Artwork Name Location Evani Snyder 15 Where Intelligence Meets Dublin, CA Shreya Srinivas 15 Childhood Fremont, CA Amanda Lin 17 Tears and tears Cupertino, CA Khushi Kolte 14 Nurturing nature's beauty Fremont, CA =w7roF, '- - ;' . . 161 PRC Meeting 03.03.22 City of Cupertino Special Award Page 162 of 306 IM!MK-- Name Age Artwork Name Location Paul Li 18 Nature vs everybody Cupertino, CA ff� Artist statement. "I wanted to connect Y`. nature to technology, seemingly two =3 opposing forces to comment on a potential future where the two cooperated to improve the natural world AND lives. And especially since I've spent my childhood in the Silicon . nn .0r Malley full of innovative techs, I wanted to ;r '• express my vision and relationship of what nature can be with the aid of tech." 162 PRC Meeting 03.03.22 Judge's Special Award - Unique Cultural Influence 9"M30� "N�"� Name Age Artwork Name Location Zhaoyi Luo 15 Tea picker San Ramon, CA 01 � Artist statement: "When l saw this u year's theme, it immediately reminded me of the Miao Clan's F culture. Tea farm, Silverware, Peacock dance, etc. ' Miao is one of the minority in China Yunnan. They live with nature, they ' ? x team in nature, they respect nature." 163 PRC Meeting 03.03.22 64 of 306 Age Group 13-21 - Encouragement Awi(ds Name Age Artwork Name Location Rudra Hariharan 17 Juxtaposition Fremont, CA Ananya Karthikeyan 14 Our actions matter Irvine, CA Sophia Lee 15 Our convenience kills Palo Alto, CA Anika Bach 17 Light in the forest Sacramento, CA Alexandra Novoa 20 Much need space San Jose, CA Chloe Wang 17 The last drop of tear Irvine, CA Aroshi Ghosh 17 The Eye of the needle San Jose, CA Emily Orozco 17 My infinite unity with nature Compton, CA Emily Orozco 17 The radiant spirit of nature Compton, CA Sophia Lee 15 Divergence Palo Alto, CA Ananya Karthikeyan 14 Nature is where I can be myself Irvine, CA Parul Gupta 17 Nature in my hands Pleasanton, CA Linda Jiang 15 Circle of life Pleasanton, CA 164 PRC Meeting 03.03.22 Age G rou p 13-2 1 - Bravo, thank you all for your parti8f0 t &i! Name Age Artwork Name Name Age Artwork Name Name Age Artwork Name Alan Jian 16 Reviving nature KaileyAdams 15 The crow and the serpent Rudra Hanharan 17 Perspective Alexa Hua 15 A new beginning KaileyAdams 15 Sun valley Sameeha Soora 13 Superpowers to save nature Alexandra Yang 17 All atone Khuyen Nguyen 18 The mountain speaks Sara Fang 17 Breaking news Alexandra Yang 17 Through a child's eye Kara Yoon 13 (Re)discoveries of beauty Serena Pei 16 Freedom in nature Amanda Lin 17 Caged Kyoko Nishikawa 13 Among the nature Shagun Jha 17 Nature and Me Larissa Vasavez 16 Sheep herder Shiva Ravinutala 16 One step at a time Anika Bach 17 Ginkgo overcast Liliana Farias 16 MY escape Shiva Ravinutala 16 Figure 8 Ava Hua 13 The catwa k Mackenzie Vencill 16 The wolf in the forest 5iddhi 5henoy 19 Divine lotus Christina Chang 15 Through the years Mackenzie Vencill 16 Alice in wonderland 5iddhi 5henoy 19 The pluck of Parijatha Christina Chang 15 Koi fairytail Matthew Tran 16 Arctic desolation Sophaktra Ly 17 The little plant Dulansa Rathnayaka 14 Nature and Me Melanie Wu 16 Tranquility Tanmayi Dasari 15 Roots Emilie Yin 16 Passing through me Historyof identity realization yy �- Tanma Qasari 15 Bloom Emma Austin 15 An otter wand Melissa Lin 18 in Taiwan Gabriella S 18 Protector of m beloved family Tiara Gonzalez 20 Tainted nature Say Y Y Nancy Hu 17 The gib living in Nature's world Grace Guan 18 Gracesprings Tiara Gonzalez 20 Beauty in a Jar Parul Gupta 17 The nature in me Helen N o 17 Home garden Tiffany Yu 16 Quarantine garden 9 9 Paul Li 18 Nature's eyes Ishika Shah 13 Ha chid Tina Iturrbaria 20 Koi at Osmosis PPY Povheng Yam 19 Healing power Jacquelin Verdin 21 Madre Naturaleza Tina Iturrbaria 20 Elephants at dusk 4 Qien Feng 18 Invisible guardian JennyLu 19 Little things in life Treina Le 19 Enjoying nature's breeze 9 Qien Feng 1fi Harmful protection Jenny Lu 19 Protect the greens Romy Chung 18 Prodi Treina Le 19 Sitting under a tree gal son Jessica Lin 21 Am I American? Ronia Naval 17 Touch Venupama Athapattu 14 I love my nature with my hef 165 Vishaka Ashok 14 Ignorance is bliss PRC Meeting 03.03.22 Tian Hong2021 Youth Art Contest Judge Panaell6of� Danuta Hutchins - Artist & Farzi R. - Artist Susan Shi - Tian Hong Linguist Foundation CFO & COO J I y L - 166 PRC Meeting 03.03.22 Tian Hong Foundation Page 167of306 2021 Cross Cultural Youth Art Contest Award Structure Award per Age group:4- 12 contestant 1 st place $300 2nd place $150 3rd place $50 encouragement $20 Age group: 13- 21 1 st place $500 2nd place $250 3rd place $100 encouragement $20 Special awards - most creative award $250 - unique cultural influence award $250 -best theme award $250 . - best artistic technique award $250 - City of Cupertino special award $250 167 PRC Meeting 03.03.22 Page 168 of 306 Special thanks to City of Cupertino ! Congratulations , young artists ! Tian Hoag Foundation Better Society via Arts and Cultural Exchange www.tianhonafoundation.orq 168 PRC Meeting 03.03.22 Page 169 of 306 Tian Hong Foundation (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the x program/project/event Identify how the funds will be used to benefit the Cupertino x community Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct service costs versus administrative costs x Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission 3 PRC Meeting 03.03.22 Page 170 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTION 1 : CONTACT INFORMATION Full Legal Organization Name: Buddhist Tzu Chi Medical Foundation Website:I https:/ftzuchimedical.us Address: City: El Monte State: CA Zip:191731 Phone: Organization President/Executive Director Name and Title: I Steven Voon, Executive Vice President Emaid steven.voon@tzuchimedical.us Phone: Contact Name and Title: Yuaner Wu, Dental Mobile Coordinator (If different) Emaid dryuanerwu@gmaii.com Phone: SECTIONINFORMATION 501(c)(3)?: ■ 'es Year Established: 'I 993 i\ia {i f different than abozle address information) Sponsor Name: Buddhist Tzu Chi Medical Foundation Sponsor Address: 9626 Flair Drive City:I El Monte State: CA Zip: Phone: 626-472-9598 Federal Tax ID: 95-4457939 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) ORGANIZATIONSECTION 3: Total Organization Budget: 16,000,000 Total# of Board Members:113 Total#of staff:170 Total#of Volunteers:300 170 PRC Meeting 03.03.22 Page 171 of 306 Mission Statement: We provide patient-centered medical care with compassion to underprivileged individuals regardless of religion, age, gender, ethnicity, or ability to pay. Brief Description of Organization and Services Provided: In 1993, we established the Tzu Chi Medical Foundation in the United States with our first free clinic in California, dedicated to providing patient-centered, high-quality community health services to low- income individuals. We now run three community clinics in Alhambra, South El Monte, and Wilmington, California, that provides care at minimal or no cost. We also host an array of free, large- scale medical outreaches across the country, along with mobile medical, dental, and vision programs, support groups, and preventive health education. In the bay area, our dental mobile provides free cleaning, filling, and extraction to the underinsured and uninsured population. Also, we provide medical outreach with free medical, dental, oriental medicine, and chiropractic services. REQUESTSECTION 4: GRANT 1. Program/Projec-t/EventName: Healthy Cupertino Health Fair 2. Date(s) and/or duration of program/project/event (if applicable): one event- date to be TB❑ 3. Total program/project/event budget: 8309 4. Requested Amount: g300 Percent of total program/project/event budget: QQ % 5. What percentage of your organization's projected income does your funding request represent? 19D % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 12021 (year) New program/project/event 171 PRC Meeting 03.03.22 Page 172 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost $00 (ongoing operational cost.) b) Materials/Equipment$ 4QQQ c) Entertainment$Q d) Room/Venue Rental$ 2QQQ e) other Professional Services such as f) other IMalpractice and general liabilities insurance I $ 150Q 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will be provided: To host a day of community health fair with free medical services to financially challenged Cupertino residents. At this Health Fair, we plan to offer free blood pressure checks, oral exams, dental cleaning, dental filling, and extraction, and oriental medical consultation. This requested fund will be used to cover facility rental in Cupertino, general and malpractice insurance, material supplies, and small instruments. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit ❑r impact the Cupertino community: To support the City's mission and values, we will be collaborating with West Valley Community Center (WVCS) to host a community health fair and to better serve the greater area of the City of Cupertino. 12. Who will be served by tlus rant? Population served: Cupertino residents who are low income that does not have insurance in dental and acupuncture referred by West Valley Community Service (WVCS) a) Number of individuals total:150 b) Number of Cupertino residents: 150 c) Will the program/project/event be available to the entire commm-dty/public or are there any eligibility criteria? Our program goal is to serve the underserved communities within Cupertino with referrals by West Valley Community Service (WVCS). 172 PRC Meeting 03.03.22 Page 173 of 306 d) Will there be a charge or fee for the program1project/event(if applicable)? No charge to the patient 13_ If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: 2021 - $7,400 grant from Community Funding Grant 14_ Describe any funding requested from other agencies organizations in regard to this program/project/event request_Indicate whether the funding was granted, denied, or is still pending: No other request funding for this project from other agencies. 173 7�] 00partme>>t oftha Traastlry yI+ 1 iw PRC Meeting 03.03.22 lolernal lZevrnue 5errice Pa 21 ��ff33c� P. D . Box 2508 , Room 4010 In reply refer to : g4MgW28.45 Cincinnati ❑H 45201 July D6, 2010 LTR 4168C 0 95-4457939 000000 00 00032666 BODC: TF i SIiDDH IST TZU CHI MEDICAL FOUNDATION L IMDA SUN C10�4A Employer Identification Number : 95-4457939 Person to Contact : Mrs . Jones Tall Free Telephone Number : 1-877-- 829-5500 Dear- Taxpayer : This is in response to your May 19 , 2010 , request for information regarding your tax-exempt status . Our records indicate that your organization was recognized as exempt under section 501 (c) ( 3) of the Internal Revenue Cade in a determination letter issued in September 1994 . Our records also indicate that you are not a private foundation within the meaning of suction 509 (a) of the Code because you are described in section ( s) 599(a) ( 1) and 170 (b) ( 1) (A) (iii ) . Donors may deduct contributions to you as provided in section 170 of the Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055 , 2106 , and 2522 of the Code . If you have anv questions , please call us at the telephone number shown in the heading of this letter . Sincerely yours , Cindy Thomas Manager , L❑ Determinations 174 PRC Meeting 03.03.22 Page 175 of 306 Buddhist Tzu Chi Medical Foundation (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the x program/project/event Identify how the funds will be used to benefit the Cupertino x community Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct service costs versus administrative costs x Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission 3 V 0 PRC Meeting 03.03.22 Page 176 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO CONTACTSECTION 1 : Full Legal Organization Name:1 Sylvia Abboud Website:I https-1/wnrw.servicesforseniors.org/ Address] 1550 El Camino Real City Santa Clara State: CA Zip:195050 Phone: 408-417-7867 Organization President/Executive Director Name and Title: I Sylvia Abboud - Executive Director Email: sylvia@servicesforseniors.org Phone: 408-417-7867 Contact Name and Title: (If different) Email: Phone: SECTION • • •' • 501(c)(3)?: t�le: Year Established:{i f different than alone address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax IDJ 770154535 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) INFORMATIONSECTION 3: ORGANIZATION Total Organization Budget: J$125,000.0 Total# of Board Members: 5 Total#of staff:13 Total#of Volunteers: 207 176 PRC Meeting 03.03.22 Page 177 of 306 Mission Statement: Heart of the Valley, SERVICES FOR SENIORS, Inc., (HOV) is a publicly supported 561(c)(3) corporation that facilitates, advocates, and supports independent living for seniors (65+) living in West Santa Clara County. Officed in Santa Clara, we serve the cities of Santa Clara, Sunnyvale, Cupertino, Campbell, Saratoga, Los Gatos, Monte Sereno, and Vilest San Jose zip codes of 95117, 95125, 95126, 95128, 95129, and 95130. Brief Description of Organization and Services Provided: HOV was founded in 1987 by the Santa Clara Methodist Retirement Foundation at the recommendation of Austen Warburton, who recognized that seniors do better when they can live independently in their own homes. Home is where everyone wants to be and that has been Heart of the Valley's mission since day one. Before COVID, our volunteers acting as`Yriendiy neighbors"provided many services including our most-requested escorted door-through-door transportation. Volunteers drove seniors to mostly medical appointment, grocery shopping and social appointments. Drivers stayed with seniors, brought them home, and even helped put away groceries/merchandise, etc. Other services included handyman services, in-house projects, yard work, paperwork, friendly visits, home safety checks, tech assist, pet care, Household Hazardous Waste(HHW)and Pharmaceutical (5D) pick up and disposal as well as referral services. HOV services and programs are at no-cost to the client, enabling our clients to stretch a small income to the end of each month and continue to live at home past the age of 80 and even 90. Many volunteers have developed life-long relationships with their clients over the years. And,while the volunteers are performing their service,the visit also becomes a wellness check, to ensure our clients are doing well. During COVID, we have had to suspend our most popular services: Escorted Transportation and In-Home services. We still offer all the other outdoor services in a no-contact manner, where the client must stay inside their home as long as the volunteer is on the premises.And,the other services transitioned into telephone services and we also expanded our Friendly Caller Program and created the new Vaccinate Angels program to help our clients schedule their vaccinationlbooster appointments and their round-trip transportation to the vaccination sites (only 1%of our clients utilize technology) and help the 33% of our clients that live at or below the poverty line with grant money for a Medical Transportation Subsidy. REQUESTSECTION 4: GRANT 1. Prograrn/Project/EventName: COVID Car Kit 2. Date(s) and/or duration of program/project/event (if applicable): Duration is for 1 year, after receiving the grant. 3. Total program/project/event budget: $ $6160.46 4. Requested Amount: $6166.46 Percent of total program/project/event budget: 1 QQ % 5. What percentage of your organization's projected income does your funding request represent? 5 °�,o 6. Ti e of Request: Program Support Event One-time project 7. Existing program/event;established in (year) ■ New program/project/event 177 PRC Meeting 03.03.22 Page 178 of 306 8_ Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) .Staffing cost 0 (ongoing operational cost) b) Materials/Equipment$ c) Entertainment$0 d) RoomJVenue Rental$® e) Other Professional Services such as 0 0 f) Other 10 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will beprovided: Friendly GaUers are telling us that their clients lack PPE supplies—masks,gloves,hand sanit¢ers and disinfectant—items very hard to fend and afford under the best of circumstances.Generous donors have helped in the past with some PRE supplies which has allowed us to continue to offer our outdoor no-contact services.But because this pandemic has dragged on for two years now and the new Omicron variant is pushing II into a third year,our original supplies have dwindled.We need to refresh that supply to continue to protect both our volunteers and our seniors_We are hoping to be able to return to full services soon,but this can only be done in a manner that protects the health and safety of everyone. Through various grants we have deep cleaned and sanitized the office.Staff is returning to work at the office—the first step to fully restore all of our services as Santa Clara County mandates allow.But,in order to once again offer our contact services—Escorted Transportation and In-Home services—we need enough PPE for 2,000 services over one year.The COVID Car Kit will protect both the volunteer and 5 clients that sthe provides a service for.The GOVID Car Kit will consist of 10-3 ply masks,10 KN95 masks,10 disposable gloves,100 disposable antiseptic towelettes, 1 bottle of Lysol,1 roll of paper towels,1 box of Kleenex,placed into zip bock bags with 1 card stating this is provided by funding from the City of Cupertino.The volunteer's vehicle or the work space in the client's home will need to be sanitized before and after the service.We need our volunteers and clients protected,even though they are vaccinatedlboosted,because even In the best case a glove tears,the ear loop to a mask snaps off making the mask unusable,or someone's mask may slip as they sneeze or cough. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit or impact the Cupertino community: The mission of the City of Cupertino is to provide exceptional service,encourage all members of the community to take responsibility for one another,and support the values of education,innovation and collaboration.We at Heart of the Valley couldn't agree more and have been providing services to seniors for going on 35 years,this year,through dedicated and responsible volunteers and a staff of 3 part-time employees.During COVID,our seniors,vulnerable in the best of times,have been feeling the physical,mental,and emotional effects of isolation with stresses that have included heat waves,fires,politics,protests,and pandemic fears.Many of them have lost human connections,missing contact with family,friends,grandchildren{not only the ones hom during the pandemic, but also the ones they are used to seeing since they were bom),celebrations and just lunch with friends—they are ready to take their lives back again!But we cannot provide them the services they need without a COVID Car Kit to keep them and the volunteers they krtow and trust,safe.We trope the City of Cupertino will partner with Heart of the Valley to achieve our mutual goals of keeping Cupertino seniors safe and active and bringing our communities back to a more normal life as soon as safely possible_ 12. Who will be served by this rant? persons xn11 De ra grant are u no c en an va n m e venous c des m e ay a,w o serve ern,n w is un ers are u no residents.while serving 45 dierHs is not ditnculf,during COV 0 it is costly.Once we are allowed to begin providing all of our services,we know these 45 clients,who haven't seen their doctor,farrdly or friends,the inside of a grocery store or the changes that have happened in their community in the last 2 years,will request between 3-4 services a month,which is 2,1SO services involving both the diem and the possible 207 volunteers that provide services to our clients,in one yeaes.time,which requires more than the 2,DOG PPE Wits that we are requesting_We are also investigating the possibiFty or requesting COV 0 Car kts for the cities of San Jose and Santa Clara dients_ a) Number of individuals total:1252 b) Number of Cupertino residents: 150 c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? From the beginning,HOV only serves clients who have registered with them.However,during COVID,our hearts broke for the large number of seniors who are not HOV clients and do not have a Friendly Caller or a volunteer come by periodically.Even though they cannot speak to each other,all that is required is a friendly wage, hello and good-bye.It is a comfort to our clients that someone is corning by to still beck anthem.So,we began offering our Friendly Caller and Medical Devices Programs to seniors who are not HOV-Iients.We also offer our pharmaceuticals pickup and disposal service to the community,mostly at Senior Apartments.Arid, we always offer our Referral services to anyone who calls in.However,during COVID,the cost of providing services is almost prohibitive for our own clients,to allow us to begin providing services to non-HOV clients. 178 PRC Meeting 03.03.22 Page 179 of 306 d) Will there be a charge or fee for the prograni/project/event(if applicable)? At Heart of the Valley, all services are no-cost. However,there is a cost to HOV in providing our services and In the case of this COVID Car Kits program, all the costs of the program are for the materials needed to ensure the volunteers are able to perform the service(s) safely for the themselves and the client(s). 13. If your organization has ever received financial or in-kind support froin the City of Cupertino outside of Community Funding Grants, please describe this support: The City of Cupertino did provide Heart of the Valley a grant for Cupertino Community Outreach in 2019. It took some time to find an Outreach Manager, but she quickly moved forward with the research, printing, mapping out of locations to place the outreach materials and was able to distribute half of the materials at the identified locations before the March 16, 2020 Shelter-In-Place order. Since then, the City of Cupertino has graciously extended this grant for the 2nd time, to June, 2022. We hope to be able to complete this project by the June deadline, however, considering this never-ending pandemic, if seniors are not leaving their homes and facilities are shutting down at their own discretion, the distributed materials may not be seen by the seniors they are intended for. 14_ Describe any funding requested from other agencies/organizations in regard to this program/project/event request.Indicate whether the funding was granted, denied, or is stilt pending: HOV has not yet requested funding from other agencies/organizations regarding COVID Car Kits. We have just started our investigation into obtaining COVID Car Kits for the cities of San Jose and Santa Clara clients. 179 PRC Meeting 03.03.22 Page 180 of 306 Internal Revenue Service Department of the Treasury P. O. Box 2508 Cincinnati, OH 45201 Date: June 21, 2001 Person to Contact: Michael Dutcher 31-07421 Customer Service Specialist Heart of the Valley Services for Seniors, Inc. Toll Free Telephone Number: PO Box 418 8:00 a.m.to 9:30 p.m.EST Santa Clara, CA 95052 877-829-5500 Fax Number: 513-263-3756 Federal Identification Number: 77-0154535 Dear Sir or Madam: This letter is in response to your request for a copy of your organization's determination letter. This letter will take the place of the copy you requested. Our records indicate that a determination letter issued in April 1992 granted your organization exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Based on information subsequently submitted, we classified your organization as one that is not a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a)(1) and 170(b)(1)(A)(vi). This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required to file Form 990, Return of Organization Exempt from Income Tax, only if its gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period, The law imposes a penalty of$20 a day, up to a maximum of$101000, when a return is filed late, unless there is reasonable cause for the delay. All exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance Contributions Act(social security taxes) ❑n remuneration of $100 or more paid to each employee during a calendar year. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, these organizations are not automatically exempt from other federal excise taxes. Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your organization or for its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. 180 �...,.-- :,"+.r'nst:x�. - •'S' .. .-_ .. :�'�S^��T"'i�?'i.^ncrr:•.r=�_ .. .. -- - a7Y,,:. r _ - •+:.; - PRC Meeting 03.03.22 Page 181 of 306 181 PRC Meeting 03.03.22 Page 182 of 306 Category Application Actual Expenditures % of Total Cupertino Community Outreach Budget — Request for extension Admin Staff $600 $600 9% Printed Materials $1,800 $1,800 26% Outreach Manager $3,400 $3.40❑ 49% Social Media $1,200 $0 17% Tota 1 $7,00❑ $5,800 Remaining Balance $1,200 182 PRC Meeting 03.03.22 Page 183 of 306 Heart of the Valley-COVID Car Kit materials table PPE Price Quantity Cost KN95 Masks—for close contact, ie transportation&in-Home Services $149.98 2,000 $149.98 3 Ply Masks—for outside services,ie yardwork/handyman/HHW/5D $155.55 2,000 $155.55 Disposable gloves—various sizes—1,000/pack $49.99 2,000 $350.00 Disposable Antiseptic Towelettes—1,000/pack—20 towelettes per service $25.47 40 $1,018.80 Lysol Disinfectant Spray—12 pack $69.99 400 $2,379.66 Paper Towels—16 rolls/case-128 sheets/roll $31.79 25 $47.69 Kleenex—18 boxes/case $26.49 400 $588.67 Jumbo Zip Lock Bags—10/box $14.98 400 $599.20 1 Gallon Zip Lock Bags—200/box $21.99 2,000 $219.90 Printed Cards $0.33 400 $132,00 Tax 9.20% $519.01 COVID Car Kits 400 $6,160.46 183 PRC Meeting 03.03.22 Page 184 of 306 Services for Seniors-Heart of the Valley (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the x program/project/event Identify how the funds will be used to benefit the Cupertino x community Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct service costs versus administrative costs x Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission 3 PRC Meeting 03.03.22 Page 185 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTION Full Legal Organization Name: Chinese American Coalition for Compassionate Care Website:I caccc-usa.org Address: P❑ Box 276 City: Cupertino State: CA Zip:195015 Phone: (866) 661-5687 Organization President/Executive Director Name and Title: I Shirley Pan, Director Emaid shirley@cacec-usa.org Phone: 626 277-5775 Contact Name and Title: Jeanne Wun, Past Board Chair (If different) Email:Ijeanne@caccc-usa.org I Phone: (408) 896-7366 SECTION • • O • 501(c)(3)?: t�le: Year Established:{i f different than abooe address information) Sponsor Name:IChinese American Coalition for Compassionate Care Sponsor Address: City: Shingle Springs State: CA Zip: 5682 Phone: Federal Tax ID: 26-0895114 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: J$140,000 Total# of Board Members: 9 Total#of staff:14 Total#of Volunteers: 400 185 PRC Meeting 03.03.22 Page 186 of 306 Mission Statement: • Encourage dialogue among Chinese Americans about end-of-life issues so that it is viewed as a natural part of life. • Enhance advanced illness and end of life care by improving advance care planning and decision-making for Chinese Americans through community outreach education and volunteer, caregiver, and health professional training. • Empower Chinese Americans by improving access to end-of-life resources: producing original Chinese language materials or translating existing materials into Chinese and providing referrals to appropriate agencies. • Use a coalition model,where expertise and resources are shared, to ensure Chinese Americans receive exceptional end of life care and services that address physical, psychosocial, emotional and spiritual needs. Vision: To build a community where Chinese Americans are able to face the end of life with dignity and respect. Brief Description of Organization and Services Provided: was formed 12f2IJUb to address the lack otlinguisbcallyand culturally approp en informationand training avai e e mese commun a a serve them. CACCC,incorporated and achieved 501 c3 status in 2007,is the first coalition in the nation devoted to end-0f4ife care concerns in the Chinese community.An active working coalition of 150 local,state and national partner organizations and approximately 1,500 individual members dedicated to the mission. 9 dedicated volunteer board of directors set policy with one full time and three part time staff.Prior to COVID,CACCC used facilities of its member partners for training and events.Today, events are provided virtually.CACCC's focus:helping the Chinese community with advance care planning(ACP)and mindful self-care-,providing hospital patient ambassadors(on hold due to COVID);hospice volunteer training;educating Chinese community,and the healthcare providers who serve them. Services: An overview of the programs,products and services CACCC provides to increase awareness and address healthcare disparity at the end-of-life care in the Chinese community. 1.Produce and translate end-of-life resources and materials from English to Chinese,or Chinese to English: a.DVDs:Loving Life...Understanding Hospice;Kathy&Windy-a documentary film b.Bock:Learning to Let Go:Saying Goodbye Peacefully c_Videos:Hospice Care&Palliative Care,Advance Health Care Directive&POLST,Heart to HearWD Cards&Heart to Hearth Cafe d.Decision Guides:What is CAR;What is Ventilator;What is Tube Feeding;What is Artificial Hydration e.The Chinese Conversation Starter Kits(Your Gonversation Starter Guide,Your Guide to Choose a Health Care Proxy,Your Guide to Being a Health Care Proxy,Your Guide to Talk to a Health Care Team,For Caregivers of People with Alzheimer's or Other Forms of Dementia,For Caregivers of a Child with Serious illness,What Matters to Me) f. End-of Lifie-Care Glossary 2.Community education and Advance Care Planning outreach 3.Heart to Heart&Cafes 4.Professional healthcare trainings 5.Caregiver and volunteer trainings 6.Weekly Caregiving Stress Reduction Meetings 7.Seven(7)Week Mindful Self Care Workshops 8.Hospital Patient Ambassador Program(on hold due to pandemic) 9.Toll free Warmline 866-661-%87 SECTIONGRANT 1_ Program/Project/EventName: Mindfully Facing Grief and Loss and Starting the Conversation 2_ Date(s) and/or duration of program/project/event(if applicable): July 2022- June 2023 3. Total program/project/event budget: 5 $65,000 4. Requested Amount: $1 3 000 1 Percent of total program/project/event budget: % 5_ What percentage of your organization's projected income does your funding request represent? 0 % 6. T e of Request: Program Support Event One-time project 7. Existing program/event;established in (year) New program/project/event 186 PRC Meeting 03.03.22 Page 187 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 3250 (o)igohig operational cost.} b) Materials/Equipment$ 3500 c) Entertainment$0 d) Room/Venue Rental$ $50 e) Other Professional Services such as 4500 f) Other I I $Fgoo 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will beprovided: SYVb a gemrprw xenon ly qad wmmng Vnm Vie 0L)ofCupE".CACCC WI tlexbp a new nnpi needed pwoTarn KknC yFacing�and Logs W ailol—M..LLh.g0ar-1 bes."Wooly,VIM CJYnese—rusty,nrWtlg3i�C�tart les a 1 L-By —g+ P d"gg"ad�tluby erase ciwherging er,ren. 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Moalle 6 Lee Menery Boot Create a 8mpla&Son people b use a a grkle W railer Viatr ores,Vet nwrgrtes,port Vr�photrc ad wM Born Vie wads grey IUe W snare Wn Vaatr raW ms,bred oSes ad axone. fat MueSs WII sqn ld Nile(%mL'n111s Wm"rg Me flea tU ndmly Facing Grer aria Lm VMrimcp wd MI spend m leeP d1alMs In,pmpang the ftmm dr 9es nerib—aUanng_ Slaltg ne Cpnxvsatkn Peg m pm 1.@I—age parft annmela mte get airM he a m arid Y HMng ad ddapra healVYaMy- 2.B,m ge a0laee rare pamng mnw.vsatbns regaMg nedlcal rare W9es, asw as Velr trved"N Wslres who ae Mig WU deist dlseare(s}ardlor faag Ve en0 dr ere 1)rnnnsder munale Care cpllms ad a—Wm raltlly m nmr,MKI roes and ee leaIM plur056gda learn=WII lead Gat mnpkVng M AM ante 7mm1 Cm Cl mere durhig a pantlelr9c CAGCC wll ploalde 6aYlce5 as beld'a' 1.Heai m Ham[car�Caes m ena�'a pYneae AntiAe 1 tlMres ECL ku�eswM Vret bvetl ones,and Velr Realmcaeleams and en[ar�a}^Vern[p canpe@ Vre AQSance ffeaM Cam Clmrbvz 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit ❑r impact the Cupertino community: According to the City of Cupertino Mission Statement, the City of Cupertino is to provide exceptional service, encourage all members of the community to take responsibility for one another, and support the values of education, innovation and collaboration, which aligns with CACCC's mission: to provide EOL education in the Chinese community to overcome misconceptions and taboos related to death and dying. CACCC use the Coalition model to take advantage of existing resources, and do that in a way that allows us to help the healthcare community best serve Chinese Americans. CACCC will provide online webinar, workshops, classes and trainings to educate and help Chinese American people in the Cupertino community, as well as the staff, case managers and trained volunteers of organizations who serve the Chinese community. CACCC continues to develop innovative programs in support of their mission. 12. Who will be served by tlus rant? Chinese Mandarin-speaking individuals, Chinese American multigenerational families residing in Cupertino, surrounding communities and in California. a) Number of individuals total:15000 b) Number of Cupertino residents: 11000 c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? All programs and events are free and available to the community and general public who speak Chinese (Mandarin); however, each participant must have completed CACCC's Mindful Self-Care Workshop a free 7-week training, prior to participating in Mindfully Facing Grief and Loss. 187 PRC Meeting 03.03.22 Page 188 of 306 d) Will there be a charge or fee for the programlproject/event(if applicable)? No 13_ if your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: No 14_ Describe any funding requested from other agencies organizations in regard to this program/projectlevent request_Indicate whether the funding was granted, denied, or is still pending: Cigna Ambassador Fellowship Funding: $16,700 188 PRC Meeting 03.03.22 Page 189 of 306 INTERNAL REVENUE SERVIC2 DEPARTMENT OF THE TREASURY P. Q. BOX 2508 CINCINNATI, GH 45201 OCT I o 2001 Employer Identification Number: bate: 26-0895114 OLN: 17053267307007 CHINESE AMERICAN COALITION FOR Contact Person: COMPASSIONATE CAR-- JOIN C KISER ID# 31211, C Q SF�.NDY MIN v Contact Telephone Number: (877) 629-5500 Accounting Period Ending: December 31 Public Charity status: 170 (b} (1) (A) tvi) Form :990 Rea_uired: Yes Effective Date of Exemption-, August 7, 2007 Contribution Deductibility: Yes Advance Ruling Ending Date: December 31, 2011 Addendum Applies: No Dear Applicant_ We are pleased. to .inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under secticm 501(c) (3) of the Internal Revenge Code. Contributions to you are deductible under section 170 of the Code, You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2105 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt: status, you should keep it in your permanent records. Crgar,izationz exempt w.der section Soo(r-) (3) of the Code are further classi€ied as either public charities or private foundations. Touring your advance ruling period, you will be treated as a public charity. Your advance ruling period begins with the effective date of your exemption and ends with advance ruling ending date shown in the headirg of the letter. Shortly before the end of yotLr advancc ruling period, we- will send you Form 8734, Support Schedule for Advance Ruling Period. You will have 90 days after the end of your advance ruling period to return the completed form. We «i11 Lhea notify you, in writing, about your public charity status_ please see enclosed Publication 4221-PC, Compliance Guide for 501(c) (3) Public Charities, for some helptul information about your responsibilities as an exempt organization. Letter 1045 (DO/CG) 189 PRC Meeting 03.03.22 Page 190 of 306 -2- CHINESE AMERICAN COALZTTON FOR Sincerely, Director, Exempt Organizations Rulings and Agreements Enclosures: Publication 4221-PC Statute Extension Letter 1045 (DO/CG) 190 PRC Meeting 03.03.22 Page 191 of 306 Program: Starting the Conversation and Mindful Self-Care Agency: Chinese American Coalition for Compassionate Care City of Cupertino Community Funding Grant Annual Project Report Agency/Organization Chinese American Coalition for Compassior Project Starting the Conversation and Mindful Self-G Contact Person Jeanne Wun Title Past Board Chair Phone 408-896-7366 E-Mail jeanne@caccc-usa.or± Grant Received: $6,000 A. Project Results: Was your program/project/event affected by COVID-19? Yes No Was the program/project/event successful? Please indicate how success was measured: 2020/2021 was an extraordinary and challenging time for everyone. We had to adjust and address the needs of our constituents, the Chinese community, caregivers, healthcare professionals, trained volunteers and staff who were all impacted by the pandemic. With a generous $61K community grant from the City of Cupertino and funding from other sources, CACCC successfully hosted seven (7) Heart to Heart Cafes with 166 participants; held eight (8) Advance Care Planning presentations and Advance Health Care Directive workshops with 377 participants; provided 81 Weekly Mindful Caregiver Stress Reduction sessions with 2877 participants for a total of 3420 participants served during the grant period. All conducted virtually, in Mandarin, at no charge to the participants. • CACCC exceeded the number of proposed participants served by 64% • CACCC exceeded the number of proposed Cupertino Residents served by 4% (Note, we reduced the proposed number of Cupertino residents reached from 80% to 30%, due to the pandemic. We did not have access the Cupertino Library to distribute Advance Directives. At the conclusion of each event, participants complete a program evaluation survey and CACCC is able to capture and access the registration and attendance information using Eventbrite and the Zoom platform applications. Success was measured by the number of programs and events held and program attendance for each one based on proposed numbers of participation against actual participation numbers. Additionally, success was measured by what participants had to say about our programs: 191 PRC Meeting 03.03.22 Page 192 of 306 Weekly Mindful Caregiving Stress Reduction: • Improved my daily life by using Mindfulness. Wish I knew about it much earlier in my life. • It's so great to learn with a group who share similar cultures with me. • This weekly session helped me go through these difficult pandemic times. Heart to Heart Caf6s: • Heart to heart support, especially in the midst of pandemic. • I'm excited to receive the Heart to Heart cards and talk about it with my parents so I know what end of life and death wishes they have that they'd like me to follow. • Having the Heart to Heart Cards, I can discuss with patients and family, which is easier than asking an open ended question such as "what are your goals at the end of your life?" ACP Presentation • 1 know more about hospital care, hospice care and preparation for the last period of my life. B. Clients Served: Please report the number of clients served as a result of this grant: Proposed in Application Actual from Event Total Number of Individuals 1232 3420 Cupertino Residents 985 1026 Particular community groups served: F_ Was the program/project/event available to the entire community/public or were there any eligibility criteria? Yes. All programs and events are free to the community and general public who speak Chinese. Was there a charge or fee for the program/project/event? Yes No What outreach methods did your organization use to promote the program/project/event? CACCC utilized our website; social media: Facebook, Eventbrite, Twitter; WeChat and Line Group; E-distribution list; partner organization referrals; word of mouth; news release; promotional flyers and TV/radio interviews to promote our programs and events. 192 PRC Meeting 03.03.22 Page 193 of 306 C. Budget: Please enter your proposed budget from your application, and your actual expenses accrued from this rant: Category Application Budget Actual % of Total Expenditures dmin Staff $3000 $3000 25% Materials/Equipment ° $5000 $4720 39/° Entertainment Room/Venue Rental $800 I� Professional Services (describe) $800 $1200 10%� $3265.82 Other: $2400 26%1 Other: �- _7 -F 0 Total12000 $12,185.82 ° Remaining Balance Note: Minus -$186 to balance actual to $12K. Do you intend to apply for Community Funding next year? Yes No If yes, how much to you intend to apply for? $12000 Please list any additional funding received last year from other sources for this program: CACCC requested a $12,000 community funding grant from the City of Cupertino and received a gracious $6,000 for this program. A grant received from Mount Zion Health Fund in 2020 was used to cover a portion of this program. Uploaded Documents: Please upload all receipts for your program/project/event. Provide your financial statement if available. Click here to go to the Upload Documents page (Your report will be saved) Person who Prepared Form I Jeanne Wun Title Past Board Chair Phone Number 408-896-7366 Date: 06/25/2021 193 Chinese American Coalition for Compassionate Care (CACCC) PRC Meeting 03.03.22 Receipts and Itemized Expenses in support of 2020/20ZI Starting the Conversation and Mindful Self-Care Programs Page 194 of 306 F'dS Th T S I~70CE. Transaction date: IV2312020 N �of AF MAIL IG Card type-. Visa �?j1�ThY, Transaction type! Purchases f sM•+/ey0 i' Merchant description: POSTAGE STAMPS ft^EdCt fhb •• Merchant information: MONTEREY PARK,CA y*q+■ fYi Ifa 1 t' a a + Reference number: 6769 �. �l t>� li:�I " CITY. CA 9!W- f5erchant Name: US POSTAL SERVICE Edit tat rMfae fJta I1 wrr Ortr Transaction Cate ❑ l Cash,Checks&Misc:Other _ 9 rY� .1►t 11r'G2�7Q11' f�f�l �e�� EKpenses Edit Ir�priry fx. ou Q14311 4;MR] 0321 4770 64 :r 17:• 02;02 FP Online Purchase: N a4M•.•�....rf.r.....arty,•arru�saa�rr... f7Pitrl iv grll■ j-pry, LT ����.r.r.r�ftii.,,•a:A==ta.ts-+i �ar.�■ Ffr1 %Wtr fo. so 111W. CA 0139 Flis hat* 1/0512021 USPS PO 0551120800 MONTEREY PARKCA $14.00 E.or irtr a.-. Pr'1d Rp �:11f1/3v147p Transaction date: 01104J20 21 l9fR! S149 fN2 am 4M In 00 1 1 t 7.75 Card type: Ursa IRr rarX,r I PW* Em to .,� ti�CliJLttK ,Ik+ &stI9 f►[', �� Transaction type: Purchases ' 1 p1 WO p,yK• fit gam, _�f Merchant description: POSTAGE STAMPS PrtirtIV Vol IA ?dN 1 F 1 at Rater Merchant information: M0NTEREY PARK,CA Flatt Onto Erlr ]EHPqKtgd DOI I V" DdY Reference number: 2486 %P"Iry PWk. CA 9I320 Morli:lay 07120121)�ft fl at *me I tUSPS Yr&*j rg 1 Merchant Name: t US POSTAL SERVICE Edit `caitll"Oct Cr I Arty , NCO!,NCO!, II'M/Xt2t] if1 8���� it t Transaction Category: t Cashr Checks RL Misc Other lryieit► 0 Expenses Edit Sj4R L3117 03"AM 1a f{] t6 V�10 Lti Irli;:ILOW Online Purchase; N :nat&'40 10-M r H 2•DGY i ft I.r5 $7 75 UP to I=W Atitl6dW =I At Rate II14 j]cAestic !12j301213211 U5PS PO 0551120800 MONTEREY PARKCA 1 $5-60 .t and Tail' ... . .. Transaction date: 12129J2920 ad,I Car 43 11M111gd dip,t Card type: Visa C"Mlrr: VISA , k1COAM 6. "l(XXX0JUAA4:7-9 +�$1�Si T1**1r1� * Transaction type: Purchases Apo Off l A: 49969L 9S1.r5 5 i d3 i29f] f]i ft@ 71HR1 a? tra-Kii Wr Of � p Me c7aant description: POSTAGE STAMPS AIL: AL VISA �,�T L � IfIG {1 Merchaniinformation: MONTEREY PARK,CA PIA' Plot Am'red Reference number: 371l Merchant Narne: 7 US POSTAL SERVICE Edit Transaction Category: x Cash,Checks&Misc:Other )1130I2021 U5P5 PO 0551120800 MONTEREY PARKCA $86.94 Expenses Edit d T3 Online Purchase: N Transaction date: D1J2912021 Card type: Visa I71 01120J2021 U5P5 PO 05511208,00 MONTEREY PARKCA s36.30 Tr5n5action type: Purchases Merchant descriPtion: POSTAGE STAMPS Transaction date: 01/19/2021 Merchant information: P40NTEREY PARK,CA card type: Visa Reference number! 5370 Transaction type,. Purchases Merchant Name: 2 US POSTAL SERVICE Edit Merchant description_ POSTAGE STAMPS Transaction Category: 3 Cash,Checks&Misc:Other Merchant information: MONTEREY PARK,CA Expenses Edit Reference number: 5366 Online Purchase: N Merchant Name: 3 US POSTAL SERVICE Edit Transaction Category: 2 Cash,Checks&Misc:Other Expenses Edrt 1 of 7 CACCC Online Purchase- N 194 PRC Meeting 03.03.22 + Page 195 of 306 0 0 711 1/20 2 0 USPS PO 0502950815 Al CA ��� $15.05 �.;, 07/07/2020 LISPS PO 0551120800 MONTEREY PARKCA "'� $37.69 Transaction date: 07/10/2020 OAS Transaction date: 07/06/2020 6'6 Card type: Visa Card type: Visa Transaction type: Purchases Transaction type: Purchases Merchant description: POSTAGE STAMPS Merchant description: POSTAGE STAMPS Merchant information: ARCADIA,CA Merchant information: MONTEREY PARK,CA Offer ID: KV2465754 Offer fD: KV2465754 Reference number: 5025 Reference number: 5067 Merchant Name: T US POSTAL SERVICE Edit Merchant Name: t US POSTAL SERVICE Edit Transaction Category: T Cash,Checks&Misc:Other Transaction Category: t Cash,Checks&Misc:Other Expenses Ldit Expenses Edit Online Transaction: N Online Transactlon7 N 01/02/2021 USPS PO 0551120800 MONTEREY PARKCA $11.73 +.05/31/2021 LISPS PO 0551120800 MONTEREY PARKCA ' $17.25 Transaction date: 12/31/2020 d'6 Transaction date: 05/29/2021 Card type: Visa Card type: Visa Transaction type: Purchases Transaction type: Purchases Merchant description: POSTAGE STAMPS Merchant description: POSTAGE STAMPS Merchant information: MONTEREY PARK,CA Merchant information: MONTEREY PARK,CA Offer TO: LK0401393 Reference number: 2330 Reference number: 8176 Merchant Name: i US POSTAL SERVICE Edit Merchant Name: ? US POSTAL SERVICE Edit Transaction Category: Z Cash,Checks&Misc:Other Transaction Category: 3 Cash,Checks&Misc:Other Expenses Edit Expenses Edit Online Purchase: N Online Purchase: N 03/30/2021 USPS PO 0551120800 MONTEREY PARKCA $69.48 1 9 01/29/2021 USPS PO 0551120800 MONTEREY PARKCA $2.89 Transaction date: 03/29/2021 Transaction date: 01/28/2021 Card type: Visa Card type: Visa Transaction type: Purchases Merchant description: POSTAGE STAMPS Transaction type: Purchases Merchant information: MONTEREY PARK,CA Merchant description: POSTAGE STAMPS Offer ID: LK0401393 Merchant information: MONTEREY PARK,CA Reference number: 0980 Reference number: 4399 Merchant Name: T US POSTAL SERVICE Edit Merchant Name: ? US POSTAL SERVICE Edit Transaction Category: •_! Cash,Checks&Misc:Other Transaction Category: 3 Cash,Checks&Misc:Other Expenses Edit Expenses Edit Online Purchase: N Online Purchase: N 2 of 7 CACCC 195 PRC Meeting 03.03.22 Page 196 of 306 C102/12/2021 USPS PO 0551120800 MONTEREY PARKCA $4.15 I 05/07/2021 USPS PO 0551120800 MONTEREY PARKCA $10.64 Transaction date: 02/11/2021 Transaction date: 05/06/2021 d� Card type: Visa Card type: Visa Transaction type: Purchases Transaction type- Purchases Merchant description: POSTAGE STAMPS Merchant description: POSTAGE STAMPS Merchant information: MONTEREY PARK,CA Merchant information: MONTEREY PARK,CA Offer lD: LK0401393 Reference number: 1874 Reference number: 5670 Merchant Name: US POSTAL SERVICE Edit Merchant Name: ? US POSTAL SERVICE Edit Transaction Category: Cash,Checks&Misc:Other Transaction Category: t Cash,Checks&Misc:Other Expenses Edit Expenses Edit Online purchase: N Online Purchase: N 102/23/2021 LISPS PO 0551120800 MONTEREY PARKCA $47.23 -M 02/17/2021 USPS PO 055112060C MONTEREY PARKCA $21.39 Transaction date: 02/22/2021 Transaction date: 02/16/2021 Card type: Visa Card type: Visa Transaction type: Purchases Transaction type: Purchases Merchant description: POSTAGE STAMPS Merchant description: POSTAGE STAMPS Merchant information: MONTEREY PARK,CA Merchant information: MONTEREY PARK,CA Offer ID: LK0401393 Reference number: 9611 Reference number: 5025 Merchant Name: ?_ US POSTAL SERVICE Edit Merchant Name: 7 US POSTAL SERVICE Edit Transaction Category: ? Cash,Checks&Misc:Other Transaction Category: ? Cash,Checks&Misc:Other Expenses Edit Expenses Edit Online Purchase: N Online Purchase: N 02/74/2021 USPS PO 0551120BOO MONTEREY PARKCA -i $48.75 02127/2021 USPS PO 0551120600 MONTEREY PARKCA $18.65 Transaction date: 02f23/2021 Transaction date: 02/26/2021 Card type: Visa Card type: Visa Transaction type: Purchases Transaction type: Purchases Merchant description: POSTAGE STAMPS Merchant description: POSTAGE STAMPS Merchant information: MONTEREY PARK,CA Merchant information: MONTEREY PARK,CA Offer ID: LK0401393 Offer ID: LK0401393 Reference number: 9423 Reference number: 7798 Merchant Narne: _? US POSTAL SERVICE Edit Merchant Name: 7 US POSTAL SERVICE Edit Transaction Category: ? Cash,Checks&Misc Other Transaction Category: ? Cash,Checks&Misc:Other Expenses Edit Expenses Edit Online Purchase: N Online Purchase: N 3 of 7 CACCC 196 PRC Meeting 03.03.22 Page 197 of 306 =; -i 10/17/2020 AMZN Mktp US*2T8LV4C32 Amzn.conn iI1WA i $31.73 j,�10/31/2020 LISPS PO 0551120800 MONTEREY PARKCA -y:� $22.39 d'a Transaction date: 10/16/2020 Transaction date: 10/30/2020 Card type: Visa Card type: Visa Transaction type: Purchases Transaction type: Purchases Merchant description: 800K STORES Merchant description: POSTAGE STAMPS Merchant information: Amzn.com/bill,WA Merchant information: MONTEREY PARK,CA Reference number. 7743 Reference number: 6035 Merchant Name: ? AMZN Mktp US*2T8LV4C32 Merchant Name: 2 US POSTAL SERVICE Edit Edit Transaction Category: Cash,Checks&Misc:Other Transaction Category: I Shopping&Entertainment: Expenses Edit Hobbies Edit Online Purchase: N Online Purchase: Y Dispute this transaction (11/07/2020 LISPS PO 0551120BOQ MONTEREY PARKCA $1a4:84 1 11/20/2020 USPS PO 0551120BOG MONTEREY PARKCA ` $34.25 Transaction date: 11/06/2020 Transaction date: 11/19/2020 Card type: Visa Card type: Visa Transaction type: Purchases Transaction type: Purchases Merchant description: POSTAGE STAMPS Merchant description: POSTAGE STAMPS Merchant information: MONTEREY PARK,CA Merchant information: MONTEREY PARK,CA Reference number: 6096 Reference number: 680a Merchant Name: ? US POSTAL SERVICE Edit Merchant Name: -1 US POSTAL SERVICE Edit Transaction Category: Cash,Checks&Misc Other Transaction Category: 1 Cash,Checks&Misc:Other Expenses Edit Expenses Edit Online Purchase: N Online Purchase: N Dispute this transaction Dispute this transaction 1 1/2 8120 2 0 USPS PO 0551120800 MONTEREY PARKCA - $11.20 Transaction date: 1112712020 Card type: Visa Transaction type: Purchases Merchant description: POSTAGE STAMPS Merchant information: MONTEREY PARK,CA Reference number: 3073 Merchant Name: ? US POSTAL SERVICE Edit Transaction Category: ? Cash,Checks&Misc:Other Expenses Edit Online Purchase: N 4 of 7 CACCC Dispute this transaction 197 PRC Meeting 03.03.22 Page 198 of 306 Zoom Meetings Pro 0 QFY SUBSCRIPTION PERIOD SERVICE EFFECTIVE DATE STATUS NEXT INVOICE DATE- Nov 17,2021 1 Annual Nov 17,2020 Active f3EXT INVOICE AMOUNT: $149.90 ZOOM MEETINGS Edit Current Plan Cancel Plan Video Webinar Webinar 100D-Promotion QTY SUBSCRIPTION PERIOD SERVICE EFFECTIVE DATE STATUS NEXT INVOICE DATE: Nov 17.2021 10 1 Annual Nov 17,2020 Active NEXT INVOICE AMOUNT_ $1,400_00 VIDEO WEBINAk Edit Current Plan(D Cancel Plan :1eoc='L,,rc TO-AL 5u1110 ORDER,112.669E017-7 19Ni1 0-a Rel Aces -0— —1-TO nau,R a.........%—ssww¢ Lily 27.20211 $11.9A Alex Tsae- Order oeralls 1—oke July 27,2020 $11.84 Sir Cho.- Order DOU16 IrrMCt am&"- Yriaapll Delivered Wednesday hadcaac Delivered Wednesday Track package Pukage rvac Iert inpde the reurl—',—illm - �� 1lie Fire lmitakiwk Oiscovenng what veeth Can TOKIN[%About Linng Puny RMum or replace terns I'�FIR The Fivq InittRtrarrs Die vering Mot DeAth Can Tearh US Ahprar LMrq Fully 1�[11YF — RPNm lac r(yfacC i[Cr11S L7s1—kl,Frank Owseskk Pra,at IkTFiIlILf Share Pt rerod L gllllTda! 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S,Dy9 1e 1 ehpWle ituaw"Aug 26.2020 WriLC•1 product rCview 11035 lry hagAY1' Yrew your rken'l write a produce B rewvr _ -- $ulr fLa�Q view your le2m A•1111we order Aru live order 5 of 7 CACCC 198 PRC Meeting 03.03.22 Page 199 of 306 o.VokPIA(Eo MIA1 sHrP Tn . ot..llr ix:ousy.xu.yo Pi A July 28.2020 S12.01 Nlo,.Carr- Order DetdAs lrr6NW 1(,�Qs LPRIN T1NG INVOICE iF 1.•D/A�TE 1'J/'"�/(/`I' 11143 GARVEY AVE„EL MONTE,CA.91738 FGI'+�Z�LL amaspn •Tel(626)444-6868,(323)64"868 •Fex.(626)575-0255 Delivered Thursday •E-Mail:mIko printing688,§aEA. rn Parka9e wac Ietr,inside the reddenre's mulbos: Track parka9e L� the her lrnnw6Wls:DiSwvenny Wlwt llealh Carl Teach Us Atwut Lermg Fully IS Chinese American Coalition for Compassionate Care s ar Irr ite um a reWace item, item, P 0.BOX 276 NI WILL CALL Dstas W.hank L ]r114871f Sold by Amaron.com Services LLC o CUPERTMO,CA 95015 P $hare gift PEM1V[ Contact Person: - — 9rtun,clgloq•ln,nPgl,Aug i'9.ioxv o Shirley Pan l626)277-5775 0 Write product re jON --- — fiuy it again V�your 114EM QUANTITY/DPSCRIPTION AMOUNT 15O pim Program books 59500 Ar Lirme order p.M.PIA<.Q rout stile to pvprxe r l2•......r5.ralo Total will be July2s-2020 s111_98 FnestrJrerx)- OrdWDetaa6 ImNKe $654.50 Thank you for your business! Delivered Thursday T a w kag Package was left inside tho reHdcnce'smaillm I'R rRi The Frye Inv word:Disoncong What(Death Can Inoxh Vs About I. irlg Fatly Return or repWce items IanililUr Sad by:wria.n..wm SY,��Cts LlL Snare Wt mmi t is u.N1g1tlp,1,Mugn Aug 29.7010 iio.fl9 v4rite a pmrhrct review �i.I&Otk �, New your Item TERMS:Net 10 Days ` IT SIIe tHtCTr •GPSI1•[xs 6s �Ws .r15EL e uf�9 sN ; A 596.OQ AreN eorder aLDGS-WEvuaIlAITnD14,14il3-PACS•s8MATES-CMHUnONG-"lETe 59.50 FR RCHLls-gRYCAMS, SIJP-D0G C4R 1:L AYWETuW1-FOLIT&ING.Est9NG•VWEAING-DIE W6-S7HNG•H#U11% MPRM•UpNdkE CC0.00 PLEASE PAY FRnM THIS INVOICE,No SIrATEMENT VAL,aESE . � 654.50 Tn.�rr a•e�re.w.rr nran.m.nr naeoYeoer,X r o,£ Date Description Amount 7/6/2020 USPS - Heart to Heart cards to Heart to Heart Cafe attendees $ 37.69 7/10/2020 USPS - Heart to Heart cards to Heart to Heart Cafe attendees $ 15.05 7/17/2020 USPS: End-of-Life educational materials $ 15.50 7/27/2020 6 Books -The Five Invitation $ 125.94 8/13/2020 USPS: Mailing out educational materials $ 23.25 8/21/2020 USPS: Shipping out AHCD forms to a warmline caller $ 7.75 8/24/2020 USPS: Shipping out AHCD forms to a warmline caller $ 7.75 6 of 7 CACCC 199 PRC Meeting 03.03.22 Page 200 of 306 10/3/2020 One month of Zoom Webinar $ 140.00 10/17/2020 Amazon purchase of certificate holders $ 19.99 10/30/2020 USPS: Mailing out heart to heart cards $ 22.39 10/31/2020 Amazon purchase of 100 envelopes and certificate papers $ 27.66 11/6/2020 USPS: Mailing out educational materials, HTH cards $ 104.84 11/16/2020 One Year of Zoom Meeting $ 149.90 11/16/2020 One Year of Zoom Webinar $ 1,400.00 11/19/2020 USPS: Heart to Heart cards, AHCD & book $ 34.25 11/24/2020 USPS: Heart to Heart cards, AHCD & book $ 18.83 11/27/2020 USPS: Mailing out educational materials $ 11.20 12/4/2020 Printing Cost: 150 copies of Program Book $ 654.50 12/23/2020 USPS: Mailing out educational materials $ 5.60 12/29/2020 USPS: Mailing out educational materials $ 5.60 12/31/2020 USPS: Mailing out educational materials $ 11.73 1/4/2021 USPS: Heart to Heart cards, AHCD & book $ 14.00 1/19/2021 USPS: Heart to Heart cards, AHCD & book $ 38.30 1/28/2021 USPS: media mail $ 2.89 1/29/2021 USPS: Heart to Heart cards, AHCD & book $ 86.94 2/11/2021 USPS: x1 HTH Cards $ 4.15 2/16/2021 USPS: Heart to Heart cards, AHCD & book $ 21.39 2/22/2021 USPS: Heart to Heart cards, AHCD & book $ 47.23 2/23/2021 USPS: Heart to Heart cards, AHCD & book $ 48.75 2/26/2021 USPS: Heart to Heart cards, AHCD & book $ 18.65 3/29/2021 USPS: Heart to Heart cards, AHCD & book $ 69.48 4/6/2021 USPS: Heart to Heart cards, AHCD & book $ 40.75 4/6/2021 USPS: Book $ 2.89 4/24/2021 USPS: Book $ 2.89 5/6/2021 USPS: Heart to Heart cards, AHCD & book $ 10.84 5/29/2021 USPS: Heart to Heart cards, AHCD & book $ 17.25 $ 3,265.82 7 of 7 CACCC 200 PRC Meeting 03.03.22 Page 201 of 306 Chinese American Coalition for Compassionate Care (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the x program/project/event Identify how the funds will be used to benefit the Cupertino x community Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct service costs versus administrative costs x Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission N O PRC Meeting 03.03.22 Page 202 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTIONCONTACT Full Legal Organization Name: Cupertino Bhubaneswar Sister City Initiative Website:I www.cuperUnobbsr.org Address: P❑ Box 1381 City: Cupertino State: CA Zip:195014 Phone: 510-9102823 Organization President/Executive Director Name and Title: I Reena Rao, Co-Founder. Chair & Executive Directo Emaid reenaprao@gmail.com Plione: 510-9102823 Contact Name and Title: Mahesh Pakala, Co-Founder & Executive Board Member (If different) Email:I mpakala gmail.com Phone: 510-7897100 SECTION ! • •R • 501(c)(3)?: ■ `es Year Established: �014 t, {i f different than ab zle address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax IDJ 45-3119826 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 1$40,000 Total# of Board Members: 5 Total#of staff:10 Total#of Volunteers:46 202 PRC Meeting 03.03.22 Page 203 of 306 Mission Statement: To foster positive multicultural interaction and understanding among people in Cupertino and in Bhubaneswar cities through immersion and exchange programs related to education, arts, culture along with trade & tourism facilitation. Brief Description of Organization and Services Provided: briet Descriptionani on Bhubaneswar(BBSR),Ddisha,India,once was the site of about 7,000 temples.A popular tourist destination due to the hundreds of temples that stil I stand and its rich cultural heritage,this city honors its past while moving into the future.Bhubaneswar recently achieved a first position in India's Smart Cities Challenge,a government initiative to drive economic growth and improve the quality of life of people by enabling local development and harnessing technology as a means to create smart outcomes for citizens_ Cupertino and Bhubaneswar officially got approved as sister city by Cupertino on Aug 16,2011 and subsequently closed the said relationship on Nov.24,2012,with the signing of a memorandum of understanding by former Cupertino mayor Gilbert Wong and Bhubaneswar Mayor Ananta Narayan Jena. The Cupertino-BBSR Sister City Initiative(CBSCI),a community-based non-profit organization,fosters positive mufti-cultural interaction and understanding through art,culture and education exchanges.This community-based non-profit organization also aims to engage individuals and irrstitudons in helping both cities to be sustainable. Activities include arts,cu@ure,youth,education,trade,tourism and community development exchange and immersion programs-To name a few-city delegations to BBSR by Cupertino city government and members of the Rotary club and vice versa.Student delegation from Bhubaneswar to Cupertino-Fall festival participation,workshops,presenting upcoming Heritage India Festival and many others. Brief Description of Services Provided Arts and Culture-Arts and cultural exchanges are the oldest and most robust in the sister cities network that take many different forms such as musical perforniances,art exhibits,parks or gardens,and international cultural festivals.By experiencing and exploring the culture of an international community,citizens may gain insight into the history,values,and aesthetic sensibilities of their partners. Youth and Education-Providing experience in international affairs and citizen diplomacy to youth is a critical part of any sister city program.Activities i nciude student exchanges,virtual exchanges,and sports tournaments.These exchanges are often described by participants as"a Iife�changing experience,"and many current leaders in international affairs or diplomacy can noe their interest to their first sister city exchange. Trade&Tourism-These connections build trust,access,and expertise that help local businesses find new opportunities and resources_Whether it is access to new markets,assistance navigating import and export regulations,or visiting historical sites,sister city programs expand the resources available to local businesses. Community Development&Philanthropy- Peer-teaming between rnur i cipal employees and elected officials through sister city activities has helped cities implement innovative policies and management techniques in varied fields.Programs raise funds or collect supplies for natural disasters and school support. SECTIONGRANT 1_ Prograrn/Project/EventName: Bhubaneswar Sister City Event/Festival for Exchange & Immersi 2_ Date(s) and/or duration of program/project/event(if applicable): Between Sep 2022 and April 2023 3. Total program/project/event budget: $ 30,000 4. Requested Amount:sF1 5,666 Percent of total program/project/event budget: 50 % 5_ What percentage of your organization's projected income does your funding request represent? 38 % 6. T e of Request: Program Support Event One-tune project 7. Existing program/event;established in 12022 (year) New program/project/event 203 PRC Meeting 03.03.22 Page 204 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 0 (ongoing operational cost) b) Materials/Equipment$ 5500 c) Entertainment$5000 d) Room/Venue Rental$® e) Other Professional Services such as Collaterals Design & Pri 3500 f) Other I Misc I $ 1 000 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will be provided: To organize a cultural arts and crafts Festival and support exchange programs. The 2020-21 year has impacted our student xchange program. However a need for emergency support in areas such as hunger has come up due to Covid -19 Pandemic. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit ❑r impact the Cupertino community: The request aligns with City's Support for the Sister City initiative to build people to people interactions for peaceful and stronger communities.. The spirit of democracy is best conveyed through arts. And in a culturally-rich country like India, the sentiments have been beautifully expressed by poets, musicians, dancers and theater artistes. The Festival is a celebration of sister city relationship with Cupertino, that will showcase a great index of all dance genres and dance forms together with the arts and crafts faire-taking us through a journey of rich Indian American cultural heritage. As part of the sister city exchange program, the Festival educates and celebrates mutual understanding of diverse cultures promoting friendship in Cupertino. 12. Who will be served by tlus rant? Residents of Cupertino, Cupertino Schools, FUHSD and neighboring cities a) Number of individuals total:13000 b) Number of Cupertino residents: 12000 c) Will the program/project/event be available to the entire commm-dty/public or are there an-- eligibility criteria? Yes, it will be open to all communities. 204 PRC Meeting 03.03.22 Page 205 of 306 d] Will there be a charge or fee for the progranilproject/event(if applicable)? N/A 13_ If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: NIA 14_ Describe any funding requested from other agencies organizations in regard to this program/projectlevent request_Indicate whether the funding was granted, denied, or is still pending: NIA 205 PRC Meeting 03.03.22 Page 206 of 306 INTERNAL REVENUE SERVICE DEA R'1MENT OF THE TREK61URY P. O. F3OX 2508 CINC!INNAT'I. OH 45201 �1 Employer identification Number: Date: FEB1 2014 4 -3119626 DLN 17053025307003 CUPERTINO BHUHANESWAR SISTER CT TY Contact pens INITIATIVE MENU WILKINS 1D# 52338 PO BOX 3581 Contact Telephone lumber FREMONT, CA 94539 (877) 829-5500 Accounting Period Ending: August 31 Public charity status : 50901 (2) FQ3.M 990 Required, Yes Effective Date of Exemption: August 10, 2011 contribution Deductibility: Yes Addendum Applies: No Dear Applicant ; e are plea6edi to inform you that upon re iev of your application for tax exemp, status we have determined that you are exempt from Federal income tax under section 5010101 of the Fraternal Revenue Cade. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive ta.x deductible bequests, devises, transfers or gifts uader section 2055, 2106 or 2522 of the Code . gecause this letter could help resolve any questiams regarding your exempt status, you shnuld keep it in your permanent records. organizations exempt under section 501 M {3) of the Code are further classified as either public charities or private foundations . We determined that you are a public charity under the code section (s) listed in the heading of this letter. Please see eaclosed Publ tcati n 4221-PC, Compliance Guide for 5PI M) {) Public chariLiew, for saw helpful information aLout your reeponsibiiivies an an - exempt organization. Sincerely, Director, Exempt g2�nil�aCions Enclonure : Publication 4221-PC Letter 947 206 PRC Meeting 03.03.22 Page 207 of 306 CBSCI Event/Festival is not yet completed. Hence, we do not have the expenses/revenue or the number of persons. 207 PRC Meeting 03.03.22 Page 208 of 306 Cupertino Bhubaneswar Sister City Initiative (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the X program/project/event Identify how the funds will be used to benefit the Cupertino X community Be awarded only once per project X For specific needs,not on going,operational costs X Have more than 75%of the requested funds allocated for direct X service costs versus administrative costs Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission N O co PRC Meeting 03.03.22 Page 209 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTIONCONTACT Full Legal Organization Name: Eu hrat Museum of Art ❑e Anza College Website:I www.deanza.edu/euphrat/ Address] 21250 Stevens Creek Blvd_ City: Cupertino State: CA Zip:195014 Phone: 14088645464 Organization President/Executive Director Name and Title: I Diana Argabrite, Director Emaid argabrltediana@fhda.edu Phone: 14088645464 Contact Name and Title: (If different) Email: Phone: SECTION ! • •' • 501(c)(3)?: t�'es Year Established:a {i f different than abazle address information) Sponsor Name: Foothill De Anza Community Colleges Foundation sponsor Address: 1 2345 El Monte Road City:I Los Altos Hills State: CA Zip: Phone: Federal Tax IDJ 94-3258220 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: J$240,500 Total# of Board Members: 6 Total#of staff:14 Total#of Volunteers:4 209 PRC Meeting 03.03.22 Page 210 of 306 Mission Statement: The Euphrat Museum of Art's mission is to research, produce and present challenging exhibitions and educational materials that provide a resource of visual ideas and a platform for communications. Our exhibitions and programs highlight our heritage of different cultures, enhance understanding of art fundamentals, art history, and esthetics and augment college instruction. Brief Description of Organization and Services Provided: The Museum traditionally presents one of a kind exhibitions, events, and programs that reflect the diverse heritage of our area. Our award-winning Arts & Schools Program joins professional artists and students of all ages in using art as a part of the community building process. REQUESTSECTION 4: GRANT 1. Program/Projec-t/EventName: Euphrat Museum of Art exhibitions and events 2. Date(s) and/or duration of program/project/event (if applicable): July 1, 2022 — June 30, 2023 3. Total programfprojectleventbudget. S 1240,500 includln ln- 4. Requested Amount: 15 000 Percent of total program/project/event budget:®% 5. What percentage of your organization's projected income does your funding request represent? 7 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 11970 (year) New program/project/event 210 PRC Meeting 03.03.22 Page 211 of 306 8. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 3000 (ongoing operational cost.) b) Materials/Equipment$ 260D c) Entertainment$850 d) Room/Venue Rental$® e) other Professional Services such as I Special Installations, Gr 6800 f) other I Pri Ming/Marketin , Fine Art Shipping 1750 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the se>v"ices that'vvill beprovided: The funds awarded will go towards exhibition and related event expenses and will greatly help enable us to offer the one of a kind exhibitions, events, special projects and programs we are known for. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit ❑r impact the Cupertino community: Cupertino is committed to being a multicultural city that appreciates and respects the complexity and richness of our residents.Euphrat Museum exhibitions,programs and events reflect the diverse heritage of our area and provide a resource of visual ideas and a platform for communications among all constituencies_This contributes to the City's ongoing goal of citizen engagement_ As Cupertino's only art museum,the Euphrat serves the community through one of a idnd exhibitions,events,special projects,and outreach through our Arts&Schools Program.The Euphrat itself provides a place where community can gather and participate in a range of enriching educational activities. Through participation in city festivals,collaborative public art projects,and more,we hope to help foster a deeper sense of community in Cupertino and bring residents of all ages together. The arts are instrumental in creating a sense of place,fostering a sense of belonging,and preserving col,lective memory.Supporting culture and creativity is essential for vibrant sustainable cities like Cupertino.Art is a vital tool for engaging community and articulating our shared values. 12. Who will be served by this rant? N lseasmweplarmpn ntaT �matedd^ate-Wmla an nspM by the Year Ylnenger no Wxrtratl &In wnt wOl pi—ni an eyYWm rardetl In Agin ftrt s VaYyRe s'=3—MaWm ,wd N me spHg preeenl the a—A Ile Ana ShdudArt SI—A new oallabualhv pubk art pn*t kT d"C perU m n%Umt&W U also be nita E& ms yearan�o,perscn a Uu.,—gm-4Wenean lwranoer"ends Febnay 17,ma2 n spnng arell pmsei¢to oe�amen[me snow am a cmlenoraure motile rm.al VW Wq=Drt ladnaee,am Resulencr,mandums ab wn Mn mom man 1W aprfwo rmtlena a A 3g—nib ag=popip'mural Ot be appea"I—Rr.sdemee d ba announcetl. a) Number of individuals total:116750 b) Number of Cupertino residents: 111500 c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? All exhibitions and events are open to the entire community. 211 PRC Meeting 03.03.22 Page 212 of 306 d) Will there be a charge or fee for the program1project/event(if applicable)? All exhibitions and events are free of charge. 13. If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: Not applicable. 14. Describe any funding requested from other agencies organizations in regard to this program/project/event request.Indicate whether the f coding was granted, denied, or is still pending: Not applicable. 212 PRC Meeting 03.03.22 Page 213 of 306 INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. O. BOX 2509 ctNciNNATI, OH 45201 JAN 02 2001 Employer Identification Number; Late ; 44-325822fl DLN 17053274041030 FOOTKILL-DE ANZA COMMUNITY COLLEGES Contact Person- FOUNDATION NANCY L PRAT14912 ZD4 31306 12345 EL MONTE Rn Contact Telephone Number- LOS ALTOS HILLS. CA 94022 �a77) 829-5500 Our Letter Dated; April 1997 Addendum Applies No Deax Applicant: This modifies our letter of the above date in which we stated that you would be treated as an arganiaation that is not a private foundation until the expiration of your advance ruling period. Your exempt status under section 501 (a) -of the internal RevenLke Code as an organization described in section 501 �0 (31 is still in effect. Based on the information you submitted, we have determined that you are not a private foundation within the meaning of section 509 �a) of the Code because you are an crganization of the type described is section 509fa) (1) and 170 (b) (1) W (iv) . Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary_ However, if you lase your section 509 (a) (1) statue, a grantor or contributor may not rely on this determination if he or she was in part responsible for. or was aware of , the act or failure to act, or the substantial or material change on the part of the ❑rganizat-ion that resulted in your loss of such xitatus, or if he or she acquired knowledge that the Internal Pevenue Service had given notice that you would na lodger be classified as a section 509(a) (1) organizaC ion. You are required to make your annual information return. Form 990 or porm 990-8 , available Eor public inspection for three years after the later of the due data of the return or the date the return is filed. You are alao required to make available for public inspection your axemption application, any supporting documents, and your exemption letter. Copica of these documents are also required to be provided to any individual upon written or in person request without charge other than reasonable fees for copying and postage_ You may fulfill this requirement by placing these documents on the Internet. Penalties may tie imposed for failure to comply with these requirements- Additiorxal information is available in publicati❑r1 557, Tax-Exempt Status for Your Organization, or you may call our toll free number shown above- if we have indicated in the heading of this letter that an addendum applies, the addezidum enclosed is an integral part of this letter. Letter 1050 tDO/M 213 PRC Meeting 03.03.22 Page 214 of 306 -2- POOTHILT,-DE ANZA C4C+d+7MI';Y COLLEGES Because this letter could help resolve any questions about your private foundation status, please keep it in your permanen[ records . It you have any questions, please contact the person whose name and telephone number are shown above. sincerely yours, Steven T. M.11ler Director, Exempt organizations Letter 10S4 (DO/CQ) 214 PRC Meeting 03.03.22 Page 215 of 306 Euphrat Museum of Art's Income Statement for fiscal year 2020 — 2021 SUPPORT De Anza Associated Student Government grant $8,650 Individual Donations/Event Fundraisers $10,548 Individual donations $15,000 $25,548 County and City City of Cupertino $10,000 Subtotal support $441198 REVENUES Arts & Schools Program Fees/Services 2020 De Anza Summer Academy with Community Education Division $14,765 Interest/Payout Income $3,120 Subtotal revenue $17,885 TOTAL INCOME $62,083 EXPENSES Director's salary $85,980 Part-Time Staff Preparator $3,172 Arts & Schools Program Instructors $0 (Summer Academy instructor fees deducted from final revenue check) Pt Thursday open mic host and special guest fees (L.E.A.'s with DASG) $4,200 $7,372 Hourly Students Student Salaries $0 Benefits Director $35,252 Casual Hourly $288 Student Hourly $0 $35,540 Subtotal Salaries + benefits $128,892 215 PRC Meeting 03.03.22 Page 216 of 306 Marketing Reception and event refreshments and meals $0 Postage $310 Online ad fees $375 Promotional vinyl signage $0 Announcement postcards and event flyers $00 $685 Exhibition/Production `Hope and Solace' banners $3,891 Exhibition and public art supplies and materials $68 Fine Art and Fed Ex shipping $0 Arts & Schools Program supplies and materials $3,959 Production Services Tech & Prof Services (total) $3,500 Travel $0 Other Equipment Rent/Lease $0 TOTAL EXPENSES $137,036 REVENUE OVER EXPENSES (-$74,953) Note: In-kind support from the college is not included(i.e. facility and maintenance) 216 PRC Meeting 03.03.22 Page 217 of 306 Euphrat Museum of Art 2020 - 2021 Exhibitions/Events Report Cupertino Community Funding Grant Sources of Solace Online exhibition November 1 - ongoing Sources of Solace explores what makes us feel more connected to life and each other in challenging times. This evolving virtual exhibit was presented in conjunction with Silicon Valley Reads 2021. Themes include expressing emotions and care, finding comfort in nature and food, with gratitude, and rescue animals and the people whose lives they transform. Hope and Solace Public Poetry Project April 15, 2020- December 15, 2021 A series of scroll-like eight-foot-tall banners circled with the breeze flashing poetry at passing cars and pedestrians. One side included art with three-word phrases about hope and the other featured poetic contributions by accomplished and budding poets, from Cupertino to New York. At the top of each banner were the characters for the word hope in different AAPI languages, ❑ message of support and solidarity in Cupertino where close to 6876 of residents identify as Asian American. 2021 De Anza Student Show Online exhibition May 1 - ongoing Paintings, drawings, mixed-media works, photography, graphic design, sculpture, ceramics, and more created by students at De Anza College. Online Arts and Humanities Programs Reclaiming Our Humanity, October 20, 6:30-7:30 p.m., featured poetry and reflections by local poet laureates and artists and a chance to reconnect with 217 PRC Meeting 03.03.22 Page 218 of 306 campus and community. Poet Laureates included Jing Jing Wang of Cupertino and Arlene Biala, Santa Clara County. Dreaming and Imagining, February 4, 6:30- 7:30 p.m., featured chef and social justice activist Jocelyn Jackson and other community caretakers and cultural curators. Hope Takes Shape, May 20, 6:30-7:30 p.m., featured AAPI musicians, poets, and artists and celebrated the power of the Arts and Humanities to preserve and give voice to our diverse stories. The event included a Tabla performance by Cupertino Fine Arts Commissioner Satish Tare and his sons, The Last Hoisan Poets and the Del Sol Quartet, and more. 1st Thursday Open Mic Nights, December 3, April 1 , May 6, and June 3, hosted by McTate Stroman II with special guests each event. Other: • Silicon Valley Reads' Kickoff with Sources of Solace Slideshow, 1/28/21 • Presentation to San Jose High School Art Classes, 1/25/21 • Art with Poetry workshop for De Anza students, guest artists Juliana Kang- Robinson, Flo Oy Wong, Jing Jing Wang, 3/9/21 • Director a Cupertino Rotary Club High School Poetry Contest Judge, 5/21 Select Press: Silicon Valley Reads: Euphrat exhibit provides `Sources of Solace' https://www.mercurynews.com/2021/01/16/euphrat-exhibit-provides-sources-of- solace De Anza public art project aims to give `Hope and Solace' https://www.mercurynews.com/2021/06/06/de-anza-public-art-project-aims-to- give-hope-and-solace/ 2020-2021 Grant Expenditure Details Admin staff - $1,800 • Applied to Director's salary Materials/Equipment - $3,891 • Hope and Solace project outdoor banners + equipment 218 PRC Meeting 03.03.22 Page 219 of 306 Technical/Professional - $1,500 • Designer for Hope and Solace banner series, Juliana Kang-Robinson Marketing (online) - $375 • Instagram, Facebook, Constant Contact Total = $7,566* Due to the pandemic and community closures we were not able to utilize all of the grant funds by June 2021 . The remaining $2,434 has been applied to 2021- 2022 museum exhibitions and events, details will be in the 2021-2022 report. Attendance Exhibitions and programming in 2020-2021 were online and included a public art/poetry project at the perimeter of De Anza College on Stevens Creek Blvd. and Stelling Road. Estimated online views of exhibitions and related events: total 6,440 Estimated viewers of Hope and Solace project: Pedestrians - c. 1,650 Vehicles waiting at stoplights - c. 32,500 219 PRC Meeting 03.03.22 Page 220 of 306 Euphrat Museum of Art (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the X program/project/event Identify how the funds will be used to benefit the Cupertino X community Be awarded only once per project X For specific needs,not on going,operational costs X Have more than 75%of the requested funds allocated for direct X service costs versus administrative costs Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission N IV O PRC Meeting 03.03.22 Page 221 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTION 1 : CONTACT INFORMATION Full Legal Organization Name:1 Monta Vista High School Speech Boosters Inc Website:I https:llmvsd.team/ Address] 21840 McClellan Road City: Cupertino State: CA Zip:195014 Phone: 1 (669) 256-2025 Organization President/Executive Director Name and Title: I Rajeswari Mahalingam Email:I m raj i27@gmail_com Phone: 1408 838 6093 Contact Name and Title: (If different) Email: Phone: SECTION • • •' • 501(c)(3)?: t,'e5 Year Established:tila {i f different than abozle address information) Sponsor Name:IMonta Vista High School Speech Boosters Inc Sponsor Address:121840 McClellan Road City: Cupertino State: CA Zip: 5014 Phone: (669) 256-2025 Federal Tax ID: 82-2152635 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: J$93288.07 Total# of Board Members: 4 Total#of staff:18 Total#of Volunteers:4 221 PRC Meeting 03.03.22 Page 222 of 306 Mission Statement: We are a 501(c)(3) non-profit organization with the mission to support and strengthen the Speech program and community at Monta Vista High School, Cupertino CA 95014. Our program priorities are: - Support our students in their goal to continuously improve their public speaking and argumentation skills - Increase team participation and success - Provide coaches and resources to inspire learning - Expand the reach of the Monta Vista Speech program Brief Description of Organization and Services Provided: - To create a long-term sustainable fund for the Monta Vista Speech program in order to sponsor the projects and initiatives that benefit the cause of excellence in public speaking - To provide additional resources for the Monta Vista Speech program through educational curriculum and/or the hiring of experienced personnel - To sponsor expenditures to tournaments at a significant distance from MVHS - To support Speech members in their journey to build excellence and rigor in public speaking through coaching students at the high school, middle school and elementary school levels - To sponsor the Annual Speak Up! Summer Program, a speech program for incoming Fl1HSD freshmen - To build the Manta Vista Alumni Network REQUESTSECTION 4: GRANT 1. Program/Project/Event Name: monta Vista Speech Program 2. Date(s) and/or duration of program/project/event (if applicable): Fiscal year 2022 -23 (July 2022 - June 2023) 3. Total prograliVproject/event budget: $193288.07 4. Requested Amount: 10,000 Percent of total program/project/event budget: 1 Q % 5. Miat percentage of your organization's projected income does your funding request represent? 72 % 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 12017 (year) New program/project/event 222 PRC Meeting 03.03.22 Page 223 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 10606,60 1 (ongoing operational cost) b) Materials/Equipment$© c) Entertainment$6 d) Room/Venue Rental$® e) Other Professional Services such as f) Other 10 $ 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will beprovided: [1] Strive to provide excellent public speaking education and competition opportunities for our growing student body despite declining member donations during the COVID pandemic [a] Hire and support additional coaches [b] Invest in speech instructional materials [2] Broaden the summer camp to increase the level of professional coaching and encompass several branches of public speaking. Open to all incoming Fl1HSD freshmen. [3] initiate Speech scholarships to provide financial aid to deserving MVHS students for participating in summer camp and tournaments, and for recognizing excellence and outstanding contributions to public speaking. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit or impact the Cupertino community: MV Speech Boosters extends the mission of our city by providing support and opportunities for our student community to take responsibility and leadership roles as well as sharpen their public speaking and communication/collaboration skills. Our successful feeder middle school program provides leadership and mentor-ship roles for our speech members. Our success in tournaments proves the effectiveness of our coaches. Manta Vista Speech team is ranked 4th in California and 18th nationwide. 12. Who will be served by tlus rant? All mi (Kennedy, awson and highschool on is students I children in the community served by the Monta Vistaarea of the city of Cupe mo_ Monta Vista high school currently serves approximately 2,193 students in grades 9-12. Kennedy middle school currently serves approximately 1,132 students in grades 6-8- Lawson middle school currently serves approximately 1,139 students in grades 6-8- a) Number of individuals total:14464 b) Number of Cupertino residents: 14464 c) Will the program/project/event be available to the entire commm-dty/public or are there any eligibility criteria? All middle(Kennedy,Lawson)and high school(Monte Vista)students t children in the community served by the Monta Vista area of the city of Cupertino.Monta Vista high school currently serves approximately 2,193 students in grades 9-12. Kennedy middle schoof currently serves approximately 1,132 students in grades 6-8- Lawson middle school currently serves approximately 1,139 students in grades 6-9- 223 PRC Meeting 03.03.22 Page 224 of 306 d) Will there be a charge or fee for the progranilproject/evenit(if applicable)? There is no charge or fee for this program. We entirely rely on contributions from the parent community to provide all our speech members a comprehensive speech curriculum, high-quality instruction and tournament preparation. We encourage a voluntary donation from our members at the time of registration. 13. If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: No, we were approved for the Community Funding grants partially last year 2421-22 for the first time. 14. Describe any funding requested from other agencies/organizations in regard to this program/project/event request.Indicate whether the funding was granted, denied, or is still pending: Not Applicable as we haven't yet applied to any other agencieslorganizations other than city of Cupertino 224 PRC Meeting 03.03.22 Page 225 of 306 INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. O. BOX 2508 CINCINNATI, OH 45201 Employer Identification Number: Date: AUG 21 2017 82-2152635 DLN: 26053626001657 MONTA VISTA HIGH SCHOOL SPEECH Contact Person: BOOSTERS INC CUSTOMER SERVICE ID# 31954 21840 MCCLELLAN ROAD Contact Telephone Number: CUPERTINO, CA 95014-0000 '(877) 829-5500 Accounting Period Ending: July 31 Public Charity Status: 509 (a) (2) Form 990/990-EZ/990-N Required: ._-- -- _ Yes Effective Date of Exemption: July 5, 2017 _ Contribution Deductibility: Yes Addendum Applies: No Dear Applicant: We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c) (3).. Donors .can `deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC. Section 501(c) (3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top. of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard) . If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c) (3) Public Charities, .which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 225 PRC Meeting 03.03.22 -2- Page 226 of 306 MONTA VISTA HIGH SCHOOL SPEECH Sincerely, Director, Exempt Organizations Rulings and Agreements Letter 947 226 PRC Meeting 03.03.22 Submission of Exemption Request ■ Pag'62;7A&�ORM Exemption Based on Internal Revenue Code(IRC)Sections 501(0)(3),501(c)(4),501(c)(5), 3500A 501(c)(6),or 501(cX7),Federal Determination Letter Enclose a copy of the Federal IDetermination Letter. Organization information Calllorn a corporation numherlCalitomia Secretary of State five number FEIN C4042901 822152635 Name of organization as shown in the creating document Manta Vista High School Speech Boosters Inc. Street address(suite,room,or PMS no.) Telephone 21840 McClellan Road 4083667600 City state ZIP code Cupertino CA 95014 Representative Information Name of representative to contact regarding additional requirements or information T e Ashwini Mahajan ress{suite,roam,or PMB na} City State ZIP code Cupertino CA 95014M Part 1—Entity information 1 Entity type(check applicable box): ®Corporation ❑Association ❑Trust ❑Foreign corporation(State of incorporation) 2 Does the IRS consider the organization a private foundation?... . ... . . .. . .. . . .. . . .. . . . .. . ... .... — . ... . ... . .. 2 ❑Yes 6e No 3 When did the organization establish,incorporate, organize,or conduct business in California?. .. . . .. . . ... . ... . ... . .. 3 07 1 fly 12017 4 Provide gross receipts for the current year and the three immediately preceding taxable years in existence.Gross receipts are defined as the total amounts the organization received from all sources during its annual account period without subtracting any costs or expenses.if the organizatian has been in existence for less than one year,provide the projected amount of gross receipts for the enti re year.List the account period beginning to the account period ending, Example:mmldd"y Current Year or Projected Gross Receipts for the three immediately preceding taxable years: Gross Receipts From: From: From: From: TO. To: To: To: 25000 5 Has the IRS ever suspended,revoked,or audited the organization? . . . .. . . .. . . .. . . ... . .. . ... . ... . ... . ... . ... . .. 5 ❑Yes F No it"Yes,"explain — Part 11—Group Exemption. See instructions. 6 is the organization applying for a group exemption?. . . .. . . .. . ... . ... . .... ........ ... . ... . ... . ... . .. . .. . .. fi El Yes M No If"Yes,"attach the federal group determination letter and a list of all California subordinates.Include each subordinate's name, corporation number.Federal employer identification number(FEIN),and address. Mail form FTI3 3500A and a caps of the federal determination letter to: EXEMPT ORGANIZATIONS UNIT, MS F120,FRANCHISE TAX BOARD, PO BOX 1286, RANCHO COR➢OVA CA 95741-1286, Under penalties of perjury,I declare I have examined this submission emption based on the IRC Sections 501(c)(3),501(c)(4),501(c)(5), 501(c)(6),or 501(c)(7),federal determination letter,and to the f knowledge and belief,it is true,correct,and complete. 9/15/2017 Board of Directors President DATE 5I Tl1R O OFFICER OR REPRESENTATIVE TITLE r�^ 8091163 I r iT8 3500A C1U1t3~Side'I ' 227 PRC Meeting 03.03.22 . Page 228 of 306 Part III— Purpose and Activity 1 Exemption based on IRC 501(c)(3)Federal Determination Letter Check the organization's primary purpose and activity: ❑Charitable ®Educational ❑Literary ❑ Prevent cruelty to animals ❑Prevent cruelty to children ❑Testing for public safety ❑Religious ❑Scientific ❑Church ❑School ❑Hospital ❑Health care center ❑Qualified sports organization 2 Exemption based on IRC 501(c)(4) Federal Determination Letter Check the organization's primary purpose and activity: ❑Civic league ❑Local association of ❑Social welfare ❑Service clubs ❑Veterans employees ❑Legislative activities ❑Festival organizations ❑Municipal building ❑ Police,sheriff, ❑Quasi governmental corporation volunteer firemen association 3 Exemption based on IRC 501(c)(5)Federal Determination Letter Check the organization's primary purpose and activity: ❑Agriculture ❑Horticulture ❑Labor ❑Agriculture or horticulture county fair ❑Public employees union ❑AFL-CIO ❑Independent ❑Transportation ❑Teamsters workers 4 Exemption based on IRC 501(c)(6)Federal Determination Letter Check the organization's primary purpose and activity: ❑Board of trade ❑Business league ❑Chamber of commerce ❑ Real estate board ❑Professional association or society 5 Exemption based on IRC 501(c)(7)Federal Determination Letter Check the organization's primary purpose and activity: ❑Social and recreational ❑Golf club ❑Camps ❑ Fraternity or sorority ❑Dog or horse club ❑Car,motorcycle, ❑Hunting or ❑Common recreational ❑Flying or airplane club trailer club fishing club area FTB 3500A C1 2016 Side 2 8092163 228 PRC Meeting 03.03.22 Page-2-29 of 30-6 Acknowledgement and General Information for Entities That File Returns Electronically 2020 Name(s)as shown on return Employer Identification Number MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC **-***2635 Entity address 21840 MCCLELLAN ROAD Cupertino, CA 95014 Thank you for participating in IRS a-file. 1.0 2020 990EZ income tax return for Federal was filed electronically. The electronic filing services were provided by ABC TAX AND ACCOUNTING 2. X� 990EZ income tax return was accepted on 10-31-2021 using a Personal Identification Number(PIN)as an electronic signature.The entity entered a PIN or authorized the Electronic Return Originator(ERO)to enter or generate a PIN signature. The submission ID assigned to this return is 7723922021304i4kcvt0 PLEASE DO NOT SEND A PAPER COPY OF ENTITY'S RETURN TO THE IRS. IF YOU DO, IT WILL DELAY THE PROCESSING OF THE RETURN. EF AMLD 229 PRC Meeting 03.03.22 Short Form Page 210WOW 1545-0047 Form 990-EZ Return of Organization Exempt From Income Tax 2020 Under section 501(c),527,or 4947(a)(1)of the Internal Revenue Code(except private foundations) ► Do not enter social security numbers on this form as it maybe made public. Open to Public Internal Revenunt of e Service ► Go to www.irs. ov1Form990EZ for instructions and the latest information. Inspection Internal Revenue Service g A For the 2020 calendar year,or tax year beginning 07-01 2020,and endin 06-30 52021 B Check if applicable: C Name of organization D Employer identification number ❑ Address change MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82-2152635 ❑ Name change Number and street(or P.O.box if mail is not delivered to street address) Room/suite E Telephone number ❑ Initial return ❑ Final return/terminated 21840 MCCLELLAN ROAD (408)797-7443 ❑ Amended return City or town,state or province,country,and ZIP or foreign postal code F Group Exemption ❑ Application pending Cupertino, CA 95014 1 Number ► G Accounting Method: 0 Cash ❑ Accrual Other(specify) ► H Check► 0 if the organization is not Website: ► required to attach Schedule B J Tax-exempt status(check only one)- 0 501(c)(3) ❑501(c)( ) / (insert no.) ❑ 4947(a)(1)or ❑527 (Form 990,990-EZ,or 990-PF). K Form of organization: 0 Corporation ❑ Trust ❑ Association ❑ Other L Add lines 5b,6c,and 7b to line 9 to determine gross receipts. If gross receipts are$200,000 or more,or if total assets (Part II,column(B))are$500,000 or more,file Form 990 instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . ► $ 88,615 Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances(see the instructions for Part 1) Check if the organization used Schedule O to respond to any question in this Part I 0 . . . . . . . . . . . . . . . . . . . 1 Contributions,gifts,grants,and similar amounts received . . . . . . . . . . . . . . . . . . . . . . . . . . 1 53,221 2 Program service revenue including government fees and contracts. . . . . . . . . . . . . . . . . . . . . . 2 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Investment income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5a Gross amount from sale of assets other than inventory . . . . . . . . . . . . . 5a b Less:cost or other basis and sales expenses. . . . . . . . . . . . . . . . . . 5b c Gain or(loss)from sale of assets other than inventory(subtract line 5b from line 5a) . . . . . . . . . . . . 5c 6 Gaming and fundraising events: a Gross income from gaming(attach Schedule G if greater than $15,000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a b Gross income from fundraising events(not including $ of contributions from fundraising events reported on line 1)(attach Schedule G if the sum of such gross income and contributions exceeds$15,000) . . . . . . . . . 6b c Less:direct expenses from gaming and fundraising events . . . . . . . . . . . 6c d Net income or(loss)from gaming and fundraising events(add lines 6a and 6b and subtract line 6c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6d 7a Gross sales of inventory,less returns and allowances. . . . . . . . . . . . . . 7a b Less:cost of goods sold. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7b c Gross profit or(loss)from sales of inventory(subtract line 7b from line 7a). . . . . . . . . . . . . . . . . . 7c 8 Other revenue(describe in Schedule O) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 35,394 9 Total revenue. Add lines 1,2,3,4,5c,6d,7c,and 8. ► 9 88,615 . . . . . . . . . . . . . . . . . . . . . . . . . 10 Grants and similar amounts paid(list in Schedule O} . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 11 Benefits paid to or for members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Salaries,other compensation,and employee benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 y13 Professional fees and other payments to independent contractors . . . . . . . . . . . . . . . . . . . . . . 13 50,401 a14 Occupancy,rent,utilities,and maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 j t 15 Printing,publications,postage,and shipping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 324 16 Other expenses(descr be in Schedule O). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 44,310 17 Total expenses. Add lines 10 through 16. ► 17 95,035 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Excess or(deficit)for the year(subtract line 17 from line 9) . . . . . . . . . . . . . . . . . . . . . . . . . 18 (6,420) w 19 Net assets or fund balances at beginning of year(from line 27,column(A))(must agree with m Qend-of-year figure reported on prior year's return). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 39,052 20 Other changes in net assets or fund balances(explain in Schedule O). . . . . . . . . . . . . . . . . . . . 20 Z 21 Net assets or fund balances at end of year.Combine lines 18 through 20. . .► 21 32,632 For Paperwork Reduction Act Notice,see the separate instructions. Form 990-EZ(2020) EEA 230 PRC Meeting 03.03.22 Form 990-EZ(2020) MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82$a --pf 306 Page 2 Part II Balance Sheets(see the instructions for Part II) Check if the organization used Schedule O to respond to any question in this Part II ❑x . . . . . . . . . . . . . . . . . . . . (A)Beginning of year (B)End of year 22 Cash,savings,and investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,057 22 32,815 23 Land and buildings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 23 0 24 Other assets(descr be in Schedule O) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 24 0 25 Total assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,057 25 32,815 26 Total liabilities(describe in Schedule O) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 26 183 27 Net assets or fund balances(line 27 of column(B)must agree with line 2a). 39,052 27 32,632 Part III Statement of Program Service Accomplishments(see the instructions for Part III) Expenses Check if the organization used Schedule O to respond to any question in this Part III . . ❑ (Required for section What is the organization's primary exempt purpose? HIGH SCHOOL SPEECH BOOSTER CLUB 501(c)(3)and 501(c)(4) Describe the organization's program service accomplishments for each of its three largest program services, organizations;optional for as measured by expenses. In a clear and concise manner,describe the services provided,the number of others.) persons benefited,and other relevant information for each program title. 28 HIGH SCHOOL SPEECH INTER SCHOOL TOURNAMENT (Grants $ ) If this amount includes foreign grants,check here . ► ❑ 28a 0 29 (Grants $ ) If this amount includes foreign grants,check here . ► ❑ 29a 30 (Grants $ ) If this amount includes foreign grants,check here . ► ❑ 30a 31 Other program services(describe in Schedule O) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Grants $ ) If this amount includes foreign grants,check here . ► ❑ 31a 32 Total program service expenses(add lines 28a through 31a). . ► 32 0 Part IV List of Officers,Directors,Trustees,and Key Employees(list each one even if not compensated-see the instructions for Part IV) Check if the organization used Schedule O to respond to any question in this Part IV El. . . . . . . . . . . . . . . . . . . . . . . . . (b) Average (c) Reportable (d) Health benefits, (a) Name and title hours per week compensation contributions to employee (a) Estimated amount of (Forms W-2/1099-MISC) benefit plans,and other compensation devoted to position if not paid,enter-0- deferred compensation Gopalswamy Rama Venkataraman CHIEF FINANCIAL OFFICER 8.00 0 0 0 Rajeswari Mahalingam CHIEF EXECUTIVE OFFICER 10.00 0 0 0 Lalitha Krishnan SECRETARY 2.00 0 0 0 Jasneet Anand Vice President 8.00 0 0 0 231 EEA Form 990-EZ(202,,1 PRC Meeting 03.03.22 Form 990-EZ(2020) MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 8;_=§F 24.1vt306 Page 3 Part V Other Information (Note the Schedule A and personal benefit contract statement requirements in the instructions for Part V.)Check if the organization used Schedule O to respond to any question in this Part V . ❑ Yes No 33 Did the organization engage in any significant activity not previously reported to the IRS?If"Yes,"provide a detailed description of each activity in Schedule O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 X 34 Were any significant changes made to the organizing or governing documents? If"Yes,"attach a conformed copy of the amended documents if they reflect a change to the organization's name.Otherwise,explain the change on Schedule O.See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 X 35 a Did the organization have unrelated business gross income of$1,000 or more during the year from business activities(such as those reported on lines 2,6a,and 7a,among others)?. . . . . . . . . . . . . . . . . . . . . . . . . . . . 35a X b If"Yes;'to line 35a,has the organization filed a Form 990-T for the year?If"No,"provide an explanation in Schedule Q . . . . . 35b c Was the organization a section 501(c)(4),501(c)(5),or 501(c)(6)organization subject to section 6033(e)notice, reporting,and proxy tax requirements during the year?If"Yes;'complete Schedule C,Part III. . . . . . . . . . . . . . . . . . 35c X 36 Did the organization undergo a liquidation,dissolution,termination,or significant disposition of net assets during the year?If"Yes;'complete applicable parts of Schedule N. . . . . . . . . . . . . . . . . . . . . . . . . 36 X 37 a Enter amount of political expenditures,direct or indirect,as described in the instructions . . . . . . . ► I 37a b Did the organization file Form 1120-POL for this year.?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37b X 38 a Did the organization borrow from,or make any loans to,any officer,director,trustee,or key employee or were any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?. . . . . . . . . . 38a X b If"Yes;'complete Schedule L,Part II,and enter the total amount involved . . . . . . . . . . . . . . . 38b 39 Section 501(c)(7)organizations. Enter: a Initiation fees and capital contr butions included on line 9. . . . . . . . . . . . . . . . . . . . . . . . 39a b Gross receipts,included on line 9,for public use of club facilities. . . . . . . . . . . . . . . . . . . . 39b 40 a Section 501(c)(3)organizations. Enter amount of tax imposed on the organization during the year under: section 4911 ► ;section 4912 ► ;section 4955 ► b Section 501(c)(3),501(c)(4),and 501(c)(29)organizations. Did the organization engage in any section 4958 excess benefit transaction during the year,or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ?If"Yes;'complete Schedule L,Part I. . . . . . . . . . . . 40b X c Section 501(c)(3),501(c)(4),and 501(c)(29)organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955,and 4958 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► d Section 501(c)(3),501(c)(4),and 501(c)(29)organizations. Enter amount of tax on line 40c reimbursed by the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► e All organizations.At any time during the tax year,was the organization a party to a prohibited tax shelter transaction?If"Yes;'complete Form 8886-T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40e X 41 List the states with which a copy of this return is filed ► 42 a The organization's books are in care of ► Gopalswamy Rama Venkataraman Telephone no. ► 408-797-7443 Locatedat ► 21921 Dolores Ave, Cupertino, CA ZIP+4 ► 95014 b At any time during the calendar year,did the organization have an interest in or a signature or other authority over Yes No a financial account in a foreign country(such as a bank account,securities account,or other financial account)? . . . . . . . . . 42b X If"Yes;'enter the name of the foreign country ► See the instructions for exceptions and filing requirements for FinCEN Form 114,Report of Foreign Bank and Financial Accounts(FBAR). c At any time during the calendar year,did the organization maintain an office outside the United States2 . . . . . . . . . . . . . 42c X If"Yes;'enter the name of the foreign country ► 43 Section 4947(a)(1)nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041-Check here. . . . . . . . . . . . . . . ► ❑ and enter the amount of tax-exempt interest received or accrued during the tax year. . . . . . . . . . . . . . . . . . ► 43 Yes No 44 a Did the organization maintain any donor advised funds during the year?If"Yes,"Form 990 must be completed instead of Form 990-EZ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44a X b Did the organization operate one or more hospital facilities during the year?If"Yes,"Form 990 must be completed instead of Form 990-EZ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44b X c Did the organization receive any payments for indoor tanning services during the year? . . . . . . . . . . . . . . . . . . . . . 44c X d If"Yes;'to line 44c,has the organization filed a Form 720 to report these payments?If"No;'provide an explanation in Schedule O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44d 45 a Did the organization have a controlled entity within the meaning of section 512(b)(13)? . . . . . . . . . . . . . . . . . . . . . 45a X b Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)?If"Yes;'Form 990 and Schedule R may need to be completed instead of Form 990-EZ.See instructions 45b X EEA Form 990-EZ(2020) 232 PRC Meeting 03.03.22 Form 990-EZ(2020) MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC a:f_=!��43)9306 Page Yes No 46 Did the organization engage,directly or indirectly,in political campaign activities on behalf of or in opposition to candidates for public office? If"Yes,"complete Schedule C,Part I . . . . . . . F46 X Part VI Section 501(c)(3) Organizations Only All section 501(c)(3)organizations must answer questions 47-49b and 52, and complete the tables for lines 50 and 51. Check if the organization used Schedule C to respond to any question in this Part VI . . . . . . . . . . ❑ Yes No 47 Did the organization engage in lobbying activities or have a section 501(h)election in effect during the tax year?If"Yes,"complete Schedule C,Part 11 . . . . . . _ . . . . . . . . . . . . . . . . . 47 X 48 Is the organization a school as described in section 170(b){1)(A)(ii)?If"Yes,"complete Schedule E. . . . . . . - 48 X 49a Did the organization make any transfers to an exempt non-charitable related organization? . . . . . . . 49a X b if"Yes,"was the related organization a section 527 organization? . . . . . . . . . . . . . . . . . . . . . . . . 49b 50 Complete this table for the organiization's five highest compensated empbyees(other than officers,directors,trustees and key empbyees)who each received more than$100,000 of compensation from the organization. If there is none,enter"None." (b)Average (c) Reportable (d)Health benefits, contributions to employee le) Estimated amount of (a) Name and tithe on each employee hours per week compensation benefit plans,and deferred other compensation devoted to position (Forms W-211099-MISC) oompensation NONE f Total number of other employees paid over$109,000. . . . . . 51 Complete this table for the organ ization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization_ If there is none,enter"None" (a)Name and business address of each independent contractor (b)Type of service (c) Compensation NONE d Total number of other independent contractors each receiving over$100,000. .■ 52 Dad the organization complete Schedule A?dote:All section 501(c)(3)organizations must attach a completed Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► X❑ Yes ❑ No Under penalties of perjury,i declare that i have examined his 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 han officer)is based on all information of which preparer has any knowledge_ Ga a i3wamy Rama. Venkataraman Sign Slgnatureofofficer Date Here Gopalswamy Rama Venkataraman, CHIEF FINANCIAL OFFICER Type or pr d name and title Printfrype preparers name Preparers signature Date Check ❑ if N Paid TEX YONG, EA �0-31-2021 sef-employed r00663070 Preparer Firms name ■ ABC TAX AND ACCO=ING Firm'sEIN ■ Use Only Firm'saddress ■ 770 RIELY BLVD Santa Clara CA 95051 Phone no. 409-688-6236 May the IRS discuss this return with the preparer shown above? See instructions ► X❑ Yes ❑ No . . . . . . . . . . . . . . . . . . . . . . EEA Form 990-EZ(2020) 233 SCHEDULE A Public Charity Status and Public Support PRc Pea e 234 @�o2ga5-ooa7 (Form 990 or 990-EZ) ��1 o Complete if the organization is a section 501(c)(3)organization or a section 4947(a)(1)nonexempt charitable tru Department of the Treasury ► Attach to Form 990 or Form 990-EZ. Open to Public Internal Revenue Service ► Go to www.irs.g,ov/Form990 for instructions and the latest information. Inspection Name of the organization Employer identification number MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82-2152635 Part I I Reason for Public Charity Status. All organizations must complete this part. See instructions. The organization is not a private foundation because it is:(For lines 1 through 12,check only one box.) 1 ❑ A church,convention of churches,or association of churches described in section 170(b)(1)(A)(i). 2 ❑ A school described in section 170(b)(1)(A)(ii).(Attach Schedule E(Form 990 or 990-EZ).) 3 ❑ A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii). 4 ❑ A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name,city,and state: 5 ❑ An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv).(Complete Part II.) 6 ❑ A federal,state,or local government or governmental unit described in section 170(b)(1)(A)(v). 7 ❑ An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi).(Complete Part II.) 8 ❑ A community trust described in section 170(b)(1)(A)(vi).(Complete Part II.) 9 ❑ An agricultural research organization described in section 170(b)(1)(A)(ix)operated in conjunction with a land-grant college or university or a non-land-grant college of agriculture(see instructions). Enter the name,city,and state of the college or university: 10 0 An organization that normally receives:(1)more than 33 1/3%of its support from contributions,membership fees,and gross receipts from activities related to its exempt functions-subject to certain exceptions;and(2)no more than 33 1/3%of its support from gross investment income and unrelated business taxable income(less section 511 tax)from businesses acquired by the organization after June 30, 1975.See section 509(a)(2).(Complete Part III.) 11 ❑ An organization organized and operated exclusively to test for public safety.See section 509(a)(4). 12 ❑ An organization organized and operated exclusively for the benefit of,to perform the functions of,or to carry out the purposes of one or more publicly supported organizations descr bed in section 509(a)(1)or section 509(a)(2).See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e,12f,and 12g. a ❑ Type I.A supporting organization operated,supervised,or controlled by its supported organization(s),typically by giving the supported organization(s)the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization.You must complete Part IV,Sections A and B. b ❑ Type It.A supporting organization supervised or controlled in connection with its supported organization(s),by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s).You must complete Part IV,Sections A and C. c ❑ Type III functionally integrated.A supporting organization operated in connection with,and functionally integrated with, its supported organization(s)(see instructions).You must complete Part IV,Sections A,D,and E. d ❑ Type III non-functionally integrated.A supporting organization operated in connection with its supported organization(s) that is not functionally integrated.The organization generally must satisfy a distr bution requirement and an attentiveness requirement(see instructions).You must complete Part IV,Sections A and D,and Part V. e ❑ Check this box if the organization received a written determination from the IRS that it is a Type I,Type II,Type III functionally integrated,or Type III non-functionally integrated supporting organization. f Enter the number of supported organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 g Provide the following information about the supported organization(s). (i)Name of supported organization (ii)E N (iii)Type of organization (iv)Is the organization (v)Amount of monetary (vi)Amount of (described on lines 1-10 listed in your governing support(see other support(see above(see instructions)) document? instructions) instructions) Yes No (A) (B) (C) (D) (E) Total For Paperwork Reduction Act Notice,see the Instructions for Form 990 or 990-EZ. Schedule A(Form 990 or 990-Ez)2020 FEA 234 PRC Meeting 03.03.22 Page 235 of 306 Schedule A(Form 990 or 990-EZ)2020 MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 82-2152635 Page Part III Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.) Section A. Public Support Calendar year(or fiscal year beginning in)► (a)2016 (b)2017 (c)2018 (d)2019 (e)2020 (f)Total 1 Gifts,grants,contributions,and membership fees received.(Do not include any"unusual grants.") 6,245 42,175 53,219 101,639 2 Gross receipts from admissions,merchandise sold or services performed,or facilities furnished in any activity that is related to the organization's tax-exempt purpose . . . . . . 3 Gross receipts from activities that are not an unrelated trade or business under section 513. 4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf . . . . . . . . 5 The value of services or facilities furnished by a governmental unit to the organization without charge . . . . . . . 6 Total.Add lines 1 through 5 . . . . . . . 6,245 42,175 53,219 101,639 7a Amounts included on lines 1, 2, and 3 received from disqualified persons . . . b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of$5,000 or 1%of the amount on line 13 for the year c Add lines 7a and 7b . . . . . . . . . . . 8 Public support. (Subtract line 7c from line 6.) . . . . . . . . . . . . . . . . . . . 101,639 Section B. Total Support Calendar year(or fiscal year beginning in)► (a)2016 (b)2017 (c)2018 (d)2019 (e)2020 (f)Total 9 Amounts from line 6 . . . . . . . . . . . 6,245 42,175 53,219 101,639 10a Gross income from interest,dividends, payments received on securities loans,rents, royalties,and income from similar sources 769 252 1,021 b Unrelated business taxable income(less section 511 taxes)from businesses acquired after June 30, 1975 . . . . . . c Add lines 10a and 10b . . . . . . . . . . 769 252 1,021 11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on 12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) . . . . . . . . . . . . 48,158 42,497 35,142 125,797 13 Total support. (Add lines 9, 10c, 11, and 12.) . . . . . . . . . . . . . . . . . . 54,403 85,441 88,613 228,457 14 First 5 years. If the Form 990 is for the organization's first, second, third,fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ► ❑ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Section C. Computation of Public Support Percentage 15 Public support percentage for 2020 (line 8, column (f), divided by line 13, column (f)) . . . . . . . . . 15 44.49 % 16 Public support percentage from 2019 Schedule A, Part III, line 15 . . . . . . . . . . . . . . . . . . . 16 0.00 % Section D. Computation of Investment Income Percentage 17 Investment income percentage for 2020(line 10c, column (f), divided by line 13, column (f)) . . . . . 17 0.00 % 18 Investment income percentage from 2019 Schedule A, Part III, line 17 . . . . . . . . . . . . . . . . . 18 0.00 % 19a 33 1/3%support tests-2020. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here.The organization qualifies as a publicly supported organization . . ► ❑x b 33 1/3%support tests-2019. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and line 18 is not more than 33 1/3%, check this box and stop here.The organization qualifies as a publicly supported organization ► ❑ 20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ► ❑ EEA Schedule A(Form 990 or 990-EZ)A 235 PRC Meeting 03.03.22 SCHEDULE O Supplemental Information to Form 990 or 990-EZ P geN16Of3W-0047 (Form 990 or 990-EZ) Complete to provide information for responses to specific questions on 2020 Form 990 or 990-EZ or to provide any additional information. Department of the Treasury ► Attach to Form 990 or 990-EZ. Open to Public Internal Revenue Service ► Go to wwwJrs.gov1Form990 for the latest information. Inspection Name of the organization Employer identification number MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC � 82-2152635 01. Description of other revenue (Part I, line 8) Description Amount TOURNAMENT INCOME 29,139 SALES OF PRODUCT INCOME 1,590 SUMMER CAMP INCOME 4,413 OTHER INCOME 252 02. Description of other expenses (Part I, line 16) Description Amount ACCOUNTING 1,896 TAX PREPARATION 439 TRANSPORTATION 30 WEB HOSTING 810 INSURANCE 540 BANK FEES 8 STRIPE FEES 2,124 ACCOUNTING SOFTWARE 211 LEAGUE MEMBERSHIP 900 SPEECH CURRICULUM 212 TOURNAMENT 27,663 ENTERTAINMENT 307 SPECIAL EVENTS 190 SUPPLIES 2,181 LEGAL 25 LEGAL SOFTWARE 100 For Paperwork Reduction Act Notice,see the Instructions for Form 990 or 990-EZ. schedule o(Form 990 or 990-Ez)(2020) EEA 236 PRC Meeting 03.03.22 Schedule O(Form 990 or 990-EZ)(2020) Page 237 of 306 page 2 Name of the organization Employer identification number MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC �82-2152635 PROJECT TRACKING SOFTWARE 600 BUSINESS ENABLEMENT SOFTWARE 2,236 OTHER NON PERSONAL EXPENSES 2,063 MARKETING 1,544 BILL PAY FEES 21 OTHER ORGANIZATION EXPENSES 210 03. Description of total liabilities (Part II, line 26) Category Beginning of Year End of Year CREDIT CARD 5 183 EEA Schedule O(Form 990 or 990-EZ)(2020) 237 PRC Meeting 03.03.22 Page 238 of 306 TAXABLE YEAR California Exempt Organization FORM 2020 Annual Information Return 199 Ca#endar Year 2020 or fiscal year beginning(mmiddlyyyy) D 7-01-2 0 2 0 and ending{mmlddlyyyy} 0 6-3 0-2 0 21 CorporationlOrganization name California corporation number MONTA VISTA HIGH SCHOOL SPEECH BOOSTERS INC 4042901 Additional information.See instrucfiais. FEIN 82-2152635 Street address{suite or roomy PMB no. 21840 MCCLELLAN ROAD City State Zip code CUPERTIND � CA 95D14 Foreign country name Foreign provirncelstatekourdy Foreign postal code A First return . . . . . . . . . . • . . . • . • . . • • . ❑ Yes ❑ No I Did the organization have any changes to its guidelines B Amended return . . . . . . . • . • . . . . . . . . • •❑ Yes ❑ No not reported to the FTB?See instructions . . . . • • • . • • ❑ Yes ❑ No C IRC Section 4947(a)(1)trust - - - - • - - - - • - - - - - - ❑ Yes ❑ No J If exempt under RSTC Section 23701d,has the organization D Final information return? engaged in political activities?See instructions O❑ Yes ❑ No O❑ Dissolved ❑ Surrendered Withdrawn) ❑ Merged/Reorganized K Is the organization exempt under R&TC Section 23701g? . . . . • . 0❑ Yes ❑ No Enter date:(mmlddfyyyy) 0 If"Yes,"enter the gross receipts from nonmember sources �$ E Check accounting method: (1)® Cash (2) ❑ Accrual (3) ❑ Other F Federal return filed? (1) ❑ 990T (2) 0❑ 990PF (3) O❑ Sch H(990) L Is the organization a limited liability company? • . • . • . . . . ❑ Yes ❑ No (4)® other 990 series M Did the organization file Form 100 or Form 109 to report G Is this a group filing?See instructions . . . . . . ❑ Yes ❑ No taxable income? . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No H Is this organization in a group exemption . . . . • . . • . • . ❑ Yes ❑ No N Is the organization under audit by the IRS or has the IRS If"Yes,"what is the parent's name? audited in a prior year) . • . • . . . • • . • • • • . . . . O❑ Yes ❑ No ❑ Is federal Form 102311024 pending? . . . . . . • . . . ❑ Yes ❑ No Date filed with IRS Part I Complete Part i unless not required to file this form. See General Information B and C. 1 Gross sales or recekpts from other sources. From Side 2,Part If,line E • • . • . . . • . . • . - . . • . . • . • • . 1 00 2 Gross dues and assessments from members and affiliates . . . . . . . . . . . . . . . . . • • • . • . • . . . . . 2 00 Receipts 3 Gross contributions,gifts,grants,and similar amounts received . . . . • . • . . . . • - • . . . . . • • . . 3 00 and Revenues 4 Total gross receipts for filing requirement test.Add line 1 through line 3. This line must be completed.If the result is less than$50,000,see General Information B . . • . . • . . . . • . . . • . . 4 D 00 5 Cast of goods sold. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - 5 00 6 Cost or other basis,and safes expenses of assets sold . • . • . . . • • . • . . • • . 0 6 00 7 Total costs. Add line 5 and line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 00 8 Total gross income.Subtract line 7 from fine 4• . . . . • • . . • . • • • . . . . . . • • • • • . • . • • . . • . • 0 8 00 9 Total expenses and disbursements. From Side 2,Part II,line 18 • • . • . • . • . . . . . . . . . . . . • . • . . • . . 0 9 00 Expense 10 Excess of receipts over expenses and disbursements. Subtract line 9 from line 8 • - • • . • • • . • . • • • - - - . . . 0 10 00 11 Total payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 11 00 12 Use tax.See General Infbmiation K . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - 0 12 00 Filing Fee 13 Payments balance.If tine 11 is more than fine 12,subtract fine 12 from fine 11 . • . • . . . . . • • . . . . . • . • . • • . 0 13 00 14 Use tax balance.If Ilene 12 is more than line 11,subtract line 11 from line 12 . • . • . . . . . • • . . . . . • . • . • • . 0 14 00 15 Penalties and Interest_See General Information J. . . . • • • . • . • • . . . • . • . • . • . • . . . . . . • . . . • . 15 00 16 Balance due.Add line 12 and line 15.Then subtract line 11 from the result . . . • • • . . . • • • - . . . - / 16 00 Under penalties of penury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,d is Sign true,correct,and complete_ Declaration of preparer(other than taxpayer)is based on all information of which preparer has any knowledge. Here Title Date -Telephone �r fice�e OGOPALSWAMY RAMA VENKATARAM HIEF FINANCI D/18/2021 408-797-7443 Date Check if self- OPT N Preparer's signature ■ �0/31/2021 employed ■ ❑ P 0 0 6 6 3 0 7 0 Paid •Firm's FEIN eparW% rm's name(or yours, Pr F Use Only if self-employed) ■ ABC TAX AND ACCOUNTING 8 7—12 3 6 D 4 0 and address 770 KI E LY BLVD •Telephone SANTA CLARA, CA 95051 408-688-6236 May the FTB discuss this return with the preparer shown above? See instructions . . . • • • . • . . • . - . . . . . • •® Yes ❑ No 04 3 3 6 512 0 4 r Form 199 2020 Side 1 238 PRC Meeting 03.03.22 Page 239 of 306 Part II Organizations with gross receipts of more than$50,000 and private foundations regardless of amount of gross receipts-complete Part II or furnish substitute information. 8 2—215 2 6 3 5 1 Gross sales or receipts from all business activities.See instructions • • . • • • • • . • . • • • • • . 0 1 00 2 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2 00 3 Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3 00 Receipts from 4 Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4 00 Other 5 Gross royalties • • • • • • • • • • • • • • • • • • . • • • • • . • . • • • • • . • . • • • • • . • . 0 5 00 Sources 6 Gross amount received from sale of assets(See Instructions) • • . • • • • • . • . • • • • • . • . • 0 6 00 7 Other income.Attach schedule • • . • • • • • • • . • • • • • . • . • • • • • . • . • • • • • • • • 0 7 00 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 00 9 Contributions,gifts,grants,and similar amounts paid.Attach schedule . • . • • • • • . • . • • • • • 0 9 00 10 Disbursements to or for members • • • • • • • • • • • • • • • • . • . • • • • • . • . • • • • • . • 0 10 00 11 Compensation of officers,directors,and trustees.Attach schedule • • . • • • • • . • . • • • • • . • 0 11 00 12 Other salaries and wages • • . • • • • • • • • • • • • • • • • • • • • • . • . • • • • • . • . • • • 0 12 00 Expenses 13 Interest • • • • • • • • • • • • • • • • • • . • • • • • . . . • • • • • . • . • • • • • . • • . . . . • 13 00 and 14 Taxes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • 14 00 Disburse- ments 15 Rents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • 15 00 16 Depreciation and depletion(See instructions) • • . • • • • • . . • • • • • • . • . • • • • • . • • • • • 16 00 17 Other expenses and disbursements.Attach schedule . . • • • • • • . . . • • • • • . . • • • • • • 0 17 00 18 Total expenses and disbursements.Add line 9 through line 17.Enter here and on Side 1,Part I,line 9 • • 18 00 Schedule L Balance Sheet Beginning of taxable year End of taxable year Assets (a) (b) (c) (d) 1 Cash. . . . . . . . . . . . . . . . . . . . . . 0 2 Net accounts receivable . • . • • • . • • • • . • 3 Net notes receivable • • • • • • • • • • • • • • • 4 Inventories• • • • • • • • • • • • • • • • • • • • 5 Federal and state government obligations • • • . • 6 Investments in other bonds • • • . • • • • • • • • 7 Investments in stock • • • • • • . • • • • • . . • 8 Mortgage loans . . . . . . . . . . . . • • • • • 9 Other investments.Attach schedule • • • . . . • 10 a Depreciable assets • • • • • • • • • • • . . b Less accumulated depreciation . . . . . . . 11 Land. . . . . . . . . . . . . . . . . . . . . . • 12 Other assets.Attach schedule • • • . . . . • • • 13 Total assets . . . . . . . . . . . . • • • • • Liabilities and net worth 14 Accounts payable . . . . . . . . . . . . • • • • 15 Contributions,gifts,or grants payable • • • . . • 16 Bonds and notes payable• • • • • • . • • • • . 0 17 Mortgages payable• • • • • • • • • • • . . . . 0 18 Other liabilities.Attach schedule • • . • • • . • 19 Capital stock or principal fund • • . • • • 20 Paid-in or capital surplus.Attach reconciliation • • 21 Retained earnings or income fund . • . • • . . • 22 Total liabilities and net worth • • . • • • . • Schedule M-1 Reconciliation of income per books with income per return Do not complete this schedule if the amount on Schedule L,line 13,column(d),is less than$50,000 1 Net income per books • • . • • • • • • • . • • • 7 Income recorded on books this year 2 Federal income tax • • . • • • • • • • . • • • • 0 not included in this return.Attach schedule 0 3 Excess of capital losses over capital gains • • • • 8 Deductions in this return not charged 4 Income not recorded on books this year. against book income this year. Attach schedule . . . . . . . . . . . . • • • • • Attach schedule • • • • • • • • • • • • • • 5 Expenses recorded on books this year not 9 Total.Add line 7 and line 8• • . deducted in this return.Attach schedule • • • . • 10 Net income per return. 6 Total.Add line 1 through line 5 • • • • . . . • • Subtract line 9 from line 6 • • . Side 2 Form 199 2020 043 3652204 239 Page 240 of 306 j9SPEECH e.. MONTA VISTA MV Speech Strategy and Budget 2022-23 Monta Vista Speech Boosters - Jan 21, 2022 PRC Meeting 03.03.22 Ij Speech _ Boosters Page 241 of 306 • Monta Vista Speech Boosters Inc is a registered 501(c)(3) nonprofit • Tax ID # 82-2152635 • Mailing Address: 21840 McClellan Rd, Cupertino, CA 95014 • Email: mvsboosters@8mail.con, MV Speech Boosters Board of Directors Manta Vista High School Raji Mahalingam President & CEO, Speech Boosters Gavin Wong Head Speech Coach, MVHS Jasneet Anand VP, speech Boosters Mike White Assistant Principal, MVHS Lalitha Krishnan Secretary, Speech Boosters I Rama Venkataraman CFO & Treasurer, Speech Boosters i 5PE 241 � MVSD & MV Speech Boosters - Do Not Distribute / ■ Vista ■ i at- a - glance • 131 awards YTa (+171D/o YoY) • 12 Tournament Champions ■ 6 tournaments, with 4 more planned • 60 Finalists ■ 118 speeches & 277 entries (+4% YoY) • 50 Semifinalists ■ 4th in CA for 2021 (300 schools in CA) . 21 Quarterfinalists and ■ 18th in U.S. for 2021 (3,500 schools in US) octofi n a l i sts • 1st in Speech at Berkeley (In 2021, 200+ schools) ■ 2nd overall at Stanford (In 2021, 350+ schools) ■ 3rd overall at Logan (In 2021, 100 schools) 5PE 242 MVSD & MV Speech Boosters - Do Not Distribute Speech Boosters : Areas of engagement Booster Fiuid Management S • Legal: Bylaws, FUHSD and IRS eecli Pr•agz•arii aerations compliant registration Membership Registration processes Assistant coaches and chaperones - • Finance, accounting, budgeting- hiring, onboarding, ongoing • Finance Plavbook compensation management Fundraising Advisory role for speech captains • Travel tournament planning Teclinology Investnneiits • Website platform and hosting Online practices: Zoom Pro Building Conm�rniity •• Project Management system: • Parent engagement (Parent Info Asana Night, Parent Coffees) • Watch scheduling: Ongoing communications simplybook.me • Newsletters f • Emergency forms: DocuSign Alumni Network •• Accounting/Sookkeeping VISTA Boosters website (coming soon!) V A 's;A stem: BQ - MV Speech Boosters: Goals for PRC Meeting 03.03.22 Page 244 of 306 • Ramp up new board members and volunteers to create a strong pipeline for next 2-3 years' • Hire Head Coach and fill gaps in assistant coaches/FUHSD chaperone positions • Targeted Outreach for annual membership drive and matching donations -grow membership to -150 • Launch Summer Camp • Run fundraisers in collaboration with Speech Captains • Sustain and further build upon Parent Community engagement • Build out/Support Alumni Network • Build out Boosters website • Continue to advise Speech Captains on Operations, Finance, PR etc • Support the flow of tournaments and PR events as in 2021-22 • Scholarships/Awards - Establish Senior Awards & PVSA seamlessly • Volunteer Recognition Programs - FUHSD Community Service Award • Establish Speech Booster board for 2022-23 /_0 C040-mg 41110:h-ffif MVSD & MV Speech Boosters - Do . 244� Not Distribute 45P EECH Speech _ Budget Model PRC Meeting 03.03.22 s I Page 245 of 306 Program Budget: $82K o Professional Coaching - approx 700 hours planned o Chaperones for Practices and Tournaments o Instructional Materials o Technology o Community Building Events o Partial support for qualifying students to attend States or Nationals o Note: Tournament Registration Fees are not covered by program budget since tournament participation varies by student Funding Model Speech Program is funded almost entirely by member donations (and corporate match), * No FUHSD funding available! o Main fundraiser is direct donations solicited during annual membership registration * Supplementary funding : a Summer Camp 2021 o Fundraisers and grants being explored A; J* p sPE 245 MVSD & MV Speech Boosters - Do Not Distribute PRC Meeting 03.03.22 DonationFunding - Membership Page 246 of 306 Did You Know? Donation Allocation by Program Category Team Events • Students scored our asst Operating Expenses coaches a 4.3 out of 5 in providing helpful feedback for their Chaperones 17.506 speeches' • Parents scored our chaperones 4.4 out of 5 in the level and quality of Coaches adult supervision at 70.9% tournaments and practices2 42465Pi 15ource: 2021 2022 MV Speech Fall Coach Feedback Survey Responses(n = 25) 2Source: 2019-2020 MV Speech Satisfaction Survey Responses (n = 18) MVSD & MV Speech Boosters - Do Not Distribute PRC Meeting 03.03.22 DonationFunding - Membership Page 247 of 306 Program Amount Category $ 81,600 expense budget / 150 Coaches $56,772 contributions* Chaperones $14,125 Operating $8,444 Expenses $ 400 Team Events $2,265 Donation / Member Total $81,606 *Assuming direct donations from 150 members plus 50 ; corporate matching donations sp'247's MVSD & MV Speech Boosters Do Not Distribute PRC Meeting 03.03.22 Mont ■ Vista Speech _ Year ■ ■ i Page 248 of 3Fk 06 1 i p. ! i p. i ass Core Areas MV Speech to Surpass • Membership levels at-150 active Membership levels at-15O active Membership levels at-180 active speech members speech members speech members • Pinnacle of"Team First" mentality is Club is"self-sustaining"where all Club is"self-sustaining"where all Cultivate Culture achieved members teach from the top- down members teach from the top - down &Team First MVSD presence at Orientation & Elective night • Healthy community of parents& administrators to support team • Summer Camp expands to cover Summer Camp best in Bay Area Summer Camp best in Bay Area additional public speaking categories; (N100 students&5 professional (-120 students &5 professional -50 students,3 professional coaches coaches &student volunteers) coaches&student volunteers) and 20+ student volunteers • KMS Speech hosts CHSSA Middle KMS Speech hosts CHSSA Middle KMS Speech hosts CHSSA Middle School State Champs(possibly online) School State Champs (online School State Champs (in-person statewide event) statewide event) • Alumni programs initiated - virtual • Alumni program established Alumni program established Strategic forums, mentorship, etc. Opportunities Scholarships granted to support Scholarship program established, Scholarship program established, deserving students for summer camp inspires students to strive for greater inspires students to strive for greater and tournament participation,and excellence in public speaking excellence in public speaking recognize excellence and outstanding Expand student funnel to Elementary contributions to MV Speech Host MVSD 50th celebration + School program • MVSD 50th anniversary + marquee Marquee Fundraiser event fundraiser planning completed Plan MV-run tournament open to ajj Screech students-`Cupertino Speech &Debate Monta Vista Invitational' 248� MVSD & MV Speech Boosters - Do Not Distribute PRC Meeting 03.03.22 Montr Vista Speech iStrategy Page 249 of 3Fk 06 1 i p. ! i p.ss 2i 11z5urpass Core Areas MV Speech to Surpass • Hire additional coaches and - Hire additional coaches and - Foundation in place for adding Speech chaperones for the year-round chaperones for the year-round to MV curriculum speech program to support the speech program to support the increased members/ Speech increased members/ Speech Categories Categories Competitive Excellence "Break ratio"surpasses other programs • Students qualifying to Nationals, NIEToC and States is a common NIEToC and States is a common occurrence occurrence Sweepstakes at qualifying tournaments • Booster fund reaches"steady state" - Ongoing grants to support Speech Ongoing grants to support Speech where it has capital to generate annual program program returns and ensures income to support the team's needs - MV Speech Boosters helps fund travel tournanents (+5 including CHSSA States, NIEToC, Nationals) • Expand grant applications to other Financial Health foundations 249 KV—Soec--eh-BeG eFsDo-Net-Djstr4bute SpeechMonta Vista MIM ro �r i Strategy 1 i p. ! i p.ss 2i iSurpass Core Areas MV Speech to Grow • Facilitate hybrid onJinelin-person - Facilitate TBD season Facilitate TBD season season {online/hybridlin-person} (online/hybrid/in-person) • Heavy use on website reduces Team is run like clockwork; 0 defects, burden on teaching captains as and reaches maximum efficiency novices have resources to succeed • Registration is fully automated • Team is run like clockwork; 0 defects, and reaches maximum efficiency Boosters website established • Registration is fully automated Expand Parent advisor, FUHSD Operational chaperone and board members Excellence Expand Parent advisor, FUHSD pipeline as needed chaperone and board member pipeline as needed • Streamline donation flow, PR such as parent communications,slide decks, annual reports, Fundraisers, etc. through the Boosters website 5Pl 250] MVSD & MV Speech Boosters - Do Not Distribute Monta Vista Speech - 3 -Year Trends ( 2020 - 22) eeting 03.03.22 age 251 of 306 Team competitive excellence on the riseM (See MV Speech Awards] 2019-20 • Banked 6th in CA,39th in US by NSDA • 16 tournaments attended (11 in-person, 5 online) • 187 awards including 6 tournament championships • Sweepstakes winners at Stanford (2nd) and Berkeley (6th) tournaments ■ 9 qualifying entries to CHSSA States, 2 qualifiers to NSDA Nationals, 9 qualifying entries to ToCs (Tournament of Champions) 2020-21 • Ranked 4th in CA, 18th in US by NSDA ■ 22 tournaments attended (all online) ■ 259 awards including 14 tournament champions ■ Sweepstakes winners at Berkeley (1st), Stanford (2nd), and Logan (3rd)tournaments • 5 qualifying entries to CHSSA States, 5 qualifiers to NSDA Nationals, 22 qualifying entries to ToCs (Tournament of Champions) 2021-22 YTD • 5 tournaments already attended in first semester (online),with ■ 131 awards including 12 tournament championships ■ Preparations in full swing for upcoming Stanford, Berkeley and States/Nationals qualifier tournaments Program Remains Stable ■ Over 100+ Speech members the last three years,online speech coaching and tournaments helped sustain membership during COVID • Leadership team of coaches and student captains teach, mentor and inspire members to develop excellence in public speaking and foster a strong and vibrant team culture. See MV Speech Coaches, MV Speech Captains. MV Speech Gallery 1 Increased Investments/Expenses � ■ Team growth translates to increasing financial investments year-over-year 5�'E251 ■ Areas of investment:coaching services,chaperoning staff, summer camp, scholarships and operational efficiencies PRC Meeting 03.03.22 Ij Speech _ Year Trend Page 252 of 306 Md However: • Donation revenues are growing at a slower pace COVID impact seen in 2020 -21 c Continuing COVID impact expected in 2021-22 • No funding available from FUHSD MV Speech Donation Trends (Year-Aver-Year 2020-23) °Io Increase YaY Total Donation Revenue Club Growth: (Members) #Members (including company match) 2022-23 (Projected) 25.00% 150 $58,234.51 Slow growth in donation revenues, possibly due to 2021-22 -0.83% 119 $42,175.23 COVID 2020-21 20.00% 120 $46,414.64 Slow growth in membership, due to the 15 5PE252� transition year due to COVID g 03.03.22 FY ` i e 253 of 306 2019- 20 Financial Background (FY 2017-18 and FY 2018-19): • Monta Vista Speech program had been run entirely by Head Coach (pro-bona) and student captains since 2017 • No assistant coaches or paid onsite/tournament chaperones • $241C in retained earnings from accumulated member donations at the end of FY 2018-19 FY 2019-20 Highlights: • Team size grew to 100 for the first time • $41K received from member donations and company match • Hired Assistant Coaches for the first time • Hired tournament/onsite chaperones (2 paid, 2 pro bona) ■ Invested in website, business enablement and financial/accounting software • $39K budget surplus: one time occurrence due to non-repeating factors • Funds allocated but not spent: 181C in Head Coach compensation - Head Coach chose to work pro-bono 11K in Assistant Coach compensation, -2 out of 4 assistant coaches were only able to work half the hours originally budgeted 5K in Chaperone compensation - 2 chaperones chose to work pro-bono Tournaments Impacted by COVID: Conversion of CHSSA States and NIEToC and conversion of NSDA Nationals to online format further reduced travel and chaperone costs IRS Tax Filing: • 2019-20 990-EZ Note: $39K budget surplus expected to be drained over a 2 year period (FY 2020-21 and FY 2021-22) SPE 253� Financial Repoft (July 1 2020 12021) Income Highlights: • $3K net income from first Summer camp completed Aug 2020 a $46K from Donation drive and corporate matches through Dec 2020 • No significant additional income expected for the remainder of 2020-21 Expense Highlights: • $59K projected in staffing expenses (Head Coach,Assistant Coaches, Chaperones) 0 Started compensating Head Coach at fair market rate after 4 years of pro bono service 0 Assistant Coach sessions fully staffed for three branches (Extemporaneous, Interpretation and Impromptu); partially staffed for Original Oratory 0 3 tournament/onsite chaperones receive additional compensation from Boosters, 1 chaperone serves pro bona 0 Several additions to tournaments this year due to online opportunities: (Princeton,Yale, Florida Blue Keys etc) • $7K in operating expenses 0 Added 10 Zoom Pro licenses and cloud storage expenses to support year-round online student-led and coach-led instruction • $1.5K in scholarships 0 Scholarship program and awards criteria are work in progress • Possible increase in coaching and chaperoning expenses if students qualify for NSDA Nationals (June 2021) IRS Tax Filing: • 2020-21990-EZ Summary: SPE 254 Expenses expected to exceed income in 2020-21, budget surplus will be applied to cover the gap Financial Repoft (July 1 202112022) Income Highlights: • $3K net income from first Summer camp completed Aug 2020 a $46K from Donation drive and corporate matches through Dec 2020 • No significant additional income expected for the remainder of 2020-21 Expense Highlights: • $59K projected in staffing expenses (Head Coach,Assistant Coaches, Chaperones) 0 Started compensating Head Coach at fair market rate after 4 years of pro bono service 0 Assistant Coach sessions fully staffed for three branches (Extemporaneous, Interpretation and Impromptu); partially staffed for Original Oratory 0 3 tournament/onsite chaperones receive additional compensation from Boosters, 1 chaperone serves pro bona 0 Several additions to tournaments this year due to online opportunities: (Princeton,Yale, Florida Blue Keys etc) • $7K in operating expenses 0 Added 10 Zoom Pro licenses and cloud storage expenses to support year-round online student-led and coach-led instruction • $1.5K in scholarships 0 Scholarship program and awards criteria are work in progress • Possible increase in coaching and chaperoning expenses if students qualify for NSDA Nationals (June 2021) IRS Tax Filing: • 2020-21990-EZ Summary: SPE 255 Expenses expected to exceed income in 2020-21, budget surplus will be applied to cover the gap 1 - 30 Income Highlights: ■ $7.7K revenue expected from Summer Camp • $58.5K revenue expected from annual donation drive and corporate matches Expense Highlights: • $70K projected in staffing expenses (Head Coach,Assistant Coaches, Chaperones) a Continue to compensate Head Coach at fair market rate o Assistant Coach sessions to be fully staffed o All 4tournament/onsite chaperones to receive additional compensation from Boosters o Increased tournament chaperoning costs as in-person tournaments resume • $3.1K will be incurred in Summer Camp expenses (fixed costs regardless of revenues from registration) $8.5K in operating expenses Continuing Zoom usage in preparation for hybrid online/in-person season • $3K in scholarships Scholarships granted to support deserving students for travel tournament participation Recognize excellence and outstanding contributions to MV Speech (incl PVSA) • $21K to fund travel costs to regional,state-level and national tournaments • $5K in operational reserves to cover early FY 2022-23 expenses o Donation revenues start arriving in mid-September o Reserves will cover July 2022-Sep 2022 staff and operational expenses o Operational reserves not required in prior years since budget surplus provided a safety net Summary: *E9 • Expenses expected to exceed income by $2G,293 • Budget surplus will be drained4 • freed to bridge the deficit by grants and fundraisers FY ■ FinancialForecast1 1 202.3, 1 2022-23 Expenses 2022-23 Income 2022-23 Summary: Head Coach $31,177.01 Donations+Company Match $58,234.41 Expenses to exceed income by $26,293 Assistant Coaching $24,035.00 Summer Camp $7 760 00 Income: $67K+, Expenses: $93K+ Events& Programs $1,000.00 Budget surplus will be drained Remaining$0 Chaperones $14,125.00 surplus to be applied in 2022-23 Summer Camp $3,100.00 Total Income $66,994.41 $lUl(grant requested to cover 40°lo of the Entertainment/Food expenses $2,265.00 gap. Grant funds to be directed towards: 2022-23 Net Income coaching and chaperoning a Summer Camp Operating Expenses $8,586.06 Net Income for 2022-23 a Scholarships Scholarships $3,000.00 Income-Expenses) -$26,293.66 Overall Net Income $26,293.66 Travel Tournaments $2,000.00 Funding Required $26,293.fi6 Reserves to cover early FY 2022-23 expenses $5,000.00 ()p Ex includes professional services such as Ling expense, ,In Legal expenses,Fax preplhling,Marketing,Web hosting expense,Insurance,Sank fees,Stripe fees,Project racking sM Zoom etc. ' Total Expenses $93,288.07 spl 257 MVSD & MV Speech Boosters - Do Not Distribute PRC Meeting 03.03.22 Page 258 of 306 * Monta Vista Speech Boosters Inc 21840 McClellan Road Cupertino CA 95014 Jan 31, 2022 SPEECH Our organization was approved for the Cupertino Community Funding grant and $3000 was awarded to us in 2021. This is a report of how the grant was used. This is how we had requested for the grant in 2021-22.Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable,put $o: a)Admin Staff$10,024 b)Materials/Equipment $o c) Entertainment $o d) Room/Venue Rental $o e)Other Professional Services $o f) Other Scholarships $3,000 Total $13,024 Out of the $13, 024 we had requested,we were awarded $3,000.We used the grant money for hiring coaches who specialize in the 00 (,Original Oratoryl branch of speech. This served 26 students which is about 24% of our MV Speech club. The contract for the coaches are as follows: • Compensation Rates: o $30 per hour for synchronous coaching(working directly with students, either 1:1 or in groups) o $25 per hour for asynchronous coaching(research, email follow-up,video watching/feedback and other offline tasks) • Billable hours: o Regular Season: ■ Regular Coaching: Maximum of 8 hours per week • 6 hours of synchronous coaching per week during scheduled Monta Vista Speech practices • 2 hours of asynchronous coaching per week ■ Variable hours to provide coaching support for a variety of meetings/initiatives such as: • Parent and/or student interest meetings and showcase events • Parent Judging Night • Parent Coffees Page 1 of 3 258 PRC Meeting 03.03.22 Page 259 of 306 • Video watching and feedback • Administrative meetings with Head Coach, Speech captains and Speech Boosters o Off-Season: ■ Variable hours to to provide coaching support for a variety of meetings/initiatives such as: • Coaching students who qualify for CHSSA States,NIEToC or NSDA National tournaments • Lesson plan creation and review • Summer camps, summer workshops and showcase events • Head start coaching for Varsity members • Video watching and feedback • Administrative meetings with Head Coach, Speech captains and Speech Boosters o Coaching Schedule,time commitments and exceptions to be approved by MV Speech Head Coach (Gavin Wong) and Monta Vista Speech Boosters Forecast for Academic year 2021-22 Weekly Practices and Emails Coach Coach Coach for Day Coach D'Sa Hadi Ettinger 00 Chaperone #Monday Practice Hours a 78 78 26 78 #Tuesday Practice Hours 93 102.5 96 96 102 Total Practice Hours 93 180.5 174 122 180 Asynchronous Hours 64 64 64 64 a Total Annual Billing $4,390 $7,015 $6,820 $5,26o $3,600 Overall the grant effectively helped us with coaching that enabled our MV Speech students to win several tournaments. Assistant Speech Coaches update + 210 hours of 1:1 coach practices YTD(420+ sessions) • 57 sessions were"subbed"; students swap with another student (-15%of total slots) + On a scale from 1-10, students gave our coaches a 9/10 that it would be helpful if they got watched again!' i There is a strong correlation between coach watch attendance and breaking to finals or semis. The data is clear-attend your watches! Page 2 of 3 259 PRC Meeting 03.03.22 Page 260 of 306 The table below shows how effective our coaches have been in enabling our students to win/break at tournaments: # of Coach Watches YTDZ # of Students Final/Semi Break Ratio 0-2 37 16% 3-5 29 27% 6+ 34 41% First Semester Speech Highlights • Stephen Stewart Invitational (200 competitors) 0 4 tournament champions in HI, DI, OI and IMP 0 21 Finalists and Semifinalists • CFL Novice (125 competitors) 0 MVHS fielded the largest Novice team (36 novices) 0 80% of our novices won an award (v. 44% field) 0 5 tournament champions in DI, OI, NX, IX, 00 • CFL 1 and CFL 2 0 4th highest number of'Wildcards' 0 4th largest school in CFL out of 30 schools • Fall SCU o Varsity: Break ratio at 36% (v. 24% schools >=10 entries) o Novice: Break ratio at 55% (v. 28% schools >=10 entries) The Monta Vista Speech club caters to about 109 students this academic year 2021-22.This club is open to the entire Monta Vista High School community of the Monta Vista area of Cupertino.The coaching has enabled the students to perform well in all the tournaments they attended. Detailed above are the first semester speech highlights. All middle (Kennedy, Lawson) and high school (Monta Vista) students/ children in the community served by the Monta Vista area of the city of Cupertino. Monta Vista high school currently serves approximately 2,350 students in grades 9-12. Kennedy middle school currently serves approximately 1,198 students in grades 6-8. Lawson middle school currently serves approximately 1,138 students in grades 6-8. The monthly timesheets/invoices of the two 00 coaches (or all 5 coaches)for the first semester can be provided if needed. Page 3 of 3 260 PRC Meeting 03.03.22 Page 261 of 306 We are excited at this opportunity of our first successful grant and how it helped set up the Monta Vista Speech team for success this coming year. Sincerely, ------------------------------------------ Rajeswari Mahalingam ------------------------- President and CEO, Monta Vista Speech Boosters Inc Date 4o8 838 6o93 Page 4 of 3 261 PRC Meeting 03.03.22 Page 262 of 306 Monta Vista Speech Boosters (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the X program/project/event Identify how the funds will be used to benefit the Cupertino X community Be awarded only once per project x For specific needs,not on going,operational costs X Have more than 75%of the requested funds allocated for direct X service costs versus administrative costs Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission N W PRC Meeting 03.03.22 Page 263 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1448-777-3120 I WWW.CUPERTINO.ORG CUPERTINO CONTACTSECTION 1 : Full Legal Organization Name: Rotary Club of Cupertino Website:I www.cupertinorotary.org Address: P❑ Box 237 City: Cupertino State: CA Zip:195015 Phone: Organization President/Executive Director Name and Title: I Rod Sinks, President Emaid rodsinksgmail.Gom Phone: Contact Name and Title: Orrin Mahoney, Fund Development Coordinator (If different) Email:I orrinnlahoney comcaSt.net Phone: SECTION • • INFORMATION 501(c)(3)?: t�le: Year Established:{i f different than ahoz�e address infarmation) Sponsor Name:lCupertino Rotary Endowment Foundation Sponsor Address:I PO Box 1101 City: Cu p e rti n a state: CA Zip: Phone. Federal Tax ID: 77-0288042 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: J$250,000 Total# of Board Members: 14 Total#of staff:10 Total#of Volunteers:210 263 PRC Meeting 03.03.22 Page 264 of 306 Mission Statement: Rotary International Mission Statement-'Together, we see a world where people unite and take action to create lasting change— across the globe, in our communities, and in ourselves_" Brief Description of Organization and Services Provided: Cupertino Rotary is the local arm of Rotary International, the world's largest service organization. We provide charitable projects and services in the local area including services for seniors,youth, and other needy members of the community. We have 210 members representing a broad cross section of local business, professional, government, and community leaders. Cupertino Rotary focuses on hands-on projects that connect us directly to with those in need. Our members volunteer over 12,000 hours yearly working to make our community a better place Our projects include: COMMUNITY SERVICE- Last year, more than 1,000 hours of volunteer work and over$45,000 were devoted to over 20 projects that delivered turkey and trimmings to more than 150 community residents; connected high school students with veterans for video interviews;and twice assembled over 50 volunteers to make individual homes safer and healthier for low income seniors.We also helped many local nonprofits expand their Covid related services to the community. YOUTH SERVICE- Youth Service programs build confidence, self-esteem, and leadership skills. We support the youth of our community through student art exhibits, and robotics competitions, as well as Kid's Shopping Day, a youth poetry contest, Safe Routes to Schools, and ❑r. Seuss Reading Day. VOCATIONAL SERVICE-Vocational Services enables our Rotary Club to be a driving force for individual success by supporting Career Technical Education Workforce Development, education grants to teachers, GED program support, and student scholarships. REQUESTSECTION 4: GRANT 1. Program/Project/EventName: S!Iicon Valley Fall festival 2. Date(s) and/or duration of program/project/event (if applicable): 9124l22 3. Total programfprojectlevent budget: $160,000 4. Requested Amount: 1 000 Percent of total program/project/event budget: 20 % 5. What percentage of your organization's projected income does your funding request represent? 5 °�,o 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 12005 (year) New program/project/event 264 PRC Meeting 03.03.22 Page 265 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost Q (ongoing operational cost.) b) Materials/Equipment$ 12 QOQ c) Entertainment$Q d) Room/Venue Rental$® e) Other Professional Services such as 0 f) Other I I $ Q 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will be provided: Beside the projects above, Rotary provides direct services to the City as follows: 1) Years ago the City held a separate Health and Safety Fair. It entailed significant City employee participation to execute. In 2005, the decision was made to incorporate it into the Fall Festival to reduce the need for City resources. The City provided $5000 to offset Rotary's costs. 2) The City presents an Earth Day festival every April, with significant resources provided by City employees. Years ago, the Environmental Resources team decided to partner with Rotary to support a second environmental event. The "Earth Zone" at the Fall Festival meets this need. Again the City provided $5000 to offset costs. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit or impact the Cupertino community: See 10 above for a few specific details, but the Fail Festival aligns with the City's Public Safety programs, Environmental Programs, Youth Programs, Diversity initiatives, and general Community engagement. Please also note, in the event that the traditional Fall Festival cannot be held, we will investigate alternative delivery options for these programs. In any case the need for the funds is actually increased, so the sponsorships continue to add the charitable funds available to meet that increased need. 12. who will be served by tlus rant? =ved�,Illar raised at the Fall Festival goes directly toward funding Cupertino Rotary's charitable n the local community. We do over 50 projects right here in the community every year. a) Number of individuals total:1800 b) Number of Cupertino residents: 1500 c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? This event is open and free to the entire community. 265 PRC Meeting 03.03.22 Page 266 of 306 d) Will there be a charge or fee for the program1project/event(if applicable)? The event is free, including free parking. 13_ If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: Fee waivers for Memorial Park. 14_ Describe any funding requested from other agencies organizations in regard to this program/project/event request_Indicate whether the funding was granted, denied, or is still pending: No funding is requested from other agencies or organization. We do solicit sponsorships from the private sector. 266 Dorothy Stow 4C8 252.7962 PRC Meeting 03. 3.22 Page 260 306 JUL 21 2005 9: ❑❑ HP LR5ERJE1 JFU❑ ��U�i] 2b�-y�+}4 }ul 29 2:145 }0:2e,9M HP LRGERJET FRX � p.2 In w rial Revenue Beirwice Depenmant of tho Trraeury P.D, Box 25D6 Data: July 23, 2005 CinaInnatl, OH 45201 Person to Cant&= CUPERTMO ROTARY PNDOWMENT Carvl Kraft -031-08206 FOUNDATION Custorrw Service $pec*lst °fa ITSUO UENAKA Toll Free Telephone Number: S. a.m• to 5:94 p.m, CT 6i"7-82��5Q0 • Fox Number. 513-2e3-3756 Federal IdenWicntlon Nurnbsr: 77-02a8D42 ..__ .-�.. • .-ter r......•.-w.i......y. • -.�� 4- Dear Sir or Madero: This is in response to the amendment to )Four arganixaticn'e Artiges of lncarporaWn filed with the state arr October S. 2004, We hove updated our recants to reflect the nama chertge as Indicated above, In SaptemW.11991 vm issued a determination letter that recognirk your orgenlaallon as exempt from federal income tax. Our records.Irrdlcete'that.you'r orgenlzmtlon is currerrtjy exampt udder section 501(c)(3)of the Internal Revr~rru19•Code. Our records indicais that your organlration I also classMed as a public charity under asetlons 549(a)(1}and.170(b)(1)(A)(vi)of the Internal Revenue Code. Our records Ir9diaate 1W cor1ributlons to your ormnIration are deductible under-section 170 of the Code, and that you are quallfied to receive tact deductible bests, devises, transfers or glflz under saction 2055, 2108 or 2522 ofthe internal Revenue Code. if you have any questions,•Plaaee reH ua'at the teieptrone rwmbor shown in ttie'hasdi6g of trla letter. Sincerety, .iaannaK.Skufca; Dirsclar. TEIGE . . . � . CuetorrtiAi'Acooun#Srr•vlcoe r 267 PRC Meeting 03.03.22 Page 268 of 306 JE OF CALIFORNIA t-RANCHISE TAX BOARD P.O. BOX 1286 RANCHO CORDOVA,CA. 95741-1286 July 9 , 1991 In reply refer to 340 : G : RB ROTARY CLUB OF CUPERTINO ENDOWMENT TOM HALL 21040 HOMESTEAD RD . CUPERTINO CA 95014 Purpose CHARITABLE Code Section 23701d Form of Organization Corporation Accounting Period Ending : June 30 Organization Number You are exempt from state franchise or income tax under the section of the Revenue and Taxation Code indicated above . This decision is based on information you submitted and assumes that Tour present operations continue unchanged or conform to those proposed in your application. Any change in operation, character, or purpose of the organization must be reported immediately to this office so that we may determine the effect on your exempt status . Any change of name or address also must be reported . In the event of a change in relevant statutory, administrative, judicial case law, a change in federal interpretation of federal law in cases where our opinion is based upon such an interpretation, or a change in the material facts or circumstances relating to your application upon which this opinion is based, this opinion may no longer be applicable . It is your responsibility to be aware of these changes should they occur . This paragraph constitutes written advice., other than a chief counsel ruling , within the meaning of Revenue and Taxation Code Section 21012 (a) (2 ) . You may be required to file Form 199 ( Exempt Organization Annual Information Return) on or before the 15th day of the 5th month ( 4 1/2 months ) after the close of your accounting period . See annual instructions with forms for requirements . You are not required to file state franchise or income tax returns unless you have income subject to the unrelated business income tax under Section 23731 of the Code . In this event, you are required to file Form 109 (Exempt Organization Business Income Tax Return) by the 15th day of the 5th month ( 4 1/2 months ) after the close of your annual accounting period . 268 PRC Meeting 03.03.22 Page 269 of 306 July 9 , 1991 ROTARY CLUB aF CUPERTINO ENDOWMENT Page 2 If the organization is incorporating, this approval will expire unless incorporation is completed with the Secretary of State within 60 days . Exemption from federal income or other taxes and other state taxes requires separate applications . A copy of this letter has been sent to the Office of the Secretary of State and to the Registry of Charitable Trusts . A SCOTT EXEMPT ORGANIZATION UNIT CORPORATION AUDIT SECTION Telephone (916 ) 369-4171 EO 269 PACIFIC AUTISM CENTER FOR 1,zC,,v'4en 03.03.22 EDUCATION (PACE): �pIiiip�1SE �UPERTIN� Cupertino Rotary has an ongoing relationship with PACE. We have ROTARYsupported this center with grants and with hands on home repairs. This year we installed water wise landscaping to Service Above Self conserve water and improve aesthetics. Rotary is a network of 1.2 million neighbors, THANKSGIVING MEAL DISTRIBUTION: friends, leaders, and problem-solvers who 3 Each year on Thanksgiving morning, see a world where people unite and take Cupertino Rotarians deliver complete, fully prepared Thanksgiving meals action to create lasting change — in our to families deemed in need by local communities and across the globe. community service agencies and schools. Recipientsmaybe unemployed, 4 infirm, elderly, in temporary shelter, or 1 otherwise incapacitated. Each meal includes a 10-to-12-pound turkey, Rotary Projects mashed potatoes, gravy, cranberry sauce, and Hawaiian rolls all fully cooked, and serves 6 to 8 people. In 2020, 60 socially distanced REBUILDING TOGETHER: volunteers delivered 120 meals. Making individual homes safer, healthier, and aesthetically pleasing for PROJECT ALES I: low-income seniors. Complying with Cupertino Rotary teamed with other Covid-19 protocols,ateam ofvolunteers _ Rotary clubs to drill water wells in assisted a neighbor in need by painting various remote villages in Kenya. This the exterior of her home, replacing the y ',_ . borehole drilling in the village of Kaikol perimeter backyard fence, and trimming reached water at a depth of 90 meters and clearing the overgrown backyard. providing safe drinking water for the village residents. OUR DAILY BREAD: Our members support the thrice weekly CAMP HIDDEN FALLS REBUILD: i preparation of hot nutritious meals ` ! Our grant to the Girl Scouts of Northern served to hungry men, women, and California enabled this organization to children by volunteering and providing upgrade facilities at the Camp Hidden Falls grants. Housed at St.Thomas Episcopal ry. - enabling them to provide young women with Church,this program pivoted to take-out ' outdoor adventures and summer camps after +� meals to protect clients and volunteers. their previous summer camp was destroyed in �J Over 280 diners are served per day. the Big Basin fire. r LEARNING THRU SPORTS: PHILIPPINES CHILDREN'S HEART The Healing Grove is a non-profit SURGERY: serving the Washington This international project supports neighborhood in the City of San much needed heart surgeries for Jose. Cupertino Rotary donated under privileged children and provides funding for playground equipment - ~ regional vocational training of local and building materials for a gated doctors enabling them to become f children's playground. certified in pediatric heart surgery. 270 4 FUHSD ADULT ED: - SENIOR CENTER ACTIVITIES: 271 ' Cupertino Rotary supported our Fremont Several of our senior activities morphed Union High School District's Adult School to reflect the Covid reality. We built thru the Principal's scholarship Fund, to custom tables for the Sunny View assist students facing financial barriers retirement community specifically impacting their GED or HS diploma designed to accommodate jigsaw i completion. puzzles including specially designed storage, sewed colorful placemats to Additionally, we supported the ESL Connect project that matched add a little cheer, and utilized Zoom Adult English as a Second Language(ESQ students with Rotarians to to bring farm animals to several senior facilities as well as to offer help the students improve their conversational English skill. Halloween pumpkin carving. DR. SEUSS READING DAY DEANZA SCHOLARSHIPS: This is an annual event designed to The Rotary Club of Cupertino strives to encourage children in every community L7eAnza be a driving force for individual success to read. Typically, Rotarians read in GDlJe e in work or career by supporting eight elementary schools throughout CUSD $1,500 Uenaka scholarships to DeAnza Schol community. This year, with the guidance , arshi' students pursuing careers in nursing, of champion Jean Gasperini and technical y- automotive technology, or health technologies, and through the support from Rotary President Stuart annual awarding of the$7,000 Jackson Family Education Scholarship Rosenberg, the project was completed � to a DeAnza student planning to transfer to a four-year university as using video recordings. Rotary volunteers an education major. We value our partnership with De Anza College. read 1 Can Read with My Eyes Shut and Green Eggs and Ham. THANK YOU TO ALL OUR VOLUNTEERS RYLA— ROTARY YOUTH LEADERSHIP AWARDS: is an intensive leadership experience organized by Rotary Clubs and districts +' to enable our local youth to developfjY; . y • leadership skills while having fun and making connections. Youth develop communication and problem-solving skills, discover strategies for becoming - • a dynamic leader, learn from community leaders, inspirational speakers, and peer mentors. Typically a week-long camp,this year we pivoted to a zoom format. CITY OF CUPERTINO MIDDLE SCHOOL ESSAY CONTEST: A new project sponsored Cupertino Rotary's members broadly reflect the rich jointly with the city of ' ethnic fabric of our community and come from various Cupertino, this essay sectors including the leaders of our local and corporate competition for 7th graders was businesses, schools, city staff, and nonprofit community organizations. designed to challenge students to think 0(:� critically and provide The club meets every Wednesday at noon for a lunch a written proposal on program and guest speaker (currently via Zoom). To what positive impact they would make to improve the Cupertino learn more, visit ourwebsite at www.cupertinorotary.org community. 271 4 PRC Meeting 03.03.22 Page 272 of 306 Fall Festival 2021 Actual Revenue $40,469 Sponsorships (1) $37,250 Elect Retail Inc in booths Bus and NP booths gross $1,919 Kids Zone (net) net $0 Soda, Beer, etc. $1,300 Expenses $22,255 Advertising/marketing $1,092 Insert Sticker $0 Graphics $600 Printing $0 Program book our portion $1,543 Printing Signs/banners $800 Sound System $2,000 Entertainment $100 Cultural Fair Food Beer,soda $500 Rental Equipment $11,000 Porta potties $1,100 Golf Carts $1,820 Sheriffs ABC plus Foodpermit $700 Art show ?? Health permits Misc $1,000 Net for charitable Giving $18,214 1/27/2022 11:39 AM IV V N PRC Meeting 03.03.22 Page 273 of 306 Rotary Club of Cupetino (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the X program/project/event Identify how the funds will be used to benefit the Cupertino X community Be awarded only once per project X For specific needs,not on going,operational costs X Have more than 75%of the requested funds allocated for direct x service costs versus administrative costs Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission N V W PRC Meeting 03.03.22 Page 274 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION 1 448-777-3120 1 WWW.CUPERTINO.ORG CUPERTINO SECTIONCONTACT Full Legal Organization Name: West Valley Community Services website:I vwww.wvcommunityservices.org Address: 10104 Vista Drive City: Cupertino State: CA Zip:195014 Phone: 408-956-6113 Organization President/Executive Director Name and Title: I West Valley Community Services Email:Ijoshs@wvcommunityservices.org Phone: 408-956-6113 Contact Name and Title: Sujatha Venkatraman (If different) Emaid SujathaV wvcommunityservices.org Phone: 408-342-0550 SECTIONNON-PROFIT •' • 501(c)(3)?: t�le: Year Established:{i f different than alone address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax IDJ 94-2211685 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) ORGANIZATIONSECTION 3: Total Organization Budget: 1$4,676,735 Total# of Board Members: 20 Total#of staff: 36 Total#of Volunteers: 500 274 PRC Meeting 03.03.22 Page 275 of 306 Mission Statement: To unite the community to fight hunger and homelessness. Brief Description of Organization alld Services Provided: West Valley Community Services offers a range of services, including a food pantry; affordable housing, emergency financial assistance, a mobile food pantry; financial coaching,family support, access to public health and food assistance benefits, case management, and referral services. Our programs target families with children, at-risk youth, seniors, individuals, and disabled adults who are extremely low-income, living on a fixed-income, homeless or are at risk of becoming homeless. Eligibility for our services is based on the federal poverty determinations, and we serve individuals and families living at or below 250% of the federal poverty line. For an individual, that is an annual household income of$31,900 or less and for a family of four, that is an annual household income of$65,500 or less. WVCS'services are intended to help tow-income and homeless individuals and families become self-sufficient by improving accessibility to services and basic needs assistance, and promoting a connection to the community. We achieve this outcome through an array of programs and services: -By providing emergency rental and utility assistance, WVCS is preventing clients from evictions and homelessness.With this help clients are prevented from entering the downward spiral that can make returning to stability difficult or impossible. -By providing food, WVCS is preventing hunger, improving health and nutrition, and enabling clients to spend more of their financial resources on housing;transportation; medical costs, and other life essentials. -By providing case management, information, and referrals,WVCS is helping clients find the resources they need to acquire suitable housing, learn about public benefits, eat more healthfully, cover health care expenses, and much more. West Valley Community Services is our community's safety net, and we exist to ensure that low income and homeless individuals and families receive the support and services they need to build the foundation for a brighter future. SECTIONGRANT 1. Program/Project/Event Name: Gift of Hope 2022. 2. Date(s) and/or duration of program/project/event (if applicable): ❑ecember 10, 2022 3. Total program/project/evert budget: S 160,000 4. Requested Amotmt: q 10,000 Percent of total prograin/project/event budget: 'i % 5. I-N-liat percentage of your organization's projected income does your funding request represent? U oa 6. Ty De of Request: Program Support Event Dice-time project 7. Existing program/event;established in 12000 (year) New program/project/event 275 PRC Meeting 03.03.22 Page 276 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost (ongoing operational cost.) b) Materials/Equipment$ 0 00D c) Entertainment$ d) Room/Venue Rental$� e) Other Professional Services such as f) Other I $ 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will beprovided: The December holidays are a challenging time for many people, and especially for families living in poverty. Isolation, stress, and food scarcity stand out starkly at a time when many community members are preparing festive meals, purchasing gifts, or preparing for remote or in person family gatherings. The reality for low income and homeless families is very different, as families that are struggling on a daily basis in the face of food or housing insecurity are unable to celebrate the holidays, and may not even have enough money to purchase seasonally appropriate clothing for themselves or their children.This reality causes increased stress and mental anguish,which can have long-term cognitive impacts, particularly on young people living in low income families. Gift of Hope was launched many years ago to strike at the heart of these challenges by providing WVCS clients with food, needed household items,and seasonally appropriate clothing during the December holiday season. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit or impact the Cupertino community: Pmordg m the Gry d CuPen�ds ge—al.Fi.R Gape seeks to cmaGea c—duty that is 6afenced and wd—e for all ressden la3uavyy has keen arse and Awe der prober.d fate.vAtt tre dredenges or food and hmuirg inse—Ky increasing in recent 7,�mrnpoLonded by the agdng inpacFs of COVIDA 4.The Silicon Val6ey trade o—d—w rnpat Owt arorerd 30%d&y Area residents are isiahle to EFF d food and tart llorseg o is have increased by 13-16%sirro+2014.while income kwJs have A gne[ed for k-and-ddle inoane—kern and the rest d arfadable houscg develogrnera has spiked,ca&bub g m the daisy in m hr lion d new irk.1Mde V w arg gioes dipped si ghtLy Acing the pendenuG oar 4uA the eoar—y has reopened and marry boanesses are operating once more. reran are agmr on the rise_ These data pdrtls do not pains the fo!pmwe,as CCMD-19 had a deep end peitrul orpad on ac dulls and t—fa.lies.Ac dcrg to the San Jose State IJrtversity Pan Index hwnelessrress in—sed by 9%and homing irrserarity inaea_sed by lCM%it Smda Clara Cot.4 since 2g18. Repat have kHbmmed trotthe pan me -dTr portorka*irrgA ewnoadrally disadvmaaged harselwlds,triggered by the fog of abut?ofMm payirg =.DDP par year ut less.As a resLgt of at OTt11 facmrs,demand for our senioes spiked.fonucd tafgely sand food,rase rnanageme 4 and rerdad Even nor In score oases.cke have rot renened tc hd enployrrent and fogs t vet-en of work form extended period of tine have acenred may m #m of rent deb,car V high an a of stress and t—held un—t i ty.While demand had slgM tapered off Tiorn the ee0v rmmhs of to pandetn q West valley C ri y Services still--d more diem la yeartran vre did to year before COVl61 g.Byte end of fret year 2g21,Vyest Valey Ce—n ay Services had served 1,165 reeve die.,rs,helped more than 3.4W urique lorr aa>onne end honrreless Hence,and distributed more than i1.31Rdai in reveal assist —. We also gave out rrrcmthan 121A pounds dfmA lastyem,eWNalern m morelhan 1.6hf meals. West Valley Ct nrty a vices is our oarnn—t is sarety rex and re east to ensue that bn i rna and f—Aless ur&oiduais and fan3es reoeive the sgpat and serrioes they r d it,bold fief hd w f r a brighter fuoca This program helps realize that vision by serving the needs of our oomr m y's low iicome and. d resident. 12. Who will be served by tlus rant? This program serves low income and unhoused residents living at or below 250% of the federal poverty line. a) Number of individuals total:11200 b) Number of Cupertino residents: 1300 c) Will the program/project/event be available to the entire community/public or are there any eligibility criteria? This program is open to the entire community. Low income and unhoused participants will receive food, household items, and seasonally appropriate clothing, and Cupertino residents will be invited to participate as volunteers to the extent that COVID-19 and social distancing allows. 276 PRC Meeting 03.03.22 Page 277 of 306 d) Will there be a charge or fee for the programfproject/event(if applicable)? There is no charge or fee for this event. 13_ If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: WVCS is a longtime partner with the City of Cupertino, and has received both Human Services and CBDG grants from the City. 14_ Describe any funding requested from other agencies organizations in regard to this program/project/event request_Indicate whether the ftmding was granted, denied, or is still pending: We have not yet started fundraising for the 2022 event. 277 4"����'' r Lf�� {7rp- 111 lit oC 111C 'Ile usurp PRC Meeting 03.03.22 +�J��b']fj I a �7 Intc-rm11 Revenue svi'vIce Pay 271 of Qp6� P . C . Box 2ra08 In reply refer to : �124819 327 Cincinnati OH 45201 Feb . 22, 2016 LTR 4168C 0 94-2211685 0000D0 00 00018002 BODC; TE WEST VALLEY C❑Mi* UNTTY SERVICES OF SANTA CLARA COUNTY INC 10104 VISTA DR -t' CUPERTINO CA 9501G 1757 Employer ID Number : 94-2211685 Forin 99C required : YES Dear Taxpayer : This is in response to your request dated Feb . 10 , 2016 ) regarding your tax-exempt status . We issued you a determination letter in August 1976 , recognizing you as tax- exempt under Internal Revenue Code ( IRC) Section 501 (c) ( 3 ) . Our records also indicate you ' re not a private foundation as defined under IRC Section 509 (a) because you ' re described in IRC Sections 509(a ) ( 1) and 170 (b) ( 1) (A) (vi ) . Donors can deduct contributions they make to you as provided in IRC Section 170 . You ' re also qualified to receive tax deductible bequests , legacies , devises , transfers , or gifts under IRC Sections 2055 , 2106 , and 2522. In the heading of this letter , we indicated whether you must file an annual information return . If a return is required , you must file Farm 990 , 990-CZ, 990-N , or 990-PF bV the 15th day of the fifth month after the end of your annual accounting period . IRC Section 6033 (j ) provides that , if you don ' t file a required annual information return or notice for three consecutive years , your exempt status will be automatically revoked on the filing due data of the third required return or notice . For tax forms , instructions, and publications, visit www . irs . gov or call I -800 -TAX- F❑RM ( 1- 800-829-3676) . If you have questions , call 1 -877-829- 5500 between 8 a . m , and 5 p . m . , local time , Monday through Friday (Alaska and Hawaii fcllo%�o Pacific Tillie ] . 278 PRC Meeting 03.03.22 Pak�79 M� 2 7 Feb , 22, 2016 LTR 4168C 0 94--2211685 000000 00 00018003 WEST VALLEY COMMUNITY SERVICES OF n SANTA CLARA COUNTY INC 10104 VISTA pR CUPS RTINO CA 95014 Sincerely yours , A;, ? 4� Voris Kenwright , Operation Mgr . Accounts Management Operations 1 279 PRC Meeting 03.03.22 Page 280 of 306 Organization Name West Valley Community Services Project Gift of Hope 2021 Revenue Sponsors $ 47,250 Individual Donors $ 14,782 Total Income $ 62,032 Expense Clothing, toys, household items $ 48,309 Staffing $ 6,102 Program Costs $ 2,968 Admin $ 4,653 Total Expenses $ 62,032 280 PRC Meeting 03.03.22 Page 281 of 306 Program Report: Gift of Hope 2021 City of Cuperno Community Gr ant Funding West Valley Community Services Thank you for your generous support of Gift of Hope 2021. The event was held the weekend of December 11, 2021. With your help, we were able to serve 1,586 men, women and children in our community, a 25% increase over last year. Of that number, 286 were Cupertino residents, including 40 unhoused Cupertino residents. Below are photos of some of this year's participants. There is no way we could have brought joy and hope to so many people without you. West Valley Community Services depends on the support of our local community to help families facing food and housing insecurity. Your kindness and generosity makes our work possible. Respectfully submitted by Josh Selo, Executive Director 281 PRC Meeting 03.03.22 Page 282 of 306 06 pl- L 4 5 Thank YOU for the Suppo 282 PRC Meeting 03.03.22 Page 283 of 306 West Valley Community Services (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the X program/project/event Identify how the funds will be used to benefit the Cupertino X community Be awarded only once per project X For specific needs,not on going,operational costs X Have more than 75%of the requested funds allocated for direct X service costs versus administrative costs Be complete and submitted by the application deadline X Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for NA the conducted activity admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved NA by Parks and Recreation Commission N 00 W PRC Meeting 03.03.22 Page 284 of 306 FUNDINGCOMMUNITY ■ ■ APPLICATION PARKS AND RECREATION [ 408-777-3120 [ W1NW.CUPERTINO.ORG CUPERTINO SECTION Full Legal Organization Name: Silicon Valley Jewish Film Festival Website:I www.svjff.org Address] P❑ BOX 2190 City: Cupertino State: CA Zip:195015 Phone: Organization President/Executive Director Name and Title: I Silicon Valley Jewish Film Festival Email:I tzvla a@svjff.org Phone: Contact Name and Title: (If different) Email: Phone: SECTION • • •' • 501(c)(3)?: ■ `es Year Established: No {i f different than atone address information) Sponsor Name: Sponsor Address: City:I State: Zip: Phone: Federal Tax IDJ 263234237 (If your program is fiscally sponsored, enter the tax ID of your sponsoring organization) SECTION 3: ORGANIZATION INFORMATION Total Organization Budget: 1358,000.00 Total#of Board Members: 12 Total#of staff: i Total#of Volunteers:50 284 PRC Meeting 03.03.22 Page 285 of 306 Mission Statement: The Silicon Valley Jewish Film Festival's mission is to reach out, excite and bring together the Silicon Valley community with and through the power of films that showcase Jewish spirit, culture, traditions and humor. We strive to spark a dialogue around entertainment, art, politics, society and global issues. Because it is engaged actively in outreach to different ethnic and religious organizations, SVJFF takes a broad view when it refers to 'bringing together the Silicon Valley community.' Brief Description of Organization and Services Provided: The San Jose Jewish Film Series was founded in 1991 by three local residents who recognized the need for high-quality films with Jewish themes in the San Jose metropolitan area. That group later changed its name to the San Jose Jewish Film Festival. In recognition of its evolution into a truly regional entity, the name was changed to the Silicon Valley Jewish Film Festival ("SVJFF"). In 2009, SVJFF became an independent, not-for-profit corporation under Sec. 501(c)(3) of the Internal Revenue Code. What began as a modest annual offering of several films has been transformed into an annual four-week festival held between October and November. In 2020 , Since Covid 19 began SVJFF transferred the festival to an on line festival and we screened 21 films. SVJFF continued in 2021 with 30 movies on line with directors and actors on zoom. We continue to provide this high- quality programming this difficult time. REQUESTSECTION 4: GRANT 1. Program/Project/EventName: Silicon Valley Jewish Film Festival 2. Date(s) and/or duration of program/project/event (if applicable): October through November I Total programfprojectlevent budget: $ 35$ 000.00 4. Requested Amount: 10,000.00 Percent of total program/project/event budget: % 5. What percentage of your organization's projected income does your funding request represent? 3 d� ,o 6. Ty e of Request: Program Support Event One-time project 7. Existing program/event;established in 11991 (year) New program/project/event 285 PRC Meeting 03.03.22 Page 286 of 306 S. Please provide a line item breakdown of how the funds will be used in the categories below. If a category is not applicable, put$0: a) Staffing cost 0 (ongoing operational cost) b) Materials/Equipment$® c) Entertainment$ 10006 d) Room/Venue Rental$® e) Other Professional Services such as 0 f) Other I I $ 6 9. More than 75%of the requested funds will go towards direct service costs versus administrative costs? Yes No 10. Describe the purpose of requested funds and the services that will beprovided: From its inception, SVJFF was envisioned as a means of bringing high-quality films with Jewish themes to an increasingly diverse metropolitan area. The presentations by SVJFF have consistently addressed the needs of the local Jewish community while, at the same time, connecting with the broader community as a whole. In 2020 we hosted our first virtual festival. in 2021 we continued with our virtual festival and had 10,000 households sign in and watch movies. Most of those households reside in the Cupertino and San Jose area. However, we do not know how many people there were at each household watching each movie. (We heard from some families that they hosted screening parties outside on a screen and had over 10 people in attendance). The requested funds will be used for programming, movie rentals, and virtual platforms. 11. Explain how the request aligns to City mission and values.Describe how funds will be used to benefit or impact the Cupertino community: We are one of the only Arts & Culture organizations in the area for Jewish content and our program serves a large amount of Cupertino residents. 12. who will be served by tlus rant? We conduct a survey asking where attendees reside and the top three areas are San Jose, Cupertino, and Palo Alto. a) Number of individuals total:120000 b) Number of Cupertino residents: 15000 c) Will the program/project/event be available to the entire commurdty/public or are there any: eligibility criteria? Yes, the program will be available to the entire community/public. 286 PRC Meeting 03.03.22 Page 287 of 306 d) Will there be a charge or fee for the program project/event(if applicable)? Yes, tickets and movie passes are available. 13_ If your organization has ever received financial or in-kind support from the City of Cupertino outside of Community Funding Grants, please describe this support: NIA 14_ Describe any funding requested from other agencies organizations in regard to this program/projectlevent request_Indicate whether the funding was granted, denied, or is still pending: NIA 287 05/11/2009 12 :18 FAX 14b82933661 BOOKKEEPINGSERVICES PRC Meeting 03REMI/001 Page 288 of 306 INTERNAL REVENUE SERVICE DPPARTM= OF THE TREASURY P. d. Box 250$ CINCINNATI, OR 45201 W ,q��(r Employer Identification Number: Date: 26-3234237 ❑LN: 6o90400S-2 SILICON VALLEY JEWISH FILM FESTIVAL Contact Perron. RARSN A EATEY IN 31641 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: June 3 Q Public Charity Status: ° 170(b) (1) (A) (vi) Form 990 Required: T. Uf;active Date of Exemption: September 9, 2000 Contribution paductibility: Yes Addendum Applies: NO Dear Applicant: We are pleased to inform you that upon review of your applicatio:t for tax cxenpt Status we have determined that you are exempt from Federal income tax under section 501 (C) (3) of the Internal Revenuir Code. Contributions to you are deductible under sectivn 170 of Llic Code. You are also qualified to receive ta,x deductible bequests, de-+riaes, transfers or gifts under scct•ion 2055, 2106 or 2522 of the Code. Because this letter could help revolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c) (3) of the Code are fur7her classlfied as either public charities or private tQ=dativaw .. we determined that you are a public charity under the Cade section(s) listed in the heading of this letter. Pleaee eee enclosed Publication 4221-Pc, Compliance Guide for 501 (c) (3} public Charities, for some J-.elpful infomation about your responsibilitiea as an exempt organimaticn. P Letter 947 RDG/cG) k 288 3160922 PRC Meeting 03.03.22 Pa e 289 of 3 6 M tlts of the state of Calltomw ARTICLES OF INCORPORATION 5EP a 2003 OF SILICON VALLEY JEWISH FILM FESTIVAL 1. The name of this corporation is Silicon Valley Jewish Film Festival. fl. A. This corporation is a nonprofit public benefit corporation and is not organized for the private gain of any person. It is organized under the Nonprofit Public Benefit Corporation Law for public and charitable purposes. B. The specific purpose of this corporation is to promote multicultural awareness and understanding. III. The name and address in the State of California of this corporation's initial agent for service of process is: Gregory W. Mathis,Esq. Dorsey & Whitney LLP 1717 Embarcadero Road Palo Alto, CA 94303 IV. A. This corporation is organized and operated exclusively for charitable purposes within the meaning of Section 501(c)(3)of the Intemal Revenue Code. B. No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or intervene in any political campaign (including the publishing or distribution of statements) on behalf of any candidate for public office. 4812-0489-03701 289 PRC Meeting 03.03.22 Page 290 of 306 V. The property of this corporation is irrevocably dedicated to charitable purposes and no part of the net income or assets of this corporation shall inure to the benefit of any director, officer or member thereof or to the benefit of any private person. Upon the dissolution or winding up of the corporation, its assets remaining after payment, or provision for payment, of all debts and liabilities of this corporation shall be distributed to a nonprofit fund, foundation or corporation which is organized and operated exclusively for charitable purposes and which has established its tax exempt status under Section 501(c)(3)of the Internal Revenue Code. DATED: September 9,2008 r/r/ Grego Mathis, Incorporator E Op CO m + �C* RY 4F=a -2- 4917-0499-03701 290 PRC Meeting 03.03.22 Page 291 of 306 E DF Thy R► P-X T State of California RY Secretary of State 1 , DEBRA BOWEN , Secretary of State of the State of California, hereby certify: That the attached transcript of page(s) has been compared with the record on file in this office, of which it purports to be a copy, and that it is full, true and correct. SE� R�A �yF 1N WITNESS WHEREOF, I execute this s, certificate and affix the Great Seal of the State of California this day of 0 m T 0 r S E P 1 1 2008 o Cgt1FpRN�P DEBRA BOWEN Secretary of State SedState Form CE-107(REV 112007) r OW06"7W 291 PRC Meeting 03.03.22 Page 292 of 306 Silicon Valley Jewish Film Festival 2022 Budget Budget Income 4000 Advertising 4100 SVJFF Fall Program 7,500.00 Total 4000 Advertising $ 7,500.00 4130 Grants&Donation 4200 Donations 4210 Business 4220 IndividuallPR Protection Prog 5,000.00 4230 Sponsors 1,000.00 Total 4200 Donations $ 6,000.00 4300 Foundation Grants 4310 Koret 50,000:00 Total 4300 Foundation Grants $ 50,000.00 4400 Grants 4410 City of San Jose 4420 Israel Consulate 1,500.00 4430 Town of Los Gatos&Other Grants 4450 Tauhe Grant 5,000.00 Total 4400 Grants $ 6,500.00 Total 4130 Grants&Donation $ 62,500.00 4600 Patrons 4610 Level 01$250 Movie Buff 31,500.00 4625 Level 03$1000 Screenwriter 31,000.00 4630 Level 04$1800 Director 31,000.00 4636 Level 05$2500 Producer 22,000.00 4640 Level 06$5000 Exec Producer 55,000.00 4645 Level 07$7500 Talent Agent 7,500.00 4650 Level 08$10000 Studio Executive 50,000.00 4655 Level 09$15000 Movie Star 30,000.00 4660 Level 10$20000 Film Mogul 30,000.00 Total 4600 Patrons $ 288,000.00 7200 Interest Income Total Income $ 368,000:00 Gross Profit $ 358,000.00 Expenses 6000 General Expenses 6010 Ask Your Accountant 6020 Bank Fees 5,700.00 6050 Insurance 2,800.00 6060 Goodie Bag Donors 6070 Personnel Search 450.00 292 PRC Meeting 03.03.22 Page 293 of 306 6080 Postage 55.00 6090 Recognition GittlVolunteer Event 120.00 6110 Constant Contact Software 1,500.00 6130 Subscriptions 200.00 6140 Survey 300.00 6150 Tax, License&Filing Service 250.00 6180 Web Hosting 360.00 Total 6000 General Expenses $ 11,735.00 6200 Marketing 6220 Printing and Mailing Services 5,000.00 6230 Publicity/Advertising 20,000.00 Total 6200 Marketing $ 26,000.00 6250 Office 6260 Automobile Expense 200.00 6270 Internet/Cable Expense 1,500.00 6280 Office Expense 1,000.00 6290 Office Rent 6,000.00 6300 Po Box Fee 450.00 6310 Printing Posters 475.00 6320 Telephone Mobile 2,200.00 6330 Utilities 240.00 Total 6250 Office $ 12,065.00 6410 Payroll&Contract Expenses 6420 Contracting Fees 6421 AcoountinglBookkeeping 10,000.00 6426 Graphic Design 7,000.00 6428 Order Entry Clerk 10,000.00 6432 Film Festival Flix 12,000.00 6433 Web design&Newsletter 11,000.00 Total 6420 Contracting Fees $ 50,000.00 6440 Payroll Expense 6441 Executive Director 119,000.00 6445 Assistant Programming Director 20,000.00 6490 Payroll Taxes 10,000.00 6491 PR Proc Fee 1,100.00 Total 6440 Payroll Expense $ 150,100.00 Total 6410 Payroll&Contract Expenses $ 200,100.00 6500 Programming Expenses 6510 Airfare&Travel 6530 Chai HauselTeen Screen 600.00 6540 Film Rental 30,000.00 6550 Film Shipping 500.00 6560 Passes 6580 Speaker Fees 5,000.00 6600 Online Theater 6610 Zoom 2,000.00 293 PRC Meeting 03.03.22 Page 294 of 306 6620 Technical Support 45,000.00 6630 Customer Service 26,000.00 Total 6600 Online Theater $ 73,000.00 Total 6500 Programming Expenses $ 109,100.00 Total Expenses $ 358,000.00 Net Operating Income $ Net Income $ Wednesday,Dec 15,2021 08-0128 AM GMT-8-Accrual Basis 294 PRC Meeting 03.03.22 Page 295 of 306 Silicon Valley Jewish Film Festival Balance Sheet As of December 15, 2021 Total As of Dec 15,2021 As of Dec 15,2020 (PY) ASSETS Current Assets Bank Accounts 1010 Union Bank Checking Account 380,631.13 345,448.05 1020 Union Bank Savings Account 52,105.67 52,068.71 Total Bank Accounts $ 432,736.80 $ 397,516.76 Accounts Receivable 1200 Accounts Receivable 0.00 0.00 Total Accounts Receivable $ 0.00 $ 0.00 Other Current Assets 1230 Prepaid Expenses 0.00 0.00 1300 Movie Rental Deposit 0.00 0.00 1400 Undeposited Funds 0.00 36.00 Total Other Current Assets $ 0.00 $ 36.00 Total Current Assets $ 432,736.80 $ 397,562.76 Other Assets 1420 Security Deposit 615.00 615.00 Total Other Assets $ 615.00 $ 615.00 TOTAL ASSETS $ 433,351.80 $ 398,167.76 LIABILITIES AND EQUITY Liabilities Current Liabilities Accounts Payable 2000 Accounts Payable 0.00 0.00 Total Accounts Payable $ 0.00 $ 0.00 Credit Cards 2050 Chase Credit Card Tzvia 11,520.68 2,186.48 2060 US CC Visa-Margalit 7245 0.00 000 2070 US CC Visa-Tzvia 6297 0.00 0.00 Total Credit Cards $ 11,520.68 $ 2,186.48 Other Current Liabilities 2100 Payroll Liabilities 0.00 0.00 2110 CA PIT/SDI 0.00 0.00 2120 CA SUI 1 ETT 0.00 0.00 2130 Federal Taxes(9411944) 0.00 0.00 Total 2100 Payroll Liabilities $ 0.00 $ 0.00 2200 Other Accrued Expenses 0.00 0.00 2210 Current Year Pledge Deferred 0.00 84,300.00 Total Other Current Liabilities $ 0.00 $ 84,300.00 Total Current Liabilities $ 11,520.68 $ 86,486.48 Total Liabilities $ 11,520.68 $ 86,486.48 295 PRC Meeting 03.03.22 Page 296 of 306 Equity 3000 Opening Bal Equity (100 0.00 3900 Unrestricted Net Assets 306,3DB.93 164,319.48 Net Income 115,522.19 147,361.66 Total Equity 3 421,831.12 $ 311,681.28 TOTAL LIABILITIES AND EQUITY $ 433,351.80 $ 398,167.76 Wednesday, Dec 15,2021 07-59-52 AM GMT-8-Accrual Basis 296 PRC Meeting 03.03.22 Page 297 of 306 Name &Occupation Email Address City of Residence Term Expiry Susan Sweedler, 2022 President emaswee44Cabgmailxom Los Gatos Bob Aptekar, raptekar gmail.com Los Altos Hills 2023 Physician Arnnon Geshuri, aaeshuri gmail.com San Jose 2023 Vice President, Human Relations Yael Landan, _yael.landan(abgmailxom Los Altos 2022 Private Investor Tina Levenfeld, tinabeena777(@gmai1.com Saratoga 2023 Marketing Mark Levine, mlevineUd)pacbell.net Sunnyvale 2023 Communications Consultant Ruth Litwin, San Jose 2023 Community Volunteer ruthalla@hotmailxom Dana Magat, rabbimagat templesanjose.ora San Jose 2022 Rabbi Jeremy Roschelle, ieremyroschelle('Omac.com Portola Valley 2022 Strategy Rob Rubenstein, robrubeCd)aol.com Palo Alto 2023 Retired Businessman Eta Somekh, eta(&somekh.ora Los Altos Hills 2023 Private Investor & Community Volunteer Marian Scheuer Sofaer, marian.sofaer@gmail.com Palo Alto 2022 Lawyer 297 PRC Meeting 03.03.22 Page 298 of 306 Silicon Valley Jewish Film Festival (Returning) Eligibility Checklist (staff use only) Eligibility YES NO Notes: Be made or sponsored by a 501(c)(3)non-profit organization with experienced members capable of implementing and managing the x program/project/event Identify how the funds will be used to benefit the Cupertino x community Be awarded only once per project x For specific needs,not on going,operational costs x Have more than 75%of the requested funds allocated for direct x service costs versus administrative costs Be complete and submitted by the application deadline x Restrictions/Guidelines YES NO Notes: An organization that is applying for multiple grants shall only NA submit one application Proceeds generated from the funded activity may only be used for the conducted activity INA admission to or participation in the event must be"free of charge"to Cupertino residents unless stated in the application and approved x Admission is charged for tickets or movie passes(amount not specified). by Parks and Recreation Commission N co PRC Meeting 03.03.22 Page 299 of 306 CITY OF CUPERTINO CUPERTINO Agenda Item 22-10540 Agenda Date: 3/3/2022 Agenda #: 3. Subject: Evaluation Process for the Fiscal Year 2022-23 Community Funding Grant Program Review the evaluation process for the Fiscal Year 2022-23 Community Funding Grant Program. CITY OF CUPERTINO Page 1 of 1 Printed on 3/2/2022 powered by LegistarTl 299 PRC Meeting 03.03.22 Page 300 of 306 CITY OF PARKS AND RECREATION DEPARTMENT QUINLAN COMMUNITY CENTER 10185 NORTH STELLING ROAD • CUPERTINO, CA 95014-5732 TELEPHONE: (408) 777-3120 • FAX: (408) 777-1305 CUPERTINO CUPERTINO.ORG PARKS AND RECREATION COMMISSION STAFF REPORT Meeting: March 3, 2022 Subject Evaluation Process for the Fiscal Year 2022-23 Community Funding Grant Program. Recommended Action Review the evaluation process for the Fiscal Year 2022-23 Community Funding Grant Program. Discussion Background At the March 3 Parks and Recreation Commission meeting, the 21 applicants for the Fiscal Year (FY) 2022-23 Community Funding Grant Program had the opportunity to attend, provide additional information on their request, and answer any clarifying questions from Commissioners. Prior to the meeting, staff reviewed all submitted applications for completeness and eligibility, determined by compliance to the Community Funding Policy. The Commission was provided with all applications as well as the staff evaluation forms. Evaluation Process At the April 7 regular meeting, the Commission will facilitate the evaluation process and will provide a funding recommendation to City Council. After receiving public comment on the item, there will be a brief recess to allow for the Commissioners to complete their evaluation form (Attachment A) before providing their total out of 100 for each application. Staff will take the totals from each Commissioner and compile them into the evaluation totals form (Attachment B). The Commission will proceed with other business on the agenda to allow staff time to organize the data provided by the Commissioners. When the Commission returns to the item, there will be another opportunity for public comment, specifically regarding evaluations. The Commission will continue to discussion of the data utilizing the evaluation totals form, will have the opportunity to adjust rankings accordingly, and will determine a funding recommendation for City Council. 300 PRC Meeting 03.03.22 Page 301 of 306 Eligibility Staff concluded that 20 applications fully met eligibility requirements and one application was pending eligibility, requiring further consideration by the Commission. This is reflected in the Community Funding Applications Summary. Final eligibility of applications will be determined by the Commission during the evaluation process. When completing the evaluation form, Commissioners should give a score of zero to any applicants they do not deem eligible. Any applicants deemed eligible should be evaluated according to the given criteria. The Commission will be able to review the scores during the evaluation process and discuss eligibility further as a group. Sustainability Impact No sustainability impact. Fiscal Impact No fiscal impact associated with reviewing community funding evaluation process. In April, the Commission will review application evaluations and provide a recommendation regarding funding to City Council for final approval. Prepared by: Rachelle Sander, Assistant Director of Parks and Recreation Reviewed and approved by: Joanne Magrini, Director of Parks and Recreation Attachments: A-Commissioner Community Funding Evaluation Form B-Evaluation Totals Form 301 PRC Meeting 03.03.22 Page 302 of 306 Evaluation Criteria Impact on and benefit Community Need Alignment with Uniqueness of Reasonable Demonstrated Qualifications NEW RETURNING to the Cupertino for the program/ City Mission and the program/ Cost effort to secure /experience APPLICANTS: APPLICANTS: > Community project/event Values project/event funding from other of the `o_ a, -How will the sources organization/ Application Application Cr -Total#participants -Demonstrated -Exceptional -Unduplicated organization members Impact Impact m o a -#of Cupertino part. community impact Service service/ use the grant -Non-City funding CL 4. c -Cost per resident -Education originality funds sources or -Originality -Past 5 -Availability of event to -Innovation -Level of -Established performance ,i the Cupertino -Collaboration collaboration if a partnerships with and program Total Community duplicated service other organizations efficacies Score NOTES: Max Points 20 20 15 15 10 10 5 5 5 100 Organization:Omniware Networks Program/Project/Event:Peace Love Unity Youth Art Contest Exhibition 0 Organization:Palisadoes Foundation Program/Project/Event:Calico Challenge SF 0 Organization:American Cancer Society Program/Project/Event:Relay for Life-Silicon Valley North 0 Organization:STEMBoost Corporation Program/Project/Event:STEMBoost Summer Workshop 0 Organization:Youngzine Program/Project/Event:Summer Youth Climate Steward Program 0 Organization:Able 2 Shine Program/Project/Event:Teens Club Events in 2022 0 Organization:Cupertino Educational Endowment Foundation Program/Project/Event:Expansion of the Teacher Grant Program 0 Organization:Cupertino Union School District Program/Project/Event:CUSD Summer Bridge 0 Organization:Fremont Union School District Foundation Program/Project/Event:Care Solace Partnership for Mental Health Services 0 Organization:Women SV Program/Project/Event:Technical Support for Domestic Abuse Survivors 0 Organization:Breathe California of the Bay Area Program/Project/Event:Seniors Breather Easy 0 Organization:Tian Hong Foundation Program/Project/Event:2022 Tian Hong Cross Cultural Youth Art Contest 0 Organization:Buddhist Tzu Chi Medical Foundation Program/Project/Event:Healthy Cupertino Health Fair 0 Organization:Senior Services-Heart of the Valley Program/Project/Event:COVID Car Kit 0 Organization:Chinese American Coalition for Compassionate Care Program/Project/Event:Mindfully Facing Grief and Loss and Starting the Conversation 0 Organization:Cupertino Bhubaneswar Sister City Initiative Program/Project/Event:Bhubaneswar Sister City Festival for Exchange Immersion 0 Organization:Euphrat Museum of Art-DeAnza College Program/Project/Event:Euphrat Museum Exhibitions and Events 0 Organization:Monta Vista High School Music Boosters Inc Program/Project/Event:Monta Vista Speech Program 0 Organization:Rotary Club of Cupertino Program/Project/Event:Silicon Valley Fall Festival 0 Organization:West Valley Community Services Program/Project/Event:Gift of Hope 2022 0 Organization:Silicon Valley Jewish Film Festival Program/Project/Event:Silicon Valley Jewish Film Festival 0 302 PRC Meeting 03.03.22 Page 303 of 306 Cupertino Commission Commission Amount Residents Status Applicant Minna Sash! Carol Gopal Seema Average Ranking Requested Tier Project Name Served Eligibility Omniware Networks 0 $2,000.00 Tier 2 Peace Love Unity Youth Art Contest Exhibition 1,000 Eligible Palisadoes Foundation 0 $3,750.00 Tier 2 Calico Challenge SF 1 Eligible American Cancer Society-Relay for Life 0 $6,000.00 Tier 3 Relay for Life of Silicon Valley North 180 Eligible STEMBoost Corporation 0 $8,000.00 Tier 3 STEMBoost Summer Workshop 4,588 Eligible Youngzine 0 $6,000.00 Tier 3 Summer Youth Climate Steward Program 12 Eligible Able 2 Shine 0 $20,000.00 Tier 4 Teens Club Events in 2022 2,000 Pending Cupertino Educational Endowment Foundation 0 $109,325.00* Tier 4 Expansion of Teacher Grant Program 6,217 Eligible Cupertino Union School District 0 $20,000.00 Tier 4 CUSD Summer Bridge 240 Eligible Fremont Union School District Foundation 0 $20,000.00 Tier 4 Care Solace Partnership for Mental Health Services 7,000 Eligible Women SV 0 $20,000.00 Tier 4 Technical Support for Domestic Abuse Survivors 10 Eligible 'Maximum award $20,000 Cupertino Commission Commission Amount Residents Amount plic Carol Gopal Seema Average Ranking Requested Project Name Served Eligibility Las ` Funded Breathe California of the Bay Area 0 $4,000.00 Tier 1 Seniors Breathe Easy 2,500 Eligible FY 2020-2021 $4,000 FY20-21 extended to FY21-22 due to COVID Tian Hong Foundation 0 $4,500.00 Tier 2 2022 Tian Hong Cross Cultural Youth Art Contest (Love in my life) 100 Eligible FY 2021-2022 $3,000 2021 Youth Art Contest (Nature and Me) Buddhist Tzu Chi Medical Foundation 0 $8,300.00 Tier 3 Healthy Cupertino Health Fair 50 Eligible FY 2021-2022 $7,400 Healthy Cupertino Health Fair Senior Services - Heart of the Valley 0 $6,160.46 Tier 3 COVID Car Kit 50 Eligible FY 2019-2020 $7,000 FY19-20 extended to FY 20-21 due to COVID Chinese American Coalition for Compassionate Care 0 $13,000.00 Tier 4 Mindfully Facing Grief and Loss and Starting the Conversation 1,000 Eligible FY 2021-2022 $12,000 Starting the Conversation and Mindful Self-Care Returning Cupertino Bhubaneswar Sister City Initiative 0 $15,000.00 Tier 4 Bhubaneswar Sister City Event/Festival for Exchange & Immersion 2,000 Eligible FY 2020-2021 $7,500 Festival and Exchanges Returning Euphrat Museum of Art -De Anza College 0 $15,000.00 Tier 4 Euphrat Museum of Art exhibitions and events 11,500 Eligible FY 2021-2022 $15,000 Euphrat Museum exhibitions and events 2021-2022 Returningd Monta Vista High School Speech Boosters Inc 0 $10,000.00 Tier 4 Monta Vista Speech Program 4,464 Eligible FY 2021-2022 $3,000 Monta Vista Speech Program Returning Rotary Club of Cupertino 0 $12,000.00 Tier 4 Silicon Valley Fall Festival 500 Eligible FY 2021-2022 $12,000 Cupertino Fall Festival Returning West Valley Community Services 0 $10,000.00 Tier 4 Gift of Hope 2022 300 Eligible FY 2021-2022 $10,000 Gift of Holiday Hope Program Returning Silicon Valley Jewish Film Festival 0 $10,000.00 Tier 4 Silicon Valley Jewish Film Festival 5,000 Eligible FY 2020-2021 $5,000 SV Jewish Film Festival Tiers TOTAL Community Funding Grants Requested $323,035.46 Tier 1 <$999.99 Tier 2 $1,000.00 - $4,999.99 Community Funding Approved Funding Range - $70,000 to $90,000 Tier 3 $5,000.00 - $9,999.99 Tier 4 $10,000.00 - $20,000.00 303 PRC Meeting 03.03.22 Page 304 of 306 COMMISSION Amount Applicant AVERAGE lRquestedI Omniware Networks 0 $ 2,000.00 Palisadoes Foundation 0 $ 3,750.00 American Cancer Society-Relay for Life 0 $ 6,000.00 STEMBoost 0 $ 8,000.00 Youngzine 0 $ 6,000.00 Able 2 Shine 0 $ 20,000.00 Cupertino Education Endowment Foundation 0 $ 109,325.00 Cupertino Union School District 0 $ 20,000.00 Fremont Union School District 0 $ 20,000.00 Women SV 0 $ 20,000.00 Breathe California of the Bay Area 0 $ 4,000.00 Tian Hong Foundation 0 $ 4,500.00 Buddhist Tzu Chi Medical Foundation 0 $ 8,300.00 Senior Services -Heart of the Valley 0 $ 6,160.46 Chinese American Coalition for Compassionate Care 0 $ 13,000.00 Cupertino Bhubaneswar Sister City Initiative 0 $ 15,000.00 Euphrat Museum of Art- DeAnza College 0 $ 15,000.00 Monta Vista High School Speech Boosters Inc 0 $ 10,000.00 Rotary Club of Cupertino 0 $ 12,000.00 West Valley Community Services 0 $ 10,000.00 Silicon Valley Jewish Film Festival 0 $ 10,000.00 304 PRC Meeting 03.03.22 Page 305 of 306 Applicant Minna Minna Rank Sash! Sashi Rank Carol Carol Rank Gopal Gopal Rank Seema Seema Rank COMMISSION COMMISSION AMOUNT AVERAGE RANKING REQUESTED Omniware Networks 0 1 0 1 0 1 0 1 0 1 0 5 $ 2,000.00 Palisadoes Foundation 0 1 0 1 0 1 0 1 0 1 0 5 $ 3,750.00 American Cancer Society - Relay for Life 0 1 0 1 0 1 0 1 0 1 0 5 $ 6,000.00 STEMBoost 0 1 0 1 0 1 0 1 0 1 0 5 $ 8,000.00 Youngzine 0 1 0 1 0 1 0 1 0 1 0 5 $ 6,000.00 Able 2 Shine 0 1 0 1 0 1 0 1 0 1 0 5 $ 20,000.00 Cupertino Education Endowment Foundation 0 1 0 1 0 1 0 1 0 1 0 5 $ 109,325.00 Cupertino Union School District 0 1 0 1 0 1 0 1 0 1 0 5 $ 20,000.00 Fremont Union School District 0 1 0 1 0 1 0 1 0 1 0 5 $ 20,000.00 Women SV 0 1 0 1 0 1 0 1 0 1 0 5 $ 20,000.00 Breathe California of the Bay Area 0 1 0 1 0 1 0 1 0 1 0 5 $ 4,000.00 Tian Hong Foundation 0 1 0 1 0 1 0 1 0 1 0 5 $ 4,500.00 Buddhist Tzu Chi Medical Foundation 0 1 0 1 0 1 0 1 0 1 0 5 $ 8,300.00 Senior Services - Heart of the Valley 0 1 0 1 0 1 0 1 0 1 0 5 $ 6,160.46 Chinese American Coalition for Compassionate Care 0 1 0 1 0 1 0 1 0 1 0 5 $ 13,000.00 Cupertino Bhubaneswar Sister City Initiative 0 1 0 1 0 1 0 1 0 1 0 5 $ 15,000.00 Euphrat Museum of Art- DeAnza College 0 1 0 1 0 1 0 1 0 1 0 5 $ 15,000.00 Monta Vista High School Speech Boosters Inc 0 1 0 1 0 1 0 1 0 1 0 5 $ 10,000.00 Rotary Club of Cupertino 0 1 0 1 0 1 0 1 0 1 0 5 $ 12,000.00 West Valley Community Services 0 1 0 1 0 1 0 1 0 1 0 5 $ 10,000.00 Silicon Valley Jewish Film Festival 0 1 0 1 0 1 0 1 0 1 0 5 $ 10,000.00 305 PRC Meeting 03.03.22 Page 306 of 306 CITY OF CUPERTINO CUPERTINO Agenda Item 22-10528 Agenda Date: 3/3/2022 Agenda #: 4. Subject: Monthly Update Reports Receive monthly update reports from the Director of Parks and Recreation and commissioners. CITY OF CUPERTINO Page 1 of 1 Printed on 3/2/2022 powered by LegistarT"306