HomeMy WebLinkAboutR16-Redevelopment Agency
~Ebr:VELOPMENT AGENCY .~QUEST FOR 'tOMMISSION/COUNCIL A~ION
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From: GLENDA SAUL
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Subject: APPROVAL OF FY 1985/86 CDBG AGREEMENT
FOR A CENTER OF ENRICHMENT (ACE)
'tfept: Redevelopment Agency
Date: OCTOBER 29. 1985
Synopsis of Previous Commission/Council ection:
-On May 23. 24. 28. 30 and 31. 1985. the Mayor and Common Council considered and
approved for funding certain FY 1985/86 CDBG Public Service Projects. one of
which was A Center for Enrichment (ACE).
-On October 21. 1985. the Mayor and Common Council considered approval of the
ACE agreement and continued this item to November 4. 1985.
Recommended motion:
(MAYOR AND COMMON COUNCIL)
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Resolution of the City of San Bernardino authorizing and directing the execution
of a Community Development Block Grant funding agreement between the City of
San Bernardino and A Center for Enrichment.
/5d/~ 4/1
Signature
Contact person: GLENDA SAUL
FUNDING REQUIREMENTS: Amount: $ ?o.ooo
Phone: 383-5081
Ward: 1-7
Project: All
Date: November 4. 1985
Supporting data attached: YES. STAFF REPORT
No adverse Impact on City:
cC iI Notes:
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CI~ OF SAN BEANARD~O - REQU~T FOR COUNCIL AC~ON
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STAFF REPORT
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75-0264
On October 2, 1985, the Mayor and Common Council continued this item to its
next regularly scheduled meeting of November 4, 1985. The item was continued,
in part, because it was felt that the letter received from the Director of
Social Services from St. Bernardines Hospital did not fully comply with the
conditions of funding the Council set in May 1985. Those conditions are
included in a letter from Agency staff to ACE staff dated October 22, 1985
(attachment "A"). Also attached is the above referenced letter from St.
Bernadines (attachment "B").
As a result of the letter of October 22, 1985, sent by staff, ACE has
submitted a response (attachment "C") for the Mayor and Common Councils
consideration. Based upon the information contained in the letter, staff
recommends funding of the ACE program in an amount not to exceed $20,000.
Adoption of the resolution by the Mayor and Common Council would authorize the
Mayor and execute an agreement between A Center for Enrichment and the City of
San Bernardino.
10/85
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RESOLUTION NUMBER
RESOWTION OF THE CITY OF SAN BERNARDINO AUTHORIZING AND DIRECTING THE
EXECUTION OF A COMMUNITY DEVELOPMENT BLOCK GRANT FIOOlING AGREEMENT BETW'EEN THE
CITY OF SAN BERNARDINO AND A CENTER FOR ENRICHMENT.
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BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN
BERNARDINO AS FOLLOWS:
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SECTION 1. The Mayor of the City of San Bernardino is hereby authorized
and directed to execute, on behalf of aaid City, an agreement for Community
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Development Block Grant funding with A Center for Enrichment, a copy of which
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agreement is annexed hereto as Exhibit -1- and is incorporated herein by
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reference as though fully set forth at length. The agreement provides for the
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granting of Community Development Block Grant funds in the following amount of
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$20,000.00.
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I HEREBY CERTIFY that the foreoing resolution was duly adopted by the
Mayor and COlDlllon Council of the City of San Bernardino at a
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meeting
thereof, held on the
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day of
, 1985, by the following vote,
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to wi t:
AYES:
Councilmen
NAYES:
ABSENT:
City Clerk
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The foregoing resolution is hereby approved this
day
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, 1985.
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Mayor, City of San
Bernardino
Approved as to form:
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EXHIBIT 1
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THIS AGREEMENT is entered into effective as of Jul,V 1
5 1985, at San Bernardino, California, between the CITY OF SAN BERNARDINO, a
6 municipal corporation, referred to as "City", and A Center for Enri chl'1ent ,
7 a nonprofit cODlllunity service organization, referred to as "Subrecipient".
12 block grant from the United States of America to City.
13 (b) Subrecipient represents that the expenditures authorized by
C 14 this Agreement are for valid co_unity deVelopment purposes, in accordance
15 with federal law and regulations, and that all funds granted under this
8 City and Subrecipient agree as follows:
9 1. Recitals.
10 (a) Subrecipient has requested financial assistance from City for
11 fiscal year 1985/1986 from funds available through a cODlDUnity development
23 Agency. Reimbursement will be made at least on a monthly basis, with the
24 total of all such reimbursements not to exceed $ 20,000 .
25 3. Term. This Agreement shall commence July I, 1985, and terminate
26 June 30, 1986.
27 4. Use of Funds; Budget; Travel Limitation. The funds paid to
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Subrecipient shall be used by it solely for the purposes set forth in
16 Agreement will be used for no purpose other than those purposes specifically
17 authorized. The apecific purposes and scope of services of this particular
18 grant are set forth in Exhibit "A", attached hereto and incorporated into this
19 Agreement as though fully set forth herein.
20 2. Payments. City shall reimburse Subrecipient for allowable costs
21 incurred under the Scope of this Agreement and applicable Federal regulations,
22 hich have not been paid for or reimbursed in any other manner or by any other
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1 Paragraph lCb) of this Agreement, and in accordance with the program budget
2 submitted by Subrecipient to the Redevelopment Agency of the City of San
3 Bernardino, a copy of which is attached to this Agreement as Exhibit "B".
4 This budget shall list all sources of funding for the program covered by this
5 Agreement, whether from State, Federal, local or private sources, and shall
6 identify which sources are paying for which specific portions of the program,
7 by line-item, to the extent practicable. No travel expenses for out-of-state
8 travel shall be included in this program unless specifically listed in the
9 budget as submitted and approved, and all travel expenses to be funded from
10 funds provided hereunder shall be specifically identified as travel expense,
11 which shall be negotiated between Agency and Subrecipient in the budget. Any
12 . travel expenses incurred by Subrecipient above the budgeted amount or for
13 out-of-town travel shall not be eligible for reimbursement unless the prior
C 14 written approval of the Executive Director of the Redevelopment Agency of the
15 City of San Bernardino, or his or her designee, has been obtained. Funds
16 shall be used for purposes authorized by the CODDDUnity Development Block Grant
17 program only, and no portion of the funds granted hereby shall be used for any
18 purpose not specifically authorized by this agreement. Only net payroll shall
19 be periodically reimbursed by City as an allowable cost. Any amounts withheld
20 by Subrecipient from an employee's pay for taxes, social security, or other
21 withholding and not ilDlDediately paid over to another entity, shall not be
22 included as wages or expenses eligible for reimbursement as an allowable cost
23 until such time as the withheld taxes, social security, or other withholdings
24 are actually paid over to the entity entitled to such payment. Upon such
25 payment and the submission of evidence of such payment to the Redevelopment
26 Agency, such expenses shall be regarded as allowable cost, and City shall
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~ 27 reimburse Subrecipient for such obligation. A variation in the itemization of
28 costs, as set forth in the proposed budget submitted to City, not to exceed
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1 10% as to any particular line item, shall be allowed, provided the prior
2 written approval of the Executive Director of tbe Redevelopment Agency of the
3 City of San Bernardino is obtained, it being understood tbat tbe total amount
4 of tbe grant sball not be varied thereby. At the end of the term, all
5 unexpended funds shall be returned to the City by Subrecipient. The parties
6 intend that grant funds be utilized witbin the time period covered by this
7 Agreement, and any funds not used shall revert to the City. No reserve for
8 the future ahall be established with tbe funds except as 1II8Y be authorized to
9 meet cODlllitments made for services provided during the period of this
10 Agreement, but not yet paid for at tbe conclusion of tbis Agreement.
11 5. Accounting. Prior to the final payment under this Agreement, and
12 at such otber times as may be requested by the Executive Director of the
13 Redevelopment Agency of tbe City of San Bernardino, Subrecipient shall submit
14 to tbe Executive Director an accounting of tbe proposed and actual
15 expenditures of all revenues accruing to the organization for the fiscal year
16 ending June 30, 1986. Financial records sball be maintained by Subrecipient
17 in accordance with generally accepted accounting principles, in a manner which
18 permits City to trace the expenditures of funds to source documentation. All
19 books and records of Subrecipient are to be kept open for inspection at any
20 time during the businesa day by the City, its officers or agents, and by any
21 representative of the United States of America authorized to audit Community
22 Development Block Grant programs. Standards for financial management systems
23 and financial reporting requirements established by Attachment "F" and
24 Attachment "G" of Office of Management and Budget Circular No. A-110 shall be
25 fully complied with by Subrecipient. Subrecipient acknowledges that the funds
26 privded are federal funds. Subrecipient's financial 1II8nagement system shall
27 provide for accurate, current and complete disclosure of the financial results
28 of each program sponsored by tbis Agreement. It is the responsibility of
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I Subrecipient to adequately aafeguard all a..ets of the program, and
2 Subrecipient shall assure that they are used solely for authorized purposes.
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6. Servicea Available to Ileaidents, Monitoring and Ileporting Program
4 Performance.
The services of Subrecipient shall be made available to
5 residenta and inhabitants of the City of San Bernardino unless otherwise noted
6 in Exhibit "A". No peraon shall be denied service because of race, color,
7 national origin, creed, sex, marital status, or physical handicapp.
8 Subrecipient ahall comply with Affirmative Action guidelines in its employment
9 practicea. Subrecipient ahall alao monitor the program's activities and
10 submit written reporta quarterly, or more often if requested, to the Executive
11 Director of the Redevelopment Agency of the City of San Bernardino, in
accordance with Attachment "B", Office of Management and Budget Circular No.
1.-110. Failure to provide auch quarterly performance reports may prevent the
proce..ing by City of Subrecipient 'a requeaU for reimbursement, and may
juatify temporary withholding as provided for in Paragraph 11 hereof.
7. Procur_nt
Practicea.
with
Subrecipient
shall
comply
procurement procedures and guidelines established by Attachment "0" to Office
of Management and Budget Circular No. 1.-102, "Procurement Standards". In
addition to the specific requirements of Attachment "0" to Circular No. 1.-102,
Subrecipient ahall maintain a code or atandards of conduct which shall govern
the performance of its officers, employeea or agents in contracting with and
expending the Federal grant funds made available to Subrecipient under this
23 Agreement. Subrecipient's officers, employees or agents shall neither solicit
24 nor accept gratuities, favors, or anything of monetary value from contractors
25 or potential contractora. To the extent permissible by State law, rules, and
26 regulations, the standards adopted by Subrecipient shall provide for
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28 violations of such standards by either the Subrecipient's officers, employees
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1 or agents, or by contractors or their agents. Subrecipient shall provide a
2 copy of the code or standards adopted to City forthwith. All procurement
3 transactions without regard to dollar value shall be conducted in a manner so
4 as to provide maximum open and free competition. The Subrecipient shall be
5 alert to organizational conflicts of interest or non-competitive practices
6 among contractors which may restrict or eliminate competition or otherwise
7 restrain trade. Subrecipient agrees to adhere to the procurement rules
8 specified in Office of Management and Budget Circular No. A-I02 Attachment "0"
9 in its expenditure of all funds received under this Agreement.
10 8. Anti-Uck Back Provisions; Equal Employment Opportunity. All
11 contract for construction or repair using funds provided under this Agreement
12 shall include a provision for compliance with the Copeland "Anti-Kick Back"
13 Act C18.U.S.C. 874) as supplemented in Department of Labor Regulations (29
14 CFR, Part 3). This act provides that each contractor or subgrantee shall be
15 prohibited from inducing, by any means, any person employed in the
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20 Agreement shall contain a provision requiring compliance with Equal Employment
construction, completion or repair of public work, to give up any part of the
compensation to which he is otherwise entitled. Subrecipient shall report all
suspected or reported violations to City. All contracts in excess
$10,000.00 entered into by Subrecipient using funds provided under
of
this
21 Opportunity provisions established by Executive Order #11246 as amended.
22 9. Prevailing Wage Requirement. Any construction contracts awarded
23 by Subrecipient using funds provided under this Agreement in excess of
24 $2,000.00 shall include a provision for compliance with the Davis-Bacon Act
25 (40.U.S.C. 276a to 276a-7) and as supplemented by Department of Labor
26 Regulations (29CFR). Under this act, contractors shall be required to pay
27 wages to laborers and mechanics at a rate not less than the minimum wages
28 specified in a wage determination made by the Secretary of Labor. In
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1 addition, contractors shall be required to psy wages not less often than once
2 a week. Subrecipient shall place a copy of the current prevsiling wage
3 determination issued by the Department of Labor in each solicitation and the
4 award of a contract shall be conditioned upon the acceptance of the wsge
5 determination. Subrecipient shall report all suspected or reported violations
6 to City.
7 10. Approval of City of any Chargee; Use of Program Income. City
8 reserves the right to require Subrecipient to obtain the prior written
9 approval of City of any charges or fees to be charged by Subrecipient for
10 services provided under this Agreement, and of any rules and regulations
11 governing the provision of services hereunder. Program income represents
12 gron income earned by the Subrecipient from the Federally supported
13 activities. Such earnings exclude interest earned on advances and msy
14 inClude, but will not be limited to, income from service fees, sale of
15 cODlDodities, ussge and rental fees. These funds shall be used first for
16 eligible program activities, before requests for reimbursement, or shall be
17 remitted to the City. Subrecipient shall remit all unspent program income to
18 the City within thirty (30) dsys subsequent to the end of the program yesr
19 (June 3D, 1986). Interest earned on funds advanced under the Agreement shall
20 be paid to the City.
21 11. TelllPorary Withholding. The Executive Director of the
22 Redevelopment Agency of the City of San Bernardino is authorized to
23 temporarily withhold the payment of funds to Subrecipient when the Executive
24 Director determines that any violation of this Agreement has occurred. Funds
25 shall be withheld until the violation is corrected to the satisfaction of the
26 Executive Director or of the Mayor and CoDlDon Council. Subrecipient shall
27 have the right to be heard by the Mayor and Common Council if Subrecipient
28 maintains no violation of the Agreement has occurred, which hearing shall be
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1 held within 45 days after the funds have first been withheld, provided
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2 Subrecipient requests such hearing within 15 days after such first withholding.
3 12. Records Iletention. Financial records, supporting documents,
4 statistical records, and all other records pertaining to the use of the funds
5 provided under this Agreement shall be retained by Subrecipient for a period
6 of three (3) years, at a minimum, and in the event of litigation, claim or
7 audit, the records shall be retained until all litigation, claims, and audit
8 findings involving the records, have been fully resolved. Records for
9 non-expendable property acquired with federal funds provided under this
10 Agreement shall be retained for three (3) years after the final disposition of
11 such property.
12 13. Property Management Standards. Non-expendable personal property,
13 for the purposes of this Agreement, is defined as tangible personal property,
C 14 purchased in whole or in part with Federal funds, which has useful life of
15 than (l) and acquisition cost of three hundred dollars
more one year an
16 ($300.00) or more per unit. Real property means land, including land
17 improvements, structures and appurtenances thereto, excluding movable
18 machinery and equipment. Non-expendable personal property and real property
19 purchased with or improved by funds provided under this Agreement shall be
20 subject to the property management standards specified in Attschment "N" of
21 Office of Management and Budget Circular No. A-I02, "Property Management
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22 Standards".
23 14. Termination for Cause. City reserves the right to terminate this
24 Agreement and any and all grants and future payments under this Agreement in
25 whole or in part at any time before the date of completion of this Agreement
26 whenever City determines that the Subrecipient has failed to comply with the
27 conditions of this Agreement. In the event City seeks to terminate this
28 Agreement for cause, City shall promptly notify the Subrecipient in writing of
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1 the proposed termination and the reasons therefore, together with the proposed
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2 effective date. Subrecipient shall be given an opportunity to appear before
3 the Kayor and Common Council at the time at which the Kayor and Common Council
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4 are to consider such recommended termination, and shall be given a reasonable
5 opportunity to show cause why, if any exists, the Agreement should not be
6 terminated for cause. Upon determination by this Kayor and Common Council
7 that the contract should be terminated for cause, notice thereof, including
8 reasons for the determination, shall promptly be given to Subrecipient,
9 together with information as to the effective date of the termination. The
10 determination of the Kayor and Common Council as to cause shall be final.
11 IS. Termination for Convenience. City or Subrecipient may terminate
12 this Agreement in whole or in part provided both parties agree that the
13 continuation of the project would not produce beneficial results CODDDensurate
14 with further expenditure of funds. In auch event, the parties shall agree
c:: 15 upon the termination conditions, including the effective date and, in the case
16 of partial terminationa, the portion to be terminated. The Subrecipient shall
17 not incur new obligations for the terminated portion after the effective date
18 and shall cancel as many outstanding obligations as possible. City shall
19 allow Subrecipient full credit for the City' a share of the non-cancellable
20 obligations properly incurred by the Subrecipient prior to termination.
21 16. Hold Harmleas. Subrecipient agrees to indemnify and save
22 harmless the City and its employees and agents from all liabilities and
23 charges, expenses (including counsel fees), suits or losses, however
24 occurring, or damages, arising or growing out of the use of or receipt of
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Payments under this Agreement are made with the understanding that the City is
funds paid under this Agreement and all operations under this Agreement.
not involved in the performance of services or other activities of
Subrecipient.
Subrecipient and its employees and agents are independent
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1 contractors and not employees or agents of City.
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17. Amendment. This Agreement ...y be amended or modified only by
3 written agreement signed by both parties, and failure on tbe part of either
4 party to enforce any provision of this Agreement shall not be construed as a
5 waiver of the right to compel enforcement of any provision or provisions.
6 18. Aubnmnt. This Agreement shall not be auigned by Subrecipient
7 without the prior written consent of City.
8 19. Rotices. All notices herein required shall be in writing and
9 delivered in person or sent by certified mail, postage prepaid, addressed as
10 follows:
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As to City:
As to Subrecipient:
Executive Director,
Redevelopment Agency of tbe
City of San Bernardino
City Ball, Third Floor RID. 320
300 Nortb "D" Street
San Bernardino, Calif. 92418
20. Evidence of Authority.
Subrecipient shall ,provide to City
evidence in the form of a certified copy of minutes of the governing body of
Subrecipient, or other adequate proof, that this Agreement bas been approved
in all its detail by tbe governing body of Subrecipient, tbat the person(s)
executing it are autborized to act on behalf of Subrecipient, and that this
Agreement is a binding obligation on Subrecipient.
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1 lK WITNESS WHEREOF. the parties hereto have executed this Agreement
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4 ATTEST:
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June/1985
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CITY OF !WI BERllADINO:
BY:
City Clerk
Kayar
SUBRECIPIENT:
BY:
President
BY:
Secretary
Approved as to legal form:
City Attorney
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.J\ CENTER. . , c~OR
'P;ograms [or Children and Adults wi", ,
OiIDCfiMENT (r:.;cfJ
P.O. BOX. 30014
San
ife-Threatening or Catastrophic Illness.
Bernardino CA 92413 714/881-2407
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July 10, 1985
GLENDA SAUL
Executive Director
Redevelopment Agency/San Bernardino
300 North D Street Rm. 320
San. Bernardino CA 92418
Dear Ms. Saul:
We appreciate your office considering this program for Community
Development Block Grant (CDBG) funding in the amount of $20,000.
Enclosed is a 6-month budget, based on anticipated funding of
$43,000 for this period of time, showing the proposed break-down
of contributions from all sources.
Also enclosed is the "Scope of Services" to be supported by CDBG
funds, and other detailed information on our program.
If you need any additional information, please do not hesitate
to call me.
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Sincerely yours,
c-~, (), -::>-b... 'M . Gv-.o~...
Encls
Cy to:
Jewel Shelton
CELESTA M. BUSCH
Admin/Support Services Coord.
fD' IE' ~ ~ pn f[ 8)f'
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,JUL- / l.;Jt<:
REDEVELOPMENT AGENcY Of THO
CITY OF SAN BERf~ARDINO, CA -
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..-4 CENTER . c~OR iC'iIDClIMENT CA-cf:J
r,;",grams for Chlldren and Adults wllh L1fe-Threalenlng or Catastrophic /1/ness.
P.o. BOX 30014 San Bernardino CA 92413 714/881-2407
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Project/Activity Title:
A Center for Enrichment (ACE)
P.O, 'Box 30014 (1759 Date Place)
San Bernardino, CA 92413 (San Bernardino, CA 92404)
(714) 881-2407
PROJECT/ACTIVITY DESCRIPTION
1. INTRODUCTION
Cancer, leukemia, multiple sclerosis and tumors can be a horrifying
experience for the afflicted and loved ones. A Center for Enrichment
(ACE) will playa vital role for families experiencing ~ny catastrophic
disease or life-threatening illness. Our goaL is to br1ng individuals
together who are experiencing similar situations. Our primary objec-
tives are: ,
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o to reach o~t to children and families experiencing
catastrophic or life-threatening illness and provide
services which will promote a healthy acceptance of
and adjustment ,to their situation in order to improve
the quality of life;
o to improve life expectancy for those suffering illness;
o to prevent social and emotional complications which often
lead to hospitalization, unemployment and public assistance.
In San Bernardino County, one referral doctor alone has over 90 termi-
nally ill childrenr and hundreds of children suffering catastrophic
illnesses. It is of utmost importance that our services be available.
II. PROGPA.'1 OBJECTIVE
1) To provide an atmosphere where people who are experiencing cata-
strophic situations can meet to actively participate in the pro-
cess of attitudinal healing.
2) To provide emotional support that supplements existing health care
and social service agencies.
3) To create an understanding, caring, and supportive community for
the special families who come to ACE.
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III. PROGRAM GQALS-
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To provide supportive services to adults, young adults, and
children ages 4-18 years through the use of art, music, and
positive active imagination.
To provide supportive services to parents of children, spouses,
and others with close emotional attachments, enabling them to
share the Concerns and fears that arise during traumatic times.
To encourage strengthening of the mind-body connection that is
so vital for positive patient participation in the treatment
of illness.
To provide an educational model for other health care and pri-
vate agencies in San Bernardino County through referrals and
networking.
2)
3)
4)
IV. A WORD ABOUT THE CENTER
A Center for Enrichment (ACE) is modeled on the Center for Atti-
tudinal Healing in Tiburon, California, which was founded by Dr.
GeraldJampolsky in 1975. We provide a non-clinical environment
and encourage peer group emotional and spiritual support without
regard to race, religion, sex, income, citizenship, or community
or professional status. One of the main reasons for establishing
ACE was the realization that families had no place where they
could discuss their concerns about their illnesses or fears about
~: death in a non-judgmental, accepting atmosphere.
V. WHAT IS ATTITUDINAL HEALING?
The concept of attitudinal healing is based on the belief that it
is possible to choose peace rather than conflict, and love rather
than fear. In attitudinal healing, health is defined as experi-
encing inner peace, and love is defined as letting go of fear.
Therefore, attitudinal healing is the process of letting of
painful, fearful attitudes. When we let go of fear, only love
remains. We believe that love is the most important healing
force in the world.
VI. OUR APPROACH
All who come to the Center, including staff and volunteers, are
committed to helping each other achieve the shift in perception
from fear to love that facilitates the process of attitudinal
healing.
When a perso~ experiences a catastrophic or life-threatening ill-
ness there are feelings of anger toward the world, a tendency to
feel alone, different, and isolated; and to see the universe as
(~ unloving and attacking. Healing begins when there is a shift in
\-. perception about illness and its related problems. This shift can
occur as a child or adult learns how to focus on helping others by
extending love, learns that each instant is the only time there iSr
and discovers that within that instant they do not perceive them-
selves as ill or in pain. One such instant can become two, threer
many.
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VII. INTENDED RESULTS (6 month goals)
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a. The Center will add at least 25 participants to the 55 who have
already been involved in the childrens group. This group is a
time of sharing and mutual support for children with an illness.
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b. Siblings group - at least 20 participants will be added. In
this group, brothers and sisters of the childrens group parti-
cipants discuss common fears, frustrations, and concerns.
c. At least 8 additional young adultsr ages 19 and up will come
together to share and extend love and learn to experience inner
peace by letting go of fear.
d. 50 adults, spouses, and parents of children will be added and
participate in the sharing of concerns and fears of those who
are emotionally involved with a person who is ill.
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e. Outreach and Networking:
o Hospital/Home/School Visitation Program _ there will
be at least 35 visitations to extend love and support
to the entire family. Meetings with physicians,
nurses, social workers, and teachers are an important
el~ent of this program and provide an educational
opportunity to discuss and demonstrate attitudinal
healing.
o Networking - we will make at least 6 presentations to
co~~unity and professional groups.
f. Phone/Pen Pal Program - at least half of the active Center
clients will participate in this program, that creates a
network of people who have had similar experiences and enables
them to relate via letter or phone. This important program
allows us to extend love and link with others all around the
country.
VIII. INCORPORATION
Pending empowerment by the State of California, Office of the
Secretary of State, A Center for Enrichment LACE) has applied
to be incorporated for nonprofit purposes only, and tax exempt
status under Section SOl(clt31 of the Internal Revenue Code;
Federal I.D. #33-0096799.
,-.
-
_P-
.~
Programs for Children and Adults wi:
P.o. BOX..30014 San Bern~
ClENTlEllr
DIrK
:QUrClBIMlENT (AtdE)
- Threatening or Catastrophic Illness.
,0 CA 92413 714/881-2407
"-""
BUDGET - FY 65/86
July 1985 - December 1985
I. PERSONNEL
A) Program Director
B) Admin/Support Services Coordinator
C) Office Manager
II. FRINGE BENEFITS & PAYROLL TAXES
A) FICA 7% of $10,837.50
B) SDI 1% of $10,837.50
C) SUI 1.5% of $10,837.50
D) Workmans Comp 1% of $10,837.50
E) Heal th Ins
F) Dental Ins
III. FISCAL & PROGRAM CONSULTANTS
A) Grant/Proposal Writer 81 hrs @ $ 8.00/hr
B) CPA review 24 hrs @ $10.00/hr
C) Art Therapist 72 hrs @ $ 5.00/hr
D) Music Therapist 72 hrs @ $ 5.00/hr
c~.
FACILITY COSTS
A) Rent*
B) Utilities
Electricity,water,rubbish pick up
C) Telephone
D) Answering Service
E) Janitorial
F) Outside maintenance
Pool, gardener (required by lease)
G) Insurance(Personal,prpty liability)
V. TRAVEL
A) Mileage (550 mi/mo. @ $.25/mi)
VI. CONSUMMABLE SUPPLIES
A) Office supplies
B) Postage
C) Host fund
For other than client meetings
D) Recreation/crafts
E) Printing
Brochures, Bus.Cds,Stationery,etc.
F) Advertising
'-,
oeD S.B. CITY
$2U:-OOO ~,ooo
$ 4,687.50 4,687.50
3,150.00 3,150.00
3,000.00 3,000.00
$10.837.50 10.837.50
758.63 758.63
108.38 108.38
162,57 162.57
108.38 108.38
360.00 360.00
220.00 220.00
$ 1.717.38 1.717.96
408.00 240.00
-0- 240.00
180.00 180.00
180.00 180.00
$ 768.00 840.00
950.00 1,750.00
300.00 660.00
400.00 800.00
360.00 -0-
330.00 330.00
405.00 405.00
(300.00)est ($300.00)est
$3,045.00 $4,245.00
$ 412.50 $ 412.50
156.97 182.39
100.00 100.00
90.00 90.00
50.00 50.00
350.00 350.00
75.00 75.00
$ 821.97 $ 847.39
(Cont'd on next page)
*$3,000 grant from Gannett Foundation will pay additional lease costs
.--c
c
. VII. EQUIPMENT/FURNITURE RENTAL
A) Copier '.
B) Furniture (Jul-Sep only)
--,
VIII.FURNITURE PURCHASE (rental buy-out)
r
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TOTAL BUDGET
- END -
1''',,\
.....,.)
- /
450.00 450.00
324.83 649.66
$ 774.83 $1,099.66
1.624.15 -0-
$20,000.00 $20,000.00
CDBG S.B. CITY
-
~~,
1'...-.- :~, [
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REDEVELOPMENT AGENCY
OF THE CITY OF SAN BERNARDINO, CALIFORNIA
...,/
GLENDA 8AUL
aXEel",\'F. bIRE~'OR
.-...
DICK OOBUa.C;CH
IlF.PL'rY IlIllF.M'OK
......
October 22, 1985
Sandy Obst
Program Director
A Center for Enrichment
P.O. BOl[ 30014
San Bernardino, Calif. 92413
ll.e: FY 1985/1986 CDBG AGREEMENT
Dear Ms. Obst:
At its regularly scheduled meeting of October 21, 1985, the Mayor and Common
Council of the City of San Bernardino continued the above referenced item
until its November 4, 1985 meeting. Agency staff was directed to request of
ACE the following information:
c:
a) An analysis of the program, the services rendered and 1mpact
upon program recipients by a doctor or group of doctors from
St. Bernadines and/or Community Hospital. Specifically the
Council desires an endorsement from qualified medical
authorities regarding the effectiveness of the services
delivered by ACE.
b) Documentation that ACE has separated from Los Padrinos and
has obtained a Section 50l(c)(3) rating.
c) Qualifications of program staff providing direct services to
program recipients.
Should you have any questions regarding the above, please do not hesitate to
contact Ken Henderson of my staff at 714/383-5081.
Sincerely,
61~,~1
Glenda Saul
Executive Director, RDA
ee: Ken Henderson
Jewell Shelton
File
,N_
GS:XJH:lo:4l9L
'-",
Attachment "A"
OTY HALL. 300 NORTH -D" STREET. RM, 320 . SAN BERNARDINO. CALIFORNIA 92418 . PHON!:: (714) 38:l-!lOll1
'iR? u En~/iiJ
AUG 7 1985 ..
REDEVELOPMCNT AG[Nt;Y Of THE
CITY OF SAN BFPNARn/NO. CA
'...../
2101 _h wateamon oue""" August 5, 1985
aGn beAf')oQbino. col!p:M:mia ~"(M
(714) 883-8711
.
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Glenda Saul
Executive Director
Redevelopment Agency
City of San Bernardino
300 North "0" Street
San Bernardino, California 92418
Dear Ms. Saul,
I am a social worker at St. Bernardine Hospital and work
with many of our cancer patients. I am co-therapist of
an on-going support group at the hospital and also participate
in the "I Can Cope" program sponsored by the American Cancer
Society.
The emotional needs of cancer patients are many and I feel
that the Center for Enrichment provides a useful adjunctive
service to those resources that are already in the community.
I have visited the center and have found it to be a warm and
friendly place where patients and their families can get help
with the special stresses of their situations.
Sincerely,
~~~~
Barbara Haveman, LCSW
Director of Social Services
St. Bernardine Hospital
BH:ejs
Attachment "B"
"(;oh. OUR Gob. hOH bh~R8P.^ Ult" Penhnfl tf7:tJ
-
C
A
C 0
CENTER FOR ENRICHMENT INC (ACE)
Programs for Children and Adults with Life-Threatening or Catastrophic Illness
Mail: P.O. Box 30014 San Bernardino CA 92413 714/881-2407
Location: 1759 E. Date place San Bernardino CA 92404 (one
block south of Route 30 between Del Rosa & Sterling)
,...)
.--,
'-,
October 28, 1985
Glenda Saul
Executive Director, RDA
City of San Bernardino, California
City Ball 300 North "D" Street
San Bernardino CA 92418
Dear Ms. Saul:
In response to your 10-22-85 request for additional information
on A Center for Enrichment, Inc. (ACE), I am sending the following:
1) A letter from Drs. Nisbet and Olson, St. Bernardine
physicians, regarding the program and its impact on
recipients.
1~"
2) Copies of articles of incorporation and amendment
documenting ACE's status as a corporation; nonprofit
status pending from IRS.
~,
Regarding item C (qualifications of program staff), staff members
have had a combination of qualifying experiences to prepare them
for providing supportive services to program participants. These
experiences include: in-service training by licensed psychologists
and therapists on various topics related to severe illness; training
in the principles of attitudinal healing at Dr. Jampolsky's center in
Tiburon, California, where the principles were developed; other work-
shops and training seminars on providing supportive services to the
seriously ill. In addition, the staff members were chosen because of
their natural capacity for warmth, empathy and the ability to give
support to others. Together these assets and experiences make the
staff well-qualified to run this program.
The staff also has a professional advisory board to consult when
problems or questions arise regarding the Center's program or its
recipients. They have also been trained to recognize problems re-
quiring professional assistance and refer recipients for medical,
legal, psychological, and other services when appropriate.
Thank you for your interest in our program. If you have further
questions regarding ACE, contact me at 7l4/882~2339.
Sincerely yours,
'-,
~ ~,JJJ:-
Ter~schmitt, Ph.D.
President
ACE Board of Directors
Attachlllent "e"
-
,......."
c_ . 0 '1-tighland
11111111.11111111111111111111111111111111111111111111111111111111111111111111111111111111_1_1_1111111111
Gemco Shopping Center
2372 Sterling Avenue
San Bernardino, CA 92404
(714) 881.2681
'\
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October 28, 1985
Ms. Glenda Saul
Executive Director
Redevelopment Agency
300 North "D" Street
San Bernardino, Ca 92418
Dear Ms. Saul:
,.-'
\",..
We are familiar with the ACE program and its services. The program
provides people facing severe and/or disabling illness and their
families the opportunity to share and understand their circumstances
through education, mutual support and a variety of social and creative
activities. In addition to the activities provided at the ACE fa-
cility, program staff visit people in the hospital and their homes
to extend support and encouragement and provide needed social contact.
The impact on recipients includes both psychological and physical
benefits. We know that people with a good understanding of their
circumstances and a strong network of social support generally cope
with illness more effectively and even recover more completely. The
services provided by ACE program help to eliminate the isolation and
loneliness of seriously ill people and also help to improve their
coping skills through education. Psychological complications of their
illness are avoided or minimized.
Since the services provided by ACE are neither medical nor psychological
treatment, there is no need for the staff to be licensed practitioners
in these fields. On the other hand, the services do require a staff
with a natural capacity for warmth and empathy, some personal experi-
ence with severe illness or the loss of a loved one, and knowledge of
basic coping skills. In addition, ACE's programs are to some degree
based on the principles of attitudinal healing and staff members re-
sponsible for conducting activities and visiting people should have
knowledge of these principles. The ACE staff certainly meets these
qualifications and has the energy and enthusiasm for providing these
much-needed services to the community.
I-
-..
Affiliated with St, Bernardine Hospital's Emergency Department Physicians
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Ms. Glenda Saul
October 28, 1985
Page 2
We support the ACE program and look forward to the continuation of
its services with the help of public funding.
Sincerely,
~ ~ /l.1D
Bill Olson, M.D. . an,is
~Cy RO?m P YSiCi~~t. Bernardine's Hospital
Ken Nisbet, M.D. /
Medical Director
fF
'--
Medical Director - Emergency Department
St. Bernardine's Hospital
~,
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128214~
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ARTICLES OF INCORPORATION
'-",
of
ENDORSEe
FI1.ED
.. d.. oHio of tho Seer....".f 5:0:,
of tho 5laI. of CoIit.....
JUL2 3 1985
MARCH FONG EU, Secretary 01 State
Leslie Glenn
Depufy
_.
A CENTER FOR ENRICHMENT
I.
The full name of this Corporation is A CENTER FOR
-'
ENRICHMENT.
II.
A Center For Enrichment 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 purposes.
III.
1. The specific and primary purpose of A Center For
<:: Enriclment is to provide a place where individuals and families
who are experiencing any catastrophic or life-threatening
illness can interact and obtain emotional and spiritual support.
2. In order to carry out said specific and primary
purposes, A Center For Enrichment shall have the general
purposes and powers specified as follows:
(al To exercise any and all rights and powers which a
corporation organized under the Nonprofit Public
Benefit Corporation Law of the State of California
may now or hereafter exercise.
IV.
The name and address in the State of California of A
'--
,^~ Center For Enrichment's initial agent for service of process is
set forth as follows:
'C
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-
Name
Address
.-
Sandi Obst
1759 E. Date Place
San Bernardino, CA 92404
'-'
V.
1. A Center For Enrichment is organized and operated
exclusively for social welfare purposes within the meaning of
Section 50l(c)(3) of the Internal Revenue Code.
2. Notwithstanding any other provision of these Articles
of Incorporation, A Center For Enrichment shall not carryon
any other activities not permitted to be carried on by a
corporation exempt from Federal Income Tax und~r Section
50l(c)(4) of the Internal Revenue Code.
VI.
A Center For Enrichment is organized by a group of
<:: concerned individuals for the sole purpose of accomplishing the
specific and primary purposes specified in Article III hereof
as a civic venure for and on behalf of the citizens. A Center
For Enrichment shall never engage in any business or activity
other than that necessary or convenient for or incidental to
the carrying out of the purposes set forth in Article III
hereof.
VII.
The property of A Center For Enrichment is irrevocably
dedicated to social welfare purposes and no part of the net
earnings, if any, of A Center For Enrichment, either during its
existence or upon its dissolution, shall ever inure to the
",...-~
benefit of any director, officer or member hereof or to the
"-
benefit of any private person, firm or corporation.
2.
.......
,'''
"-'
VIII.
.........
...)
..;
'.'''.'''''.
Upon the dissolution, liquidation or winding up of A
Center For Enrichment, or upon abandonment, the assets of A
Center for Enrichment remaining after payment, or provision for
payment, of all debts and liabilities of A Center for
~~
Enrichment shall be distributed to the County of San Bernardino.
IX.
The principal office for the transaction of the business
of A Center for Enrichment is located as follows:
County of San Bernardino
State of California
The name and address of the persons who are to act in the
capacity of directors of A Center For Enrichment until the
selection of their successors are set forth as follows:
....."', Name
-
~ 1. Terry Schmitt, Ph.D.,
Psychologist
2. Mary Easterday, Realtor
3. Judith Ann Davis, t-1.S. .
Address
1255 E. Highland Ave.,
Suite 106
San Bernardino, CA 92404
5673 Edgemont Dr
San Bernardino, CA 92404
Psychological Health
Services
1255 E. Highland Ave.,
Suite 106
San Bernardino, CA 92404
XI.
Any proposed amendment to these Articles of Incorporation
or any appointment to the Board of Directors of A Center For
Enrichment or any proceedings of A Center For Enrichment to
expend any funds, to incur any obligations or to take any
-,-. similar action shall be subject to the approval of the Board of
.~
3
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Directors and shall take effect only after a majority approval
has been obtained.
IN WITNESS WHEREOF, for the purposes of forming A Center
for Enrichment under the laws of the State of California, we the
undersigned, constituting the incorporators of A Center for
Enrichment and the persons named herein as the initial
directors of A Center for Enrichment, have executed these
Articles of Incorporation this 22nd day of
July
. 1985.
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T~rr'lc . ~ t
?n' ~
Mary ~r ay
\ ("t;\h ,~""~..., 1:"-
~dith Ann Davis
4
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STATE OF CALIFORNIA
J""'."'e,
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)
)
)
~
'-'
COUNTY OF SAN BERNARDINO
ss.
-
On this 22nd day of Julv , 1985, before me the
undersigned, a Notary Public in and for said County and State,
personally appeared Terry Schmi tt, tIrIti(J~1.t/ Mr/.~"/ltl /fI~/m (or
proved to me on the basis of satisfactory evidence) to be the
person who executed these Articles of Incorporation and
acknowledged to me that he executed the same.
WITNESS my hand and official seal.
@ LEANNA LANDERS
.. NOTARY PUBLIC
" SAN BERNARDINO COUNTY
CAliFORNIA
Mv Commission Expi_ April 1 6. 1986
~_ ~ 6.-..1
.,~ .,.%P":
Nary Public 0 California
(SEAL)
e
STAT~ OF CALIFORNIA )
) ss.
COUNTY OF SAN BERNARDINO )
On this 22nd day of July , 1985, before me the
undersigned, a Notary Public in and for said County and Stater
personally appeared Mary Easterday, personally known to me (or
proved to me on the basis of satisfactory evidence) to be the
person who executed these Articles of Incorporation and
acknowledged to me thatshe executed the same.
WITNESS my hand and official seal.
~~~J
No ary Public of California
(SEAL)
e'.. LEANNAlANDERS
- .' . NOTARY PUBLIC
'. SAN BERNARDINO COUNTY
CALIFORNIA
My Commission Expil8& April 16. 1986
t
---
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~
STATE OF ~LIFORNIA )
) ss.
COUNTY OF SAN BERNARDINO )
-
On this 22nd day of Julv , 1985, before me the
undersigned, a Notary Public ~RvAnd for said County and State,
personally appeared Judith Ann/ liJfiff>#t<I1.J..r/ flrr1.P1IPI I1P/ m (or proved
to me on the basis of satisfactory evidence) to be the person who
executed these Articles of Incorporation and acknowledged to me
that she executed the same.
WITNESS my hand and official seal.
~"7~iL/ ~
No ary Public of California
(SEAL)
LEANNA LANDERS
NOTARY PUBLIC
SAN BERNARDINO COUNTY
. CALIFORNIA
lIIIy'CommiSSion Expi_ AlJI'il t8, t98e
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CERTIFICATE OF AMENDMENT
OF
ARTICLES OF INCORPORATION
OF
A CENTER OF ENRICHMENT
"-
The undersigned hereby certify that:
1. We are the duly elected. qualified and acting
President and Secretary of the Board of Directors of A Center
of Enrichmentr a nonprofit public benefit corporation organized
and existing under and pursuant to the Nonprofit Public Benefit
Corporation Law of the State of California (Title 1. Division
2. Part 2 of' the Corporations Code of the State of California).
2. On September 30. 1985. at a duly noticed and held
meeting. a majority of the Board of Directors unanimously
adopted to amend the Articles of Incorporation as herein set
forth.
3. Articles V. VI and VII are amended to read as follows:
V.
r-
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1. A Center For Enrichment is organized and operated
exclusively for educational and charitable purposes within
the meaning of Section 501(c)(3) of the Internal Revenue
Code.
2. Notwithstanding any other provision of these
Articles of Incorporationr A Center For Enrichment shall
not carryon any other activities not permitted to be
carried on by a corporation exempt from Federal Income Tax
under Section 501(c)(3) of the Internal Revenue Code of
1954 (or the corresponding provision of any future United
States Internal Revenue Law) or (b) by an organization
contributions to which are deductible under Section
170(c)(2) of the Internal Revenue Code of 1954 (or the
corresponding provision of any future United States
Internal Revenue Law).
VI.
"."....'~
Upon the winding up and dissolution of A Center of
Enrichment. after paying or adequately providing for the
debts and obligations of A Center of Enrichment. the
remaining assets shall be distributed to a nonprofit fund.
foundation. or corporation which is organized and operated
exclusively for charitable. educationalr religious and/or
scientific purposes and which has established its tax
exempt status under Section 501(c)(3) of the Internal
Revenue Code.
"-
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VII.
-
The property of A Center For Enrichment is irrevocably
dedicated to educational and charitable purposes and no
part of the net earnings, if any, of A Center For
Enrichment, either during its existence or upon its
dissolution, shall ever inure to the benefit of any
director, officer or member hereof or to the benefit of any
private person, firm or corporation.
4. Article VIII is deleted in its entirety:
VIII.
[DELETED IN ITS ENTIRETY]
5. Pursuant to Article IX of the Articles of
Incorporationr the persons who are the directors of A Center of
Enrichment shall be its only members.
6. Pursuant to Article XI of the Articles of
Incorporation of A Center of Enrichment, the foregoing
amendment has been approved by a majority of the Board of
Directors of A Center of Enrichment at a meeting duly held and
conducted on September 30, 1985.
,...."'"""
\.....
The undersigned hereby declares under 'penalty of perjury
that the statements contained in the foregoing Certificate are
true and correct of our own knowledge and that this declaration
was executed on ::' c 1'- \ " ,1985, at San Bernardino,
Ca lifornia.
<r rz;;t~/iir
PresJ.dimt
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Secretary
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2.
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O....n"'.nl .f tho T,u.vry
'ftt.,,,.1 R..."". Service
Application fC RecognitionO Exemption
Under Section 501(c}(3} of the Internal Revenue Code
0"1 HI. 1545-00SI
....)
,.-.
for Paperwork Reduction Act Notice. see page 1 of the instructions.
To be filed in Ihe by dis.
trid for the area in which
the orllnilltion hIS Its
principal office Dr pllce of
business.
'-
This application, when properly completed, constitutes the notice required under section 508(8) of the Internal Revenue Code
so that an applicant may be treated as described in section 501 (c}(3) of the Code, Ind the notice required under section 508(b)
for an organization claiming not to be a private foundation within the meaning of section 509(1). (Reid the instructions for each
part c:arefully before making any entries.) If required information. a conformed copy of the organizlnl and operatianal documents,
or financial data are not furnished, the application will not be considered on its merits and the organization wiU be notified
accordingly. 00 not file this application if the applicant has no organizing instrument (see Part II).
Part I.-Identification
1 Full name of organization
A CE~TER FOR ENRICHMSNT (ACE)
2 Employer identification number
(If none. see instructions)
33-0096799
3(a) Address (number and street) Check here if applying under section:
P () Rrw '1nn'4 f17c;Cl ~ 1'1"'..." P' "'r''') 0 SOl (e) 0 SOI(f)
3(b) City or town. State, and Zip code 4 Name and phone number of p:erson to be contacted
San Bernardino CA 92413 (92404) Sandi Obst ~14) 881-2407
5 Month the annual accounting period ends /6 Date incorporated or formed 17 Activity co Ides
June
8 Has the organization filed Federal income tax returns or exempt organization information returns?. 0 Ves I(] No
If "Yes, to state the form number(s). years filed, and Internal Revenue office where filed. ....n....nuu..pu.........................._.........n.................
Part II. Type of Entity and Organizational Document (see instructions)
Check the applicable entity box below and attach I conformed copy of the organization's organizing document and bylaws
as indicated for each entity.
o Corporation-Articles of incorporation and bylaws. 0 Trust-Trust indenture. 0 Other-<:onstitution or articles of
association and bylaws.
Part III. Activities and Operational Information
.....~ ". 1 What are or will be the organization's sources of financial support? List in order of size.
~ Office of Community Development
Redevelopment Agency, San Bernardino
State of California
Corporations
Private Foundations
Community organizations
IndiViduals
2 Describe the organization's fund-raising program, both actual and planned, and explain to what ext~nt it has ~een put into
effect. (Include details of fund.raising activities such as selective mailings, formation of fund.raisIMg commIttees, use of
professional fund raisers. etc.) Attach representative copies of solicitations for financial support.
Short range fund raising activities include seeking in-kind donations
from local merChants, i.e., inside and outside maintenance materials and labor
meals for group meetings, volunteer trainings, board meetingSr etc. We also
hope to be adopted by a local community organization and become the beneficiar:
of their fund raisers.
A "Fun Night at Reubens" was held (flyer attachea); expenditures:
estimated income: %500.
A 5-l0K Wheel Chair Run is planned; costs of $7,000 will be donated,
P~"';~","'pn income: SlO.OOO. (Continued on attached sheet)
- I dec:la.re unde~ the penalties of periury th.t I am aulhorrleCl to StS:~ thiS application on behaU of the above orranizalion and I have examined
~r 'IS applicatIon. IncludInG 'he acc:ompa"Ylnc: statements, and to the best of my Itno....leds:e II is "ue, correct. and cnmplete.
'-
$ -0-,
_....n.............._..u... "isji;;~i~;~-)-...n... '...nn. _n........ ...-.. n. n.. -- .(r.iii;-~.;~.~t;.;;;ji;.-~; -;ti~~.r)nnnnnunn ....nu.u.(.D~;~.)n.u.._..
c. C
Application for Recognition of
A CENTER FOR ENRICHMENT
",.,
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Exemption (Form 1023)
'--'
Part III, 2 (Cont'd)
-
Other activities planned, but not scheduled are: a golf tournament,
a silent wine auction, a recognition dinner, a pancake breakfast, a
scavenger hunt, and solicitation of funds by mail, using the telephone
sticker below:
Long range plans include a profit-making bookstore that would focus
on selling inspirational literature.
----------
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Form IOU (Rev. 4-a4)
~
C1'1II.-Activilies and Operational Informal Ccnlinued)
3 Give a detined narrative description of the organization's past, present. Ind proposed future Ictivitie,s, I.nd the purp~ses for
which it was formed. The narrative should identify the specific benefits, s.rvices. or, products the or,~n!zatlon his provided or
will provide. If the organizition is not fully oper.ational, expllin what stlge of develc;>pment its activIties have reached, what
further steps remain for it to become fully operational. and when such further Iteps will tlke place. (Do not state the purposes
and activities of the orcanizltion in eeneral terms or repeat the .Ineulee of the orClnizltionl1 documents.) It the organization
is a school, hospital. or medical research organization, include enough in'ormati~n in YO~1f description to clearly show that the
oreanization meets the definition of that plrticular activity, thlt is contained in the Instructions for Part VI-A.
A Center for Enrichment (ACE) was organized in O~tober 1983 as the
Attitudinal Center for Enrichment (ACE) and operated under the auspices of
another nonprofitr incorporated entity Until July 1, 1985. Our Center is
modeled on, but not connected with, a program in northern California that
has been operating successfully since 1978.
ACE was formed to p~ovide a non-clinical environment where individuals
and their families who are experiencing any life-threatening or catastrophic
illness can meet on a regular basis to share concerns, express feelingSr find
and offer support, and participate in the process of attitudinal healing.
The concept of attitudinal healing is based on the belief that it is
possible to choose peace rather than conflict, and love rather than fear. At
the Center, health is defined as experiencing inner peace, and healing as let-
ting go of fear. Attitudinal healing is the process of letting go of painful,
fearful attitudes. When we let go of fear, only love remains. We believe
that love is the most important healing force in the world. Attitudinal heal-
ing begins when there is a shift in perception about illness and its related
problems. This shift in perception can Occur as a child or an adult learns
how to focus on helping others by extending love, learns that each instant is
the only 'time there is, and discovers that within that instant they do not per
ceive themselves as ill or in pain. One such instant can become two, three,
then many.
P.....' .~
.......,,,
;
'/-
;;_..
J In addition to encouraging openess and honesty in speaking and writing much
'-effort is made at the Center to provide many avenues of self-expression and
ways of communicating with ourselves and others, such as art, music, dance (or
movement). Other activities are provided that strengthen the mind-body con-
nection and promote a sense of wellness and wholenessr such as relaxation tech
niques and visualization. Gardening, animal husbandry, and other ,craft ori-
ented hobbies are encouraged in order to emphasize a sense of productivity and
self-worth.
Nhen a family contacts the Center, a staff member arranges a meeting with
them, at home or in the hospital, to extend support and explain ehe Center's
services. The staff member continues to meet with the family on a one-to-one
basis! as we find the group that will be most effective for each family member
4 The membership of the organization's governing body is:
(.) Names, addresses, and titles of officers, directors, trustees. etc.
(b) Annual compensation
.~.""'''..
',-
C'
--
'-
,'"""
....;
-'
Part III.- Activities and Operational Information (continued)
'~Trained facilitators also work with group members, under the supervision of
the main facilitator, who is a staff person.
Most of the work of the Center is done in group settings. Staff members
also meet with individuals or families outside of the group, as needed.
Groups are comprised of 8-12 participants. Evening groups share a meal to-
gether, provided by the Center.
Groups are open-ended, with the averaged expected length of participation
being 8 months to one year. Regular follow-up is maintained through letters,
telephone and personal contacts. When a family member dies, follow-up with
the family continues for at least a year, in order to offer supportr caring
and guidance through the most difficult stages of the grieving proce~s.
The Center provides a Phone/Pen Pal Program and encourages families to
stay in touch with each other between group meetings, maintaining the support
system begun at the Center. This program also permits participation by people
unable to attend group meetings.
In addition to work with families, we provide in-service training to lay
ministry personnel, school health aides and counselors, psychologists, and
mental health practioners. This training helps to create an understanding,
caring, and supportive community for these special families.
f"'"
--
........-,
......
forln lC23 (Rev. 4..-84)
1I1,-'.Activilies and Operational Informali
ontinued)
:)
P.,~ '"
--
.
4 (e) 00 any of the above persons serve IS members of the governing body by reason of being public officials
or being appointed by public officials] . . n Yes 0 No
If "Yes:' name thase persons and explain the basIs of their selection or appointment.
"'-
(See List of Board of Directors ~ attached)
(d) Are any members of the organization's governing body "disqualified persons" with respect to the organi-
zation (other than by reason of being a member of the governing body) or do any of the members have
either a business or family relatianship with "disqualified persons]'. (See specific instruction 4(d).) . 0 Ves Yeg No
If "Yes," explain.
(e) Have any members of the organization's governing body assigned income or assets to the organization,
or is it anticipated that any current or future member of the governing body will assign income or assets
to the organization1 . 0 Yes XIXJ No
If "Yes," attach I complete explanation statine which applies and including copies of Iny assignments
plus a list of items assigned.
5 Does the organization control or is it controlled by any other organizltion? . 0 Yes IXI No
Is the organization the outgrowth of another organization, or does it have a special relationship to another
organization by reason of interlocking directorates or other factors? . 0 Yes Qg No
If either of these questions is answered "Ves," explain.
,..,....
'-
6
Is the organization financially accountable to any other organization? . .. . 0 Ves
If "Ves." explain and identify the other organization. Include details concerning Iccountability or attach
copies of reports if any have been submitted.
~ No
7 (a) What assets does the organization have that are used in the performanc:e of its exempt func:tion? (Do not include prop.
erty producing investment income.) If any assets are not fully operational, explain their status, what additional ste'ps reo
main to be completed, and when such final steps will be taken.
None
(b) To what extent have you used, or do you plan to use contributions as an endowment fund. i.e.. hold contributions to pro.
duce income for the support of your exempt activities?
N/A
8 Will any of the organization's facilities be managed by another organization or individual under a con.
lraclual agreemenl1 . . . . . . . . . . . . . . . . . . . . . . .. . . . . 0 Yes 9 No
If "Yes:' attach a copy of each contract and explain the relationship between the applicant and each of the
other parties.
/:-...
'-
9FoR
'-A
. ClEf'iTlER
-....) . 'J:I~
IE riEJI <C Kif.i.lCA ~l'"f
-...i
I =1 ~""'I_
\h.. \l........
Programs for Children and Aduits with Life'Threatening or Catastrophic IlInes~
P.O. Box 30014 San Bernardino CA 92413 714/881-2407
(1759 E. Date Place, 1 block' south of Rte. 30' btwn Del Rosa & Sterlinc)
-
BOARD OF DIRECTORS - Charter Members
i""..'''''~
---
'.
l-IILNER CARTER-JACOCKS
19649 Kauri
Rialto CA 92376
825-24721B
820-1700
JeDY DAVIS (Treasurer)
1255 E. Highland 1106
San Bernardino CA 92404
~~RY EASTERDAY (Vice-President)
5673 :.dgcmont Dr
San Bernardino CA 92404
~/VZl.fl- 4f3'i
882-2339/B
e86-4846/B
852-8326
Jf.1'lES R. EDGERLY
P.O. Box 1153
Wright~ood CA 92397
EARL GOCJWIN
Huntley Prcoerties
P.O. E?x 500
San Bernardino CA 92412
619/249-60121B
c
888-4040/B
793-5084
t:r::.:: L.;.~~~
;;~:4 r::::-:-e ::c.y
,~:::l :-.e.-1.~~=~.:.r66 c~.~ $::(0:
,H6 -e--''''
, .J+., u..
a::c ~::S
LAh~ENCE E. NEIGEL
13L5 PU[;'Jalo
San Bernardino CA 92404
JENNIFER OBERHEL~~N {secretary)<~~
685 W. 3jth St 11
San Bernardino CA 92404
381-1245/B
.} r \
" tC,- /..,J ;> T
~\.vJ 'Ii .
3S3-1493/B
So
886-8029/H
LESTER RUNBLE
P.O. :'ox 447
Redlsncs CA 92373
TERRY SC!}lITT (Pre.:iident)
1255 E. Highland 3106
San Bernardino eA 92404
882-2339/B
~l )ANNE UYE>\N
5;35 Orange Knoll Ave
San Bernardino CA 92404
#""...
':""'"
H4-1939/H
f'orm 1023 fRev, ~4)
'~':",.-Activities and Operational lnformatio ontinued)
9 (a) Have the recipients been required or will they be required
services, or prOduc!s? .
If uYes," explain and show how the charges are determined.
Pure
-../
to p~y for the organization's benefits. .
o Yes JQl No
'-' (b) Does or will the organization limit its benefits, services, or products to specific classes of individuals? . XJ Yes 0 No
If "Yes,'. explain how the recipients or beneficiaries are or will be selected.
Services are limited to individuals and families who are experiencing
any life-threatening or catastrophic illness.
10 Is the organization a membership organization? . . 0 Yes ~ No
If "Yes," complete the following:
(a) Describe the organization's membership requirements and attach a schedule of membership tees and
dues. '. .
(b) Describe your present and proposed efforts to attract members, and attach I copy of any descrj1Jtive
literature or promotional material used for this purpose.
(c) Are benefits. services. or products limited to members? .
If "No," explain.
. 0 Yes 0 No
11 Does or will the organization engaee in activities tendini to influence legislation or intervene in any way in
political campaigns? . . . . . . . . . 0 Yes rn No
If "Yes," explain. (Note: You may wiSh to file Form 5768, Election/Revocation of Election by an Eligible Section SOl (c)
(3) Organization to Make Expenditures to Influence Lerislation.)
~
........
Does the organization have a pension plan for employees?
(a) Are you filing Form 1023 within 15 months from the end of the month in which you were created or
formed as required by section 508(a) and the related regulations? (See general instructions.) .
(b) If you answer "No," to 13(.) and you claim that you tit an exceptian to the notice requirements under
section 508(a), attach an explanation of your basis for the claimed exception.
(c) If you answer "No," to 13(a) and section 508(a) does apply to you, you may be elirible for relief under
regulations section 1.9100 from the application of section 508(a). Do you wish to request relief? .
(d) If you answer ."Yes." to 13(c) attach a detailed statement that satisfies the requirements ,of Rev. Proc.
79-63.
(e) If you answer "No," to both 13(a) and 13(c) and section 508(a) does apply to you, your qualification
Is a section 501(c)(3) organization can be recognized only from the date this application is tiled with
your key District Director. Therefore, do you want us to consider your application as a request for recog.
nition ot exemption as a section 501(c)(3) organization from the date the application is received and
not retroactively to the date you were formed (see instructions)? . 0 Yes fJ No
o Yes rn No
DYes lG No
DYes :f] No
Part IV.-Statement as to Private Foundation Status (see instructions)
1 Is the organization a private foundation? . 0 Yes Q No
2 It y,ou answer "Yes," to question 1 and the organization claims to be a private operating foundation, check
here 0 and complete Part VII.
3 It you answer UNo," to question 1 indicate the type at ruling you are requesting regarding the organization's
status under <ection 509 by checking the box(es) below that apply:
(a) Definitive ruling under section 509(a)(I), (2), (3), or (4) ~ GQ. Complete Part VI.
(b) Advance ruling under ~ 0 sections 509(a)(l) and 170(b)(I)(A)(vi) or ~ 0 section 509(a)(2)-
see instructions,
I"-'(C) Extended advance ruling under ~ 0 sections 509(a)(l) and 170(b)(I)(A)(vi) or ~ 0 section 509
. (a)(2)-see instructions.
"'--'<Note: If you want an extended advance ruling you must check the appropriate boxes for both 3(b) and 3(c).
You must also complete and attach two Forms 872~ to the application.)
r 10~3 fR.v. 011-64)
~ement of Support.
,
C"rt V.-Financial oalO P.'J
Revenue. and Expenses for the ~eriod beginning ..!Il,;J..Y....:!.....:........ 19.11,;;.... and end-
ing ......P~.<::.....L...... 19.~2....
Note: Complete the financial statements for the current year and for each of the three years immediately before it. If in existence
less than fOur years, complete the statements for each year in existence. If in existence less than one year, also provide proposed
budgets for the two years following the current year.
"'-.
~
1 Cross contributions. gifts, grants. and similar amounts received . . . . . . 1
2 Gross dues and assessments of members . . . . . . . . . 2
3 (a) Gross Imounts derived from activities related to organization's
"
= exempt purpose (attach schedule) . . . . . . . . .
c: ,
" (b) Minus cost of sales. 3c
> .
"
ll:: 4 (I) Gross .mounts f,om unrelJted business .clivities (Ittach schedule)
." 4c
c: (b) Minus cost of sales . .
.. . . . ...
.1: 5 (a) Gross amount received from sale of assets, excluding inventory W
8- items (attach schedule) . t:l
"- Cl
= (b) Minus cost or other basis and sales expenses of aSSets sold 5c ::>
III . ILl
6 Investment income (see instructions) . . . . . . 6
. .
7 Other revenue (attach schedule) 7 Cl
. . . . . . . . . . . . Id
8 Total support Ind revenue . . . . . . . . . 8 :c
9 '-'
9 Fund raising expenses . . . . . . . . . . . . . . . . ""
10 Contributions, gifts, grants. and similar amounts paid (attach schedule) . 10 Eo<
. . . . . . C
11 Disbursements to or for benefit of members (attach schedule) . . . . . . 11 ol:
. .
12 Compensation. of officers, directors. and trustees (attach schedule) . 12 r.l
.. . . . . . .
" 13 Other salaries and wages 13 r.:'
.. ~
c: . . . .. . . . . . . . . . .
8- 14 Interest 14
. . . . . . . . . . . . . .
" 15
... 15 Rent . . . . . . . . . . . . . . . . . . .
16 Depreciation and depletion . . . . . . . . . . . . . . . . . 16
.
17 Other (attach schedule) . . . . . . . . . . . . 17
18 Total expenses . . . . . . . . . . . . . . . . 18
19 Excess of support and revenue over expenses (line 8 minus line 18) . . . . . 19
Balance Sheet Enter EndinE date
Cat the end of the period shown above) date ~
Assets
20 Cash (a) Interest bearing accounts . . . . . . . . . . . . . . 20.
. . .
(b) Other . . . . . . . . . . . . . . . . . . 20b
. . . . .
21 Accounts receivable. net . . . . . . . . . . . . . . 21
22 Inventories . . . . . . . . . . . . . . . . . . . . 22
23 Sands and notes (attach schedule) . . . . . . . . . 23
24 Corporate stocks (attach schedule) . . . . . . . . . . . . 24
25 Mortgage loans (attach schedule) . . . . . . . . . 25
26 Other investments (attach schedule) . . . . . . 26
27 Oepreciable and depletable assets (attach schedule) . 27
28 Land 28 ~
. . . . . . . . " . . . . . ,
29 Other assets (attach schedule) 29 ~
. ...;
30 Total assets . . . . . . . 30 C)
H
Liabilities ...:!
31 Accounts payable 31 p.,
. . I>.
32 Contributions, gifts, grants, etc.. payable . . . 32 .::
33 Mortgages and notes payable (attach schedule) . . . . 33 '"
34 Other liabilities (attach schedules) 34 0
.. . . g
35 Tatalliabilities . . . ..!L
Fund Balances or Net Worth
36 Total fund balances or net worth. . . .... . . . 36
37 Total liabilities and fund balances or net worth (line 35 plus line 36) 37
c
--
l '.here has been any substantial change in any aspect of your financial activities since the periOd shown above ended.
~eck the bax and attach a detailed explanation . . . . . . 0
I JEm fn
ft,. ,~l1Jl 'i JL lCtn lrlUJlli\. JEf'iIDClBfM .lIT V')<ClE.
ograms for Children and h...;Ulls with Llfe-l1i.reatening or Catastrophic Illness.
P.o. BOX,300l4 San Bernardino CA 92413 7l4/88l-2407
I .,
I ~ (
I--
I'
BUDGET - FY 85/86
July 1985 - December 1985
r-
I. PERSONNEL
A) Program Director
B) Admin/Support Services Coordinator
C) Office Manager
II. FRINGE BENEFITS & PAYROLL TAXES
A) FICA 7% of $10,837.50
B) SDI 1% of S10,837.50
C) SUI 1.5% of $10,837.50
D) Workmans Comp 1% of $10,837.50
E) Health Ins
F) Dental Ins
III. FISCAL & PROGRAM CONSULTANTS.
A) Grant/Proposal Writer 81 hrs @ $ 8.00/hr
B) CPA review 24 hrs @ S10.00/hr
C) Art Therapist 72 hrs @ $ 5.00/hr
D) Music Therapist 72 hrs @ $ 5.00/hr
C.:v. FACILITY COSTS
A)
B)
C)
D)
E)
F)
G)
Rent*
Utilities
Electricity,water,rubbish pick up
Telephone
Answering Service .
Janitorial
Outside maintenance
Pool, gardener (required by lease)
Insurance(Personal,prpty liability)
V. TRAVEL
A) Mileage (550 mi/mo. @ S.25/mi)
VI.
CONsm'~BLE SUPPLIES
A) Office supplies
F.) Postage
C) Host fund
For other than client meetings
D) Recreation/crafts
E) Printing
Brochures, Bus.Cds,Stationery,etc.
F) Advertising
'''~
'"'-
oeD S.B. CITY
$ 2 iJ,'OIT 0 -no,ooo-
$ 4,687.50 4,687.50
3,150.00 3,150.00
3,000.00 3,000.00
$10,837.50 10,837.50
758.63 758.63
108.38 108.38
162.57 162.57
108.38 108.38
360.00 360.00
220.00 220.00
$ 1,717.38 1,717.96
408.00 240.00
-0- 240.00
180.00 180.00
180.00 180.00
$ 760.00 840.00
950.00 1,750.00
300.00 660.00
400.00 800.00
360.00 -0-
330.00 330.00
405.00 405.00
(300.00)est ($300.00)es
$3,045.00 $4,245.00
$ 412.50 $ 412.50
156.97 182.39
100.00 100.00
90.00 90.00
50.00 50.00
350.00 350.00
75.00 75.00
$ 821. 97 $ 847.39
(Cont'd on next page)
*S3,OOO grant from Gannett Foundation will pay additional lease costs
C
VII.
c
,-...
~
-.I
I
1-"
,~
VIII.FURNITURE PURCHASE (rental
EQUIPMENT/FURNITURE RENTAL
A) Copier '.
B) Furniture (Jul-Sep only)
450.00 450.00
324.83 649.66
$ 774.83 $1,099.66
buy-out) 1,624.15 -0-
TOTAL BUDGET $20,000.00 $20,000.00
OCD* S.B. CITY**
- END -
* Office of Community Development
474 w. Fifth St.
San Bernardino, CA 92451-0040
** Redevelopment Agency
City of San Bernardino
City Hall
300 North D St., Rm. 320
San Bernardino, CA 92418
c
.-.~
'-
f'"rm 1023 (Rev. .-84)
P,'"1 -VI. Non.Private Foundation Status (DeQive ruling only)
:"',,,,)~f~O~~F~~SLatus (Ch One of the boxes below.)
he organization is not a private foundation because it qualifies as:
p.<<to
"",)
;''''.,
" . Kind of organiZJtion Within the meaning af Complete
Sections 509(a)(l) .
1 a church or a convention or association of churches and 170(b)( J )(A)(i)
- .
Sections 509(a)(l)
2 a schaol and 170(b)(I)(A)(ii) ~W~
Sections 509(a)(l) .
3 a hospital or a medica' research organization operated in conjunction with a hospital and 170(b)(1 )(A)(iii)
- .
Sections 509(0)(1 )
4 a governmental unit described in section 170(c)(1) and 170(b)(I)(A)(v)
-
5 being organized and operated exclusively for testing for public safety Section 509(a)(4) .
being operated for the benefit of a college or university which is owned or operated by Sections 509(a)(l) Part
6 a governmental unit and 170(b)(I)(A)(iv) VI.-B
-
nOrmally receiving I substantial part of its support from a governmental unit or from Sections 509(a)(l) Part
7 the general public and 170(b)(I)(A)(vi) VI,-B
-
normally receiving not more thin one-third of its support from gross investment income
}! and more than one.third of its support from contributions, membership fees, and gross Part
8 receipts from activities related to its exempt functions (SUbject to certain exceptions) Section 509(a)(2) VI.-B
-
being operated solely for the benefit of or in connection with one or more of the organi. Part
9 zations descrited in 1 through 4, or 6, 7, and 8 above Section 509(a)(3) VI.-C
B.-Analysis of FinanciaJ Support
''"-
I'
r
"-
(a) Most reo (Years next preceding
cent tax most recent tax year)
year . (e) Total
19..8.,5.. (b) 19........ (e) 19........ (d) 19,.......
1 Gifts, grants, Ind contribu.
tions received . . .
. Membership fees received
Grass receipts from .dmis.
sions. saJes . of merchandise
or services, or furnishing of
facilities in any activity which
is not an unrelated business
within the meaning of section
513 . . . . . .
4 Gross investment income f-<
(see instructions for defini- (<'
tion) . . . . . r"
Q
5 Net income from organjza- ::> -
tian's unrelated business ac- III
tivities nat included on line 4 n
6 Tax revenues levied for and ~
either paid to or spent on be. lI:
half of the organization . U
...
7 Value of services or facilities f-<
furnished by a governmental f-<
unit to the organization with- .0:
out charge (not inClUding the ~
value of services .or facilities ~
generally furnished the public tIl
without charge)
8 Other income (not including
gain or loss from sale of cap-
ital assets)-aUach sched.
ule. . . .. .
9 Total 01 lines 1 through 8 .
10 Line 9 minus line 3
II Enter 2% of line 10, column (e) only .
r" the or"aniz'tion has received any unUSu,1 grants during any of the above tax years, attach a list for each year showing Ihe
~me of the contributor, the date and amount of grant, and a brief description of the nature of suCh grant_ Do not Include
such r,rants on line] above-(See instructions).
(continued on nut palE.)
~
.~~J"i3 fRev. 4-84)
~ VI. Non.Priwate Foundation Status (De
B.-Analysis of Financial Support (Contulucd)
13 If the organization's non.pnvate foundation status is based on:
(a) Sections 509(a)(1) and 170(b)(1)(A)(iv) or (vi).-Atlac.h a list showmc the name and amount contributed ~y each person
(other than a governmental unit or "publicly supported" organization) whose total ClftS for the entire period were more
than the amount shown on line 11.
(b) Section 509(al(2).-For each of the years included on lines 1, 2. and 3. attach a list showing the name of and amount
received from each person who is a "disqualified person:'
for each of the years on line 3, attach a list Showing the name of and amount received from each payor (other than
· "disQualified person") whose payments to the orgaMlzation were more than $5.000. for this purpose, "p3yor" includes
but is not limited to, any orga.nization described in sections 170(b}(1)(A)(i) through (vi) and any government agency or
bureau.
C.-Supplemental Information Concerning Organizations Claiming Non-Private foundation Status Under Section S09(a)(3)
Pace
,
-
ve ruling only) (ConI
d) ,
1 Organizations supported by applicant organization: H.. the supported organization received
a rulinl .. determination lener that it i.
addres~ n.t a prIVate foundatiOn Oy reason ..
Name and .. Suppot1ed o'..anization section SOgCaHI) .. C2H
..P-P...........P....P...............P...____P.......PP........_.P............P..__...._P...._._.__P.P.............___. 0 Yes 0 No
....................NCiNE.....................................................................................n... 0 Yes 0 No
...PP............._.........P.........-P..P.........-..P.....P....__......_...............__...__...__...__..P..._....... 0 Yes 0 No
.......................-.P...........ppp..--......-......_....____.......P......_.._..P._......__....P....__P....P...___....._ 0 Yes 0 No
....-...---....-.--.......P--....-.----.P.....-.......-....._..............._.__........_.._.........._........P...__.......___p.. 0 Yes 0 No
2 To what extent are the members of your governing board elected or appOinted by the supported org2lnization(s)?
3 What is the extent of common supervision or control that you and the supporte~ organization(s) share?
~..
.......
4 To what extent do(es) the supported organization'(s) have a significant voice in your investment policies, the making and tim.
ing of grants, and in otherwise directing the use of your income or Issets?
5 Does the mentioning of the supported organization(s) in your governing instrument make you a trust that
the supported organization(s) can enforce under State law and compel to make an accounting? . 0 Yes 0 No
If "Ves," explain.
6 What portion of your income do yo~ pay to each supported organization and how significant is the support to each?
7 To what extent do you conduct activities which would otherwise be carried out by the supported organization(s)? Explain why
these activities would otherwise be carried on by the supported organization(s).
8 Is the applicant organization controlled directly or indirectly by one or more "disqualified persons" (other
~han one who is a disqualified person solely because he or she is a manager) or by an organization which
tS nol described in section S09(a)(l) or (2)? ....... . . . . . . . . . . . . . 0 Yes 0 t;o
:~ If "Yes," explain.
'-'
Form JO:i3 (Rev. o1IpS4)
p""1 VII. Basis for Status as a Private Op
g Foundation
P.lto
f"'C organization_
(a) bases its claim to private operating foundation status on normal and regular operations over a period of years: or
(b) is newly created, set up as a private operating foundation. .nd has at least one year's experience;
provide the information under the income test and under one of the three Supplemental tests (assets. endowment, or support).
If the arganization does. not have at least one year's experience, complete line 21. If the organization's private operating round,).
lion status depends on its normal and regular operations as described in (a) above, attach a schedule similar to the one below
,- showing the data in tabular form for Ihe three years next preceding the most recent tax year, (See regulat'ons section
~ 53.4942(b)-1 for additional information before completinR the "Income Test'. section of Part VII.)
-.i
c:
Income Test Mo~t recent
1 (a) Adjusted net income. IS defined in regulations section 53.4942(a)-2(d). t.. ye.r
(Complete this line for each tax year covered by the application.) . . . .
(b) Minimum investment return, as defined in regulations section 53.4942(a)-2(c).
(Complete this line only for tax years beginning after December 31. 19B1.) .
2 Qualifying distributions:
(a) Amounts (including administrative expenses) paid directly for the active conduct of the activities
for which organized and operated under section S01(c)(3) (attach SChedule) ....hh........P............
(b) Amounts paid to acquire assets to be used (or held for use) directly in carrying out purposes de.
scribed in sections 170(c)(1) or 170(c)(2)(B) (attach schedule). . . . . . . . . . . ...P.......n...._..._..__P..
(c) Amounts set aside for specific projects which are for purposes described in section 170(c)(l) or
170(c)(2)(B) (attach schedule) . . . . .
(d) Total qualifying distributions (add lines 2(a). (b), and ,(c)) . . . . . . .
3 For tax years beginning before January 1. 1982. enter an amount on 3(a) only. For tax years beginning -
after December 31,1981, enter 8n amount on 3(a) or 3(b) whichever is smaUer.
(a) Percentage of qualifying distributions to adjusted net income (diVide line 2(d) by line 1(a)) . %
(b) Percentage of qualifying distributions to minimum investment return (divide line 2(d) by line
l(b)) . . . . . . . . . . . . . . . %
(Percentage must be at least B5% for 3(a) or 3(b)) ~
Assets Test rz:l
...:l
4 Value of organization's assets used in activities that directly carry out the exempt purposes. 00 not IP
include Issets held merely for investment or production of income (attach schedule) . . . . . -----.-------.tJ-----------.
5 Value of any stock of a corporation that is controlled by applicant organization 'and carries out its ex. I-<
...:l
empt purposes (attach statement describing corporation) . . . . . . . . l>.
Value of all qualifying assets (add lines 4 and 5) . . . . . . . . . . . . tl.
""
7 Value of applicant organization's total assets . . . . . . . . . . . . . . . .
8 Percentage Of qualifying assets to total assets (divide line 6 by 'ine 7-percentage must exceed 65%) . Eo< %
0
Endowment Test Z
9 Value of assets not used (or held for use) directly in carrying out exempt purposes:
(a> Monthly average of investment securities at fair market value . . . . . . ...-...-P..-P.-P...-.....--..
(b) Monthly average of cash balances. . . . . . . . . . . ...........P...._.-.......P.
(c) fair market value of all other investment property (attach schedule) . . . . .
(d) Total (add lines 9(a), (b), and (c)) . . . . . . . . ..-...-.......-........P.....
10 Subtract acquisition indebtedness related to line 9 items (attach schedule) . "
. .
11 Balance (subtract line 10 from line 9(d))
12 Multiply line 11 by 3 % % (% of the percentage for the minimum investment return computation
under section 4942(e)). line 2(d) above must equal or exceed the result of this computation.
Support Test
13 Applicant organization's support as defined in section S09(d) - ..h...__....__......_.....__
14 Subtract amount of gross investment income as defined in section 509(e) .
15 Support for purposes of section 4942(j)(3)(B)(iii) (subtract line 14 from line 13) .
16 Support received from the general public, five or more exempt organizations, or a combination of these
SOurces (attach schedule) .
17 For persons (other than exempt organizations) contributing more than 1% of line IS; enter the total
amounts that are more than 1 % of line 15 . . .
18 Subtract line 17 from line 16 . . .
19 Percentage of total ::upport (divide line 18 by line IS-must be at least 85%) . %
. 0 Yes
o No
20 Does line 16 include support from an eumpt or2anizafion thai is more than 25% 0' the amount on line 15? .
j"~
L ,_Iewly Created organizations with less than one year's experience: Attach a statement explainlOg how the organizat.ion. is
~Ianning to satisfy the requirements of section 4942(j)(3) for the income test and one of the supplemental tests dUring Its
first year's operation, Include a description of plans and arranEements, press clippings, public announcements. soliCitatIOns
for funds. etc.
- ~'?3 (Rev. 011-84)
c
o
Pa<<e 9......,..1
If "Yes," And,
Part VIII.-Required Schedules for Special Activities NOT APPLlCABL:: Cht'Ck complete
hefe: acheclul_
. Is the organIzatIon. or any part of it. iJ SChool? . A
1
,'~ Does the organization provide or administer any Scholarship benefits, student aid, etc.? B
, Has the orr.anizatlcn taken Over. Or wIll it takl! over. the facilities of a "for profit" institution? . C
4 Is the organization, or any part of it, a hospital or a medical research arganization? . . . 0
5 Is the orgaMlZatlon, or any part of it. a hame for lhe aged? . . ., E
6 Is the organizalicn, or any part of il. a litiralinc organization (public interest Jaw firm or similar orl.nizalion)? . F
7 Is the organization, or any part of it, formed to promote Imateur sports competition? . . G
SCHEDULE A.-Schools, Colleges. and Universities
1
Is the organization an inSlrumentality of a State or POlitical subdivision of a State? .
It "Yes:. document this in Part III anddo not complete items 2 through 8 of this schedule. (See instructions
for Schedule A.) .
Does or will the organization (or any department Or division within it) discriminate in any way on the basis
of race with respect to:
(a) Admissions?
(b) Use of facilities or exercise of student privileges1
(c) Faculty or administrative staff?
Cd) Scholarship or loan program? .
DYes
o No
2
.
DYes
DYes
DYes
DYes
o No
o No
o No
o No
ff "Yes," for any of the above. explain.
3 Does the organization include a statement in its charter, bylaws. or other loverning instrument. or in I reso-
lution of its governing body, that it has a ,acially nondiscriminatory policy as to students? . 0 Yes 0 No
Attach whatever corporate resolutions or other official statements the organization has made on this subject.
4
(a) Has the organization made its racially nondiscriminatory policies known in a manner that brings the
policies to the attention of a,lI segments of the general community which it lerves? _
c
If "Ves," describe how these policies have been publicized and state the frequency with which relevant
notices or announcements have been made. If no newspaper or broadcast media notices have been
used, explain. .
DYes 0 No
Cb) If applicable, attach clippings of any relevant newspaper notices or advertising, or copies of tapes or scripts used for media
broadcasts. Also attach copies ot brochures and catalogues dealing with student admissions. programs, and schalarships.
as well as representative copies of III written advertising used IS a means of informing prospective students at your
programs.
5 Attach a numerical schedule showing the racial composition, as of the current academic year, and projected as far as may be
feasible for the next academic year, of: (a) the student body, (b) the faCUlty and administrative staff.
6 Attach a list showing the amount of any scholarship and loan funds awarded to students enrolled and the racial camposition of
the students who have received the awards.
7 (8) Attach a list of the organization's incorporators, founders, board members. and donors of land or buildings, whether indi.
viduals or organizations.
(b) State whether any of the organizations listed in (a) have as an objective the maintenance of segregated public or private
school education, and, if so, whether any of the individuals listed in (a) are officers or active members of such organiza.
tions. .
a Indicate the public school district and county in which the organization is lacated.
,..-....
~
I
i . , ';q"",~T - 2
I MNTo,
: Re-gis.ry 01 Charitable Trush
1 . P.O, 80. 13447
I Sacramento, CA 95813-4447
.-relephone (916) 445.2021
I __CCOUNTlNG PERIOD F
QRIODlC REIQRT
hi... to Ii. this re~ Ih.
15th d.y of the fiftil month ,It"
the ,10.. of yOlK 'C<OII1linr period
may reslAt in the di"lowlnce 01
roll' tn tll!~tion and the assess.
menl of . orininun III of S200.
TO ATTORNEY GENERAL OF CALIFORNIA
s.c..." 12S16. Calif.Ria Government Cod.
or e or ginning . on " lng ,
Stote registration IWfnber If oddress chonged check here. . . . . ~
CT W-LLJ ond show .he changes below Corporate or
Organization No.
file Name of MQonizQtKan
fa,", A Center for Enrichment (ACE) ~
wnt. Addreu (number and Ifreet) Is the organization exempt from
lobo!. federal income tax?
Orner. P.O. Box 30014 (1759 Date Place)
wile'. City or 'own. Slote. and ZIP c.ode If "no", attach ,explanation. See instructions:
print .
or type, San Bernardino, CA 92413
lh Ye
Be'
Jul~ 1
19~
dE d'
D~l"!pmhp", '11
19..8..2..
PART I FILING REQUIREMENTS: CHECK THE APPROPRIATE BOX. SEE GENERAL AND SPECIFIC INSTRUCTIONS
I8l This entity is not a private foundation. We have attached a completed copy of IRS Form 990, and Schedule A (Form 990) and
related attachments (even though we may not be required to file these uniform forms with the IRS). Complete Part II below.
o This entity is a private foundation. We have attached a completed copy of IRS Form 990.PF and related attachments. Complete Parts
II and 11/ below.
'-'
PART II STATEMENTS REGARDING THtS ORGANIZATION DURING THE PERIOD OF THIS REPORT Yes No
1 Was 50% or more of your total revenue from government grants? (See line 1 instructions). . . . . . . . . . . . . . . . . . . . 1 x
If "yes", attach a schedule showing the agency(s) name, address, purpose of the grant and the amount. if .
List only the four different government agencies that provide the largest amounts.
2 Were you audited by any government agency? .......................................... . 2 x
If "yes", provide: Name of agency and unit .'l.,~~ :ti;
Address Contact Person /;~~
~ '.,~
Telephone ( ) - :~;
- Year(s) audited (If audited by more than one agency, attach schedule)
3 Did an independent public accountant issue a report on your financial statements? .,o....... "."............ 3 x
If "yes", provide: Name of accountant ..~ . 1-\/
,.;'
Address .C.~. .
Telephone ( ) - ,on
4 Is any of your properly held in the name of or commingled with the property of any other organization or person? 4 I~
...... .
If "yes", attach Justification, inCluding value of assets commingled. I....:, Ie,.
5 Did you engage in any transactions in which a trustee, director, or officer has a material financial interest other than I':;:
reasonable compensation for services? 5 x
....................................... .
If "yes", attach a detailed explanation and enter here the total amount involved in all such transactions Sa ' . .
6 Did you donate anything to an organization that is not tax-exempt under Section 510 (c) (3) or 501 (c) (4) of the IRC? . . . . 6 x
If "yes", attach explanation and enter here the fair market value of the donation . . . . . . . ,. 6a ~..,
.. .
7 Did this organization regularly solicit salvage, sell salvage in a thrift store, or was it a party to a contract , x
involving the solicitation or sale of salvage? If "yes", include amounts on Form 990, line 10. . . . . . . . . . . . . . . . . . 7
8 Were you or any of your officers, directors or trustees a party to any court action in which there was _.
an alleged breach of trust? If "yes", attach explanation. . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . 8 ~
9 Did you payor incur any tax.related penalty, fine or judgment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 x
If "yes", attach an explanation and specify amounts involved.
10 Did you receive $10,000 or more in direct public support (Form 990, line 1 (a) or included in Form 990-PF, line 1)1 . . . . . . 10 x
If "yes", enter the following amounts: .
(a) Direct support from the general public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lOa
(b) Foundation and trust grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lOb
(c) Corporate and other business grants. . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . 10c
(d) Bequests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10d :
(e) Total direct public support (add lines a through d) . . . . . . . . . . . . . . . . . . . . . .10e
~1 Did you contract with or use the services of an independent professional fund raiser? If "yes", complete Part IV (Form CT.2). 11 x
Did your invested assets total $50,000 or more? If "yes", complete Part V (Form CT-2) (See line 12 instructions) ...... . 12 x
-
V
(13 19 not currently In use)
Unckr penalties of periCH)'. I declore thOI I hove ClComined this report, including occompcmying documt:nts. schedules and statements, and 10 the best o( my
!now/edge and ~/je/. it is true, corred and complete.
Signaf\lte of authorized officer (See instructions)
Printed Nome
Title
n-..
I
PART III ADDITIONAL INFORMATION FROM PRIVATE FOUNDATIONS ONLY
~ Re Ie J:ems: '... . ,
20',~et rental income (after deducting rental expenses tram line 6, 990.PF, Part I) . . . . . . . . . . . . . . . . . . . . . . 20
21 Income tram other investments reported on Form 990.PF, Part III, lines 12 and 13 . . . . . . . . . . . . . . . . . . . . 21
· Expense Items:
I' ..,_22 Professional tund.raising tees .................,................................ 22
. '3 Accounting fees .......................................................... 23
'-L4 legal tees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
25 Travel expenses .......................................................... 25
26 Conference, convention and meeting expenses ................ . . . . . . . . . . . . . . . . . . . . . . . . . 26
Functional Expense Summary:
27 Total program services including grants (Fofm 990-PF, Part XIII, lines 2 and 4(a) . . . . . . . . . . . . . . . . . . . . . 27
28 Total management and general ....,............................................ 28
29 Total fund raising, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
30 Total functional expenses (Sum of 27, 28 and 29 should agree with 990-PF, Part I, line 24(A) . . . . . . . . . . . . . 30
",",I'
SEE
ATTAC:iED
BUDGE'!'
Statement:
31 Did you file a Form 4720 with the Internal Revenue Service? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
If "yes", attach a copy of Form 4720 and enter here the amount of total taxes paid with that return . . . . . . . 31a
(32-39 not currently in use)
PART IV PROFESSIONAL FUND-RAISERS (PFR) (SEE QUESTION 11)
I Yes I ~o
EVENT # 1 EVENT # 2 EVENT # 3 TOTAL
40 Brief Description of Campaign, . ""~..\:....,~~:\?
Drive or Event . '....<.~ t;;.
41 Date or Period Covered ........j'...,.;:<
42 Name of PFR ie'. i:);:~j
43 Address of PFR S::E ATTACHE SHEET !'"'i;jHi\jI:"x1,:\,
."",
44 Total Public Donations. 44
.&.5 All Pavments to PFR 45
{ All Other Fund-Raisine Exoenses 46
"Il'7' Net Proceeds (line 44 less 45 and 46 47
(48-59 not currently in use) . On line 44, do nol deduct ony costs from gross donotions.
NOTE: If more thon three events, attach a schedule using the same format and include amounts in Part IV totols.
PART V SUMMARY OF INVESTMENTS TOTALING $50,000 OR MORE (SEE QUESTION 12)
60 Securities, beginning of year at cost (990, line 54(A) or 990.PF, Part III, line 10(A)) . . . . . . . . . . . . . . . . . . . .60
61 Securities acquired, at cost or original basis ............. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
62 Securities sold, at cost or original basis (may include sales expenses). . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
63 Securities, end of year at cost (990, line 54(B) or 99C.PF, Part III, line 10(B)) . . . . . . . . . . . . . . . . . . . . . . . 63
64 Securities, end of year at market value .............................................. 64
65 Sum of all gains on sales during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
66 Sum of all losses on sales during the year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
67 Dividends and interest from securities (990, line 5 or 990-PF, Part I, line 5(A)) . . . . . . . . . . . . . . . . . . . . . . . 67
68 Total return realized (line 65 less line 66, plus line 67) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
69 less investment counsel fees . : ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
70 Net return realized from investments in securities (line 68 less line 69). . . . . . . . . . . . . . . . . . . . , . . . . . . . 70
Has this organization engaged in, purchased, sold or held during the year:
71 Investments (any type) which produce no current income? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
72 Investments (any type) worth one half or less of original basis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
73 Securities on margin? .............................,.........,................ 73
74 Warrants, puts, calls, options, commodity futures, or short sales? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
75 Stocks fated "Speculative Grade" by Moody's, or ranked "B-" or lower by Standard & Poor's? . . . . . . . . . . . . . 75
~""'''''ecurities not publicly traded? ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , . . . , . . . . 76
""-'ax exempt securities? ..............................................,........ 77
78 Stock in which an officer, director or trustee owns 10% or more of the outstanding shares? . . . . . . . . . . . , . , . 78
If "yes" on any line from 71 through 78, attach a full explanation.
Yes No
X
X
X
X
X
X
X
X
.C
o
--
....,.;
-.I
,
'-
Short range fund raising activities include seeking in-kind donations
from local merchants, i.e., inside and outside maintenance materials and
labor, meals for group meetings, volunteer trainings, board meetings, etc.
We are also working on being adopted by a local community organization so
that we become the beneficiary of their fund raisers.
A qFun Night at Reuben's" is being planned for July 15, 1985. ACE
will receive 10% of the bar profit for the evening, all of a requested
donation admittance fee, and all of the profits from a raffle or prizes
donated by various businesses. Estimated expenditures: $ -0-
Estimated income: $500.
FUND RAISING ACTIVITIES
A 5-10K, 1/2 Marathon, Wheel Chair Run in 'planned for October 1985.
Costs of $7,500 will be donated. Estimated income: $10,000.
r
'-
Other activities planned, but not scheduled are: a golf tournament,
a silent wine auction, a recognition dinner, a pancake breakfast, a
scavenger hunt, and solicitation of funds by mail, Using the telephone
sticker below:
Long range plans includd a profit-making bookstore that would focus
on selling inspirational literature.
"",,-
'-
,
I
C
7l
CE1'1TEK FOkE1'1RICn9IE1'11:
(Ad:)
,
11'1 C
Programs for Children and Adults with Life-Threatening or Catastrophic Illness
Mail: P.O. Box 30014 San Bernardino CA 92413 714/881-2407
Location: 1759 E. Date Place San Bernardino CA 92404 (one
block south of Route 30 between Del Rosa & Sterling)
""".~"
-
BOARD OF DIRECTORS
as of October 15, 1985
OFFICERS
President
Terry Schmitt, Ph.D.
Psychological Health Consultants
1255 E. Highland Ave, '106
San Bernardino, CA 92404
714/882-2339
Vice-President
Mary Easterday, R.N.
Realtor
Jim Vaughn Realty
5673 Edgemont Drive
San Bernardino, CA 92404
714/886-4846
Secretary
Jennifer Oberhelman
Field Investigations
DA Child Support
685 W. 36th Street
San Bernardino, CA 92404
714/383-1493
Treasurer
Judy Davis, M.S.W.
Psychological Health Consultants
1255 E. Highland Ave., #106
San Bernardino, CA 92404
714/882-2339
c
MEMBERS
James R. Edgerly
Regional Manager
Bristol-Meyers
619/249-6012
Lester Rumble, M.D. (Ret.)
Loma Linda University
Medical Center
714/792-2634
Maiu Espinosa, H.E.d.
President
Center for Personal
Effecti veness
714/682-3245
Joanne ;iyman
Director
Highland Senior Center
714/362-2104
Earl Goodwin
Managing Partner
Huntley Properties
714/888-4040
Linda Slue-Anderson
Office Manager
Highland Urgent Care Center
714/881-2681
Lawrence E. Neigel
President
SB City School Board
714/381-1245
Nick Hambrick, M.B.A.
Founder - Rolling Start
714/883-3348
,~'
~ Board meetings are held monthly at A Center for Enrichment, 1759
E. Date Place, San Bernardino, CA 92404