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Rating Tool for 2009/2010 Funding Applications
SECTION 1. Mary Ann: Pass/Fail: If all answers are yes, the application goes forward. If any
answer n., the application review stops.
Ye. o
F❑ Submitted before deadline?
❑A questions answered on City supplemental application?
❑I []'Common Application Checklist—all items "yes"?
COMMON APPLICATION CHECKLIST
Yes . o Cover pages
❑ Agency Information and Questions 1-7.
❑ Question 8 Organizational Experience (2 page maximum)
® ❑ Question 9 Need for Your Program (2 page maximum) ., ..
❑ Question 10 Proposed Program/Service(6 page maximum).
s� A- Question 11 Long Range Plan (1 page maximum)
L ❑❑ Question 12 Budget (2 page maximum)
Data Tables
17'1E1 Question 13 Number of Individuals/Households Served
1 ❑ Question 14a-c Performance Measures and Average Cost of Service
Question 15 Demographics (from all funding sources)
� Question 16 Program Staff
LJ LJ Question 17 Program Revenue& Expense Budgets
EK❑ Question 18 Subcontracts
Required Documents
�❑ Proof of non-profit status
2'1=1 Organizational Chart
❑Agency/Organization Mission Statement
❑ [ :Card resolution authorizing submittal of the application (may be submitted up to 60
days after application).
❑ [ Eist of the current governing board and local board, if applicable, (include name,
position/title, City residence, length of time on the Board, and expiration of terms.
Note any vacancies.)
❑ ® Board Meeting Minutes of last three board meetings of governing board and local
��— board as applicable
I"I L❑ Annual Budget
❑ :FFinancial Audit Cover Letter
❑ 2-Financial Audit Management Letter
❑ }''Financial Statement
❑ "verification of Non-Discrimination Policy
® ❑ Program Intake Form
❑ ®'Slidi ee Scale
PASS /`FAIL
Rating Tool v. 1
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SECTION 2. Karen & Dianne: All pre-applications Passed
•
No Score
Rating Tool p. 2
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SECTION 3. Dianne: For informational purposes this year: Agency's Past Performance
Past Funding History for last two funding cycles 2005-2008
(Circle CDBG or GF) Amount Allocated:
2005-2006 CDBG / GF
2007-2008 CDBG / GF
Yes No
❑ ❑ Were quarterly reports on time in `07?
❑ ❑ Was first quarter report in '08 submitted on time?
❑ ❑ Did agency meet 100% of all the performance measures in 2007? If not—
which ones did they not meet?
❑ ❑ Did agency submit an annual outcomereport, on time for `07?
❑ ❑ Was a monitoring visit done? If yes, were there any findings? Yes _ No_
❑ ❑ Did agency staff respond to staff requests for information in a timely
manner? (looking for a pattern, not one-time occurrences).in 2007?
❑ ❑ Did agency staff attend:the City of Renton contract workshop in 07?
❑ ❑ Did agency staff attend the Joint City funding workshop in 2008?
❑ ❑ Was there key staff turnover in 2007? If so, what position(s) and how
many?
No Score
Rating Tool p. 3
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SECTION 4. Staff check (Mary Ann and Dianne): make sure numbers in
tables match. Score based on the number of boxes checked "Yes"
Yes No
❑ ❑ #5 Total project costs need to match the totals on #17.
❑ ❑ #6 Total City funds requested for 2008 and requested for 2009 must match
numbers given in table #17.
❑ ❑ Last column of#6 must match first column of#14C.
❑ ❑ Average cost of service per client for Renton in``#12C must match same in
#14C
❑ ❑ Last column of#13 must match middle column:of#14C.
❑ ❑ In #13 - column two percentages must add to 100%.
❑ ❑ In #13 - if agency selected individuals or households; should be answered
the same in question #15.
❑ ❑ #13 1st column numbers must match numbers on the top 0#15.
❑ ❑ Three columns in #17,,p 19.(Revenue Source) add correctly?
❑ ❑ Three columns in #17 p: 20 (Program Expense) add correctly'?
SCORE: / 10
Rating Tool p. 4
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SECTION 5. Finance Subcommittee of Human Services Advisory Committee:
Scores financial health of the agency
Originally the thought was that this would be pass/not pass. However, it does not
get to the financial health of the organization.
1. Level of Financial Statements without "going concern" noted in Auditor Cover
Letter
❑CPA Audited 3 points
❑CPA Other/reviewed 2 points
❑Internally prepared 1 point
2. Program Budget
A) Is there a change of over 20% in the total program budget line on Table 17 Revenue
Source between 2007 Actual and 2008 Budgeted?
❑Yes ❑No
•
If yes, has this been adequately explained in question 12 B,"Changes to budget"?
['Yes 0 Points
❑No -2 Points
B) On Question 17, are the totals for program budget Revenue or Expenses off by
more than $100?
•
❑Yes -3 points
❑No 0 points
3. Balance Sheet Strength
Does the program%agency have a positive total net assetfigure on the
balance sheet?
[Yes 1 points-
❑No. 0:points
4. Balance Sheet`.Liquidity;
Is the current ratio'atleast 1.10 on the Program /Agency Balance Sheet?
(Current assets divided by current liabilities = current ratio).
❑ Yes 2 points
❑ No 0 points
5. Diversified Funding
Program has a mixture of funding sources for 2007 as shown in Question 17,
revenue source.
❑ At least 1 each City, Other Government Funds and Private Sources
3 points
❑ Has funding from at least two of the three types listed above.
2 points
❑Only City funding sources, but receives funding from more than one city.
1 point
SCORE: / 9
Rating Tool p. 5
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6. Human Services Advisory Committee: Scores quality of the
application 0-3
a. Organizational Experience
(score 0-3) Agency has track record of providing service
(score 0-3) Staff has applicable/related experience in working with
proposed program and/or training
(score 0-3) Was there an explanation,as to how the Board stays
informed and connected about needs in South King
County?
b. Is the need in the City supported by data?
(score 0 —3) Is the data specific to Renton or to South King County?
(score 0— 3) Is there a quantifiable need?
c. How easily can Renton residents access the program?
(score 0-3) Does the'proposed outreach fit Renton or show knowledge of
Renton?
(score 0-3) Were the language arid cultural needs of the clients
addressed?
(score 0-3) Does the agency propose to have subcontractors or partners?
Are services accessible through 1) the organization or 2) the
subcontractors/partners? (Circle one)
d: Long Range Plan.
(score 0:3) Is a long-range plan described, versus a strategic plan?
(score 0-3) Does the plan list multiple funding sources for future
- funding?'
(score 0-3) Was evaluation of services mentioned in the plan?
SCORE: / 33
Total Score: / 52
Rating Tool p. 6
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Application Cover Pages (Agency Information and Questions 1 —7)
Agency Information
Agency Name: Somali Community Services Coalition
Applicant Name and Address: Agency Director:
15027 Military Road South, Suite 4 and 5 Ahmed Jama, Executive Director
SeaTac, WA 98188 Name and Title :
(206) 431-3536
(Area Code)Telephone
Ai urjama@a yahoo.com
E-mail address (if available) (Area Code)Fax Number
Required signatures: By signing below,you certify that the information in this application is accurate to
the best of your knowledge and that you have read the application, ce i is ions,and app= dixes.
(SIGNATURES MUST BE IN BLUE INK)
itkaitaititt4:4444
6�0`
Signature of Agency Board President/Date Signatur f Agency irector/Date
Abdulhakim A. Hashi Ahmed Jama
Prated Name of Agency Board President Printed Name of Agency Director
Program Information
1. Program Name
Contact Person(available to answer specific questions on this application)
Ahmed Jama (206)431-3536/431-7967
ame (Area Code)Telephone
;Same as above
Address(if different than above)
bnurjama@yahoo.com
1E-mail address(if available) (Area Code)Fax Number
2. Program is New for our agency ❑An Ongoing Program X
3. Bief Description of Program(One sentence)
Somali Refugee Family and Youth Support Program provide services to help Families and Youth
access available social services and achieve self-sufficiency.
4. Where are services provided? (If different from agency location)
The services are mainly provided in Somali Community Services Coalition's SeaTac office. Some
Case management services will be offered at an apartment in Renton. Services such as outreach and
i iterpretation may occur in appropriate locations in Renton, SeaTac, and Tukwila.
Page 2
5. Tpta1 Program Cost:
1,ctual 2007: $13,000.00 Proposed 2009: $ 70,000.00
lirojected 2008: $ 13,000.00
6. ToLtal City Funds Requested for this Program:
City Awarded 2008 Requested 2009*
General Fund CDBG Total Requested**
,auburn
Federal Way
Kent
Renton 1 1 20,000.00
City Awarded 2008 Requested 2009*
General Fund General Fund
iurien
Covington
De Moines
Enumclaw
SeaTac $5,000.00 20,000.00
ljukwila $8,000.00 30,000.00
Page 3
7. A ency Contact Sheet
Provid the following information for the agency and for the program requesting funds.
Age cy Contacts
Generi 1 Agency Name: Somali Community Services Coalition
Address: 15027 Military Road South, Suite 4&5
City/State/Zip: SeaTac, WA 98188
Phone/Fax: (206) 431-7967/(206) 335-3704
Agency Web Address: www.scscseatac.cfsites.org
Executive Director Name: Ahmed Jama
Title: Executive Director
Direct Phone: (206) 335-3704
E-Mail: Anurjama@yahoo.com
Develo ment Director Name: Pam Carter
(or Gran Writer) Title: Consultant and Grant writer
Direct Phone: (206) 244-0558
E-Mail: pmcarter@jps.net
Finan'elAccountant Name: M.A McCullister, Inc
(person ireparing invoices) Title: Accountant
Direct Phone: (206) 723-6860
E-Mail:
Prog am Contact
(St contact for contracting, reporting and program implementation)
Program Name: Somali Refugee Family and Youth Support
Staff Name: Ahmed Jama
Title: Executive Director
Direct Phone: (206) 335-3704
E-Mail: Anurjama@yahoo.com
Page 4
Ap lication Narrative Section (Questions 8— 12)
8. ORGANIZATIONAL EXPERIENCE
A. E ,perience.
Somali Community Services Coalition(SCSC) is a 501(c) 3 non-profit community based organization,
forme in 1995, and incorporated in 1998. The mission of SCSC is to provide essential services to the
Somali and other East African refugees and immigrants in South King County. These services include:
• Resettlement Assistance -providing interpretation&translation services, locating emergency&
transitional housing, counseling, advocacy and referral services.
• Family&Youth Support-helping refugee and immigrant families deal with different cultural
expectations, supporting parents and youth in their academic endeavors, and supporting preservation of
the family unit.
• Job'Training&Assistance-helping refugees and immigrants develop and practice the skills needed to
accp}ire and maintain living-wage jobs.
• Advocacy Support for those requiring it.
• Comprehensive translation and interpreting
In past years, SCSC began with a Seattle location and worked with the Seattle School District to improve
stude t learning. It was the lead agency for the Somali Education Taskforce to increase staff's
understanding of the Somali students. In partnership with the Seattle School District it held a summer
progr.m which resulted in students' improved math,reading, and writing skills. As part of the City of
Seattl 's Immigrant and Refugee Family Support Project, SCSC it conducted parenting workshops and
youth biasses where students gained a greater understanding of their ethnic history and culture.
Last year, SCSC closed its Seattle office and now works out of its SeaTac location. It has met with the
Tukwila School District administrators and other staff to discuss the challenges faced by Somali students
and strategies to address those challenges. SCSC partnered with the Tukwila School District to provide
after-school programs and parent workshops through OPSI's Refugee Child School Impact Grants. The
after-school program provides homework help and tutoring for elementary school students.
SCSC has held employment workshops to help individuals find, apply for, and secure employment.
SCSC as held ESL classes for adults and assisted refugees on immigration/citizenship matters including
"gree card" applications and preparation for citizenship tests.
SCSC currently employs a case manager who works with clients to help them access services and achieve
self-sufficiency.
ficiency.
B. 0 erational Structure.
The Somali Community Services Coalition(SCSC)provides services to immigrants from Somalia and
other African communities in King County from its office in SeaTac. All current staff are Somali and
fluent in English.
Page 5
The Executive Director is the senior staff member and is responsible for supervision of all employees and
administration of all programs. He is Somali, was a founding member of SCSC, and has held this position
since in 2002. He reports to the Board of Directors.
The Program Coordinator is a new position added to increase supervision and coordination of the
program. This will be a part-time position. The Program Coordinator will supervise the Case Manager and
report I o the Executive Director.
The Case Manager is the case worker who performs outreach functions and works directly with clients.
She reports to the Program Coordinator. She is also Somali has been a case worker at SCSC for over one
year . d is currently attending college.
SCSC 's governed by a 11 member Board of Directors elected to two-year terms by the Somali
comm 'ty members and meets quarterly. The Executive Board consists of the President, Vice President,
Secret.ry, and Treasurer. The Board is organized into four committees:
• Education
• Consoling and conflict resolution
• Grants, fund-raising, and public relations
• Sports and outdoor activities
Each ciommittee recruits volunteers, coordinates its activities,holds meeting, and reports quarterly to the
entire Board. Volunteers play a crucial role in the organization by providing transportation,raising funds,
teachii g ESL classes, coordinating youth activities, and assisting in the completion of various forms and
applications.
Since the Board members are themselves members of the Somali community,they are very much in touch
with the needs and concerns of the community. The Board is diverse in that it includes 2 women, 1
disabl&d, and several senior citizens.
9. NEED FOR YOUR PROGRAM
A. Pr blem Statement
The Somalis in King County are refugees who fled their homeland because of the civil war in 1991. Many
childr In and adults witnessed murder of first-hand and endured harsh conditions during their years.in
refuge camps. Although they are grateful to be in the US,they now face challenges such as learning a
new 1 guage, isolation, absence of culturally-appropriate support services, and adapting to a new and
differe t culture. They find everything from the school system, social life, culture, traditions, and
parent/youth roles are different from their past experience.
Many pf the more than 230 Somali students in Tukwila schools are struggling academically due to their
lack o1 English proficiency as well as the usual challenges of adapting to a new culture. Some students
arrive n this country with little or no previous education but are placed in their age-appropriate grade
level. Some high school students who are frustrated with their lack of educational progress and support
become dropouts and may begin to experiment with alcohol and drugs.
Somali parents do not understand how the school system works and how they can support their children's
academic progress. For some,this is because of both the different school system and the different cultural
expect6tion of parental involvement in this country. Other parents have no formal education themselves.
In fact the majority of the parents are not literate in any language. These cultural differences added to the
langu ge barrier result in communication difficulties. A commonly used, but not necessarily appropriate,
Page 6
solutio is for the student to act as interpreter. A few students have purposely deceived their parents by
descri ing their grades as very good when in fact they are failing.
Li
Most of the adult Somali refugees arrive in this country knowing little or no English. Until they attain a
level of fluency in English,they are usually able to obtain only low-wage jobs. Obtaining a driver's
license opens other employment opportunities but also requires knowledge of traffic regulations. ESL and
driver's training classes are required to address these needs. Many also lack job readiness skills.
Somali refugees are understandably concerned that they retain their ability to remain in this country. They
need assistance in completing forms to change their immigration status and later to apply for citizenship.
Case management services are needed to assist families to access social services and to provide support as
they learn to navigate the cultural and economic challenges of starting a new life in a new country. Due to
the language barrier and lack of familiarity with the culture,many Somalis need help with many basic
tasks such as finding medical care, finding a job, locating housing, and accessing available services. And
of course,these tasks (and many others)typically require the applicant to properly fill out a form in a
language that the applicant is still struggling with.
B. Target Population.
SCSC offers services to refugees and immigrants from Somali and other East African countries. A major
focus has been students and their parents. Services such as ESL classes, interpretation services, and case
management services are offered for adults and seniors. These Somalis live in South King County such as
cities of Tukwila, SeaTac, Renton and Burien. Because the Cities of SeaTac and Tukwila provided
funding for the years 2007-2008,the majority of clients have been residents of those two cities.
Additional funding from the City of Renton would enable an expansion of services to its residents.
10. PROPOSED PROGRAM/SERVICE
A. Program Description.
The S mali Refugee Family and Youth Support program is designed to assist families and their youth to
access available services, expand career plans and skills to achieve livable jobs, and to reduce language
and c tural barriers. The program provides outreach, ongoing assessments, and counseling services to
help clients and coordinate the delivery of services. The program will help families—elders,parents, and
youth I to access the social services they need and to provide support as they transition to their new life in
King County. SCSC staff,which is bilingual in English and Somali,will provide the services listed below
in a culturally appropriate environment. Through meetings with the Tukwila Community Schools
Collaboration(TCSC) and the Tukwila School District, SCSC will coordinate its services with student
needs and services offered by TSCS and the District. Since the staff itself is Somali,they interact
regularly with other Somalis in the community.
The services will be mainly provided in Somali Community Services Coalition's SeaTac office. Services
such as outreach and interpretation may occur in appropriate locations in Renton,SeaTac, and Tukwila.
SCSC will also expand to offer case management services at an apartment complex in Renton. The
Somali families in Renton have requested the services, and there is a space available that SCSC would be
able to use. In order to meet this demand,the caseworker hours need to be increased to 1 FTE.
Page 7
Through the provision of these services, SCSC will assist clients in working to improve their economic
situations and cope with the challenges of living in a different culture.
Services include:
• Resettlement Assistance—providing interpretation&translation services, locating emergency&
transitional housing, counseling, advocacy and referral services.
• Immigration assistance—completing forms, citizenship application classes and assistance
• Health and hospital referrals
• Housing—housing application assistance
• Comprehensive translation and interpreting services
• DSHS—assistance in accessing services and completing forms
• Employment Services—job skills, application assistance, resume preparation
• Cultural and behavioral orientations
B. Performance Measures and Outcomes.
Perfo 1 ance measure number of case management hours provided
Outco a increase in individual/family self-sufficiency
Indica or 90% of clients service plan goals to increase/maintain self sufficiency
Performance Measure Number of Clients assisted for immigration papers for status change,
Housing applications, utility assistances and health&hospital referrals
Outco a Increase in family/Individual self-sufficiency
Indica or 80% of Clients connected to services will increase/maintain self-sufficiency
C. St ffing Plan & Evaluation
i. Staffing Plan.
Staffing for this program will consist of a total of 1.5 FTEs. A case worker (1 FTE) will provide case
management services. The Program Coordinator(0.5 FTE)will provide supervision of the case worker
and general management/oversight of the program.
ii. Evaluation.
The Program Coordinator will regularly meet with the Case Manager to monitor and evaluate evidence
that t4 clients have been connected to social services and to track their progress toward improving their
quality-of-life. This evidence with include the data required for quarterly submission to the cities which
provide funding. This data along with client feedback will be used to improve client services. SCSC's
Board Twill receive reports on the status of current activities and approve major changes in any program.
D.Differences in Service Delivery by City
The same services will be provided to residents of Renton, SeaTac, and Tukwila. Case management
servics will be delivered at the SeaTac office except for Renton residents who will be served at a location
in Renton.
11. LONG RANGE PLAN
Page 8
SCSC will continue to strengthen the organization's capacity to work toward creating sustainable
solutions that reduce poverty and increase self-sufficiency in the Somali community. It will seek other
funding sources and possibilities for collaboration with other agencies. Participation in the Tukwila
Providers Network has demonstrated the value of working with other agencies.
SCSC has come to realize the importance and value of working with other organizations and helping the
Somali community to integrate with the larger(majority) community while retaining its cultural identity.
In the ture, leadership training would help some community members gain the skills to help them move
into le dership positions.
SCSC plans to begin working with the Renton School District and the Highline School District to see how
it can support the Somali students in those districts.
SCSC would like to hire the services of a grant writer to find and apply for other sources of funds.
Long-range plans include the acquisition of a building to serve as a true center for the Somali community.
This will require an extensive fund-raising campaign coupled with financial support from the Somali
comm ity. SCSC anticipates that the Somali community will follow the pattern of other immigrant and
refuge- groups where the earlier arrivals begin to achieve financial stability and are able to assist those
who e more recently arrived and are struggling to meet the challenges they themselves had once faced.
12. BUDGET
A. B dget Request Narrative.
Perso el Costs— 1.0 FTE Case Manager paid at$13 per hour for an annual salary of$27, 040. A .5
FTE Pi ogram Director paid at$15 per hour for an annual salary of$19, 500. Benefits are calculated at
18%o wages ($3,510 and $4,867) and total $8,377.
Opera ing and Supplies—Supplies for consumable program supplies including papers,pens, file folders,
binder , labels,paper clips,binder clips,tape, etc. is budgeted at$ 2,600. The program will pay 30% of
the offce rent which is $2,000 per month. (30%x$2000= $600 x 12 mos. =$7,200). The program will
pay 30%of costs for telephone and Internet service which is $200 per month. (30%x $200= $60 x 12
mos. = $720). Administrative costs are figured at 7% of the program costs.
B. Changes to Budget.
The major changes in the 2009-2010 expenses will be the increase in the caseworker hours to that of a
full-time employee and the addition of a half-time Program Coordinator. SCSC is requesting new funding
from the City of Renton which will allow SCSC to provide services requested by Renton residents. SCSC
is requesting additional funding from SeaTac and Tukwila in order to serve more clients from those cities.
C. Cost per Service Unit(s).
Cost p r Service Unit: $269.23
Explanation of how determined:
Number of people to serve each year for the 2009/2010 are estimated to be more than 260.00,when
divided that number by the Program Budget can give you the cost per person, we may serve the person
more than four or five times the period for different services
Page 9
Agency: SCSC
Program: SRFAYP
13. NUMBER Of INDIVIDUALS/HOUSEHOLDS SERVED BY PROGRAM
X In a ividuals? or n Households? (Check which applies and use for reporting all demographics.)
Unduplicated
*Unduplicated Number of all Clients Served by Clients Served
All Funding Sources with Funds
Requested
• 2007 2009
2007 % of column 1 2008 2009
(Actual) clients served (Anticipated) (Projected) (City Requested
by City Funding Only)
Aubur
la
Burien
Covington
Des Moines
Enum�law
Federa Way
Kent
Renton 80 $20,000.00
SeaTac 56 42% 70 80 $20,000.00
Seattle
Tukwila 77 58% 86 100 $ 30,000.00
Other
100%
Total 133 (This column must 156 260 260
total 100%)
*Unduplicated means count each client only once per calendar year per program. This number should match the number
of clients by city indicated in the top row of Question 15.
Page 10
14. Performance Measures (Data Table) Agency: S SC Program: SRFAYP
14a. Service with 2009 Requested Funds
Proposed Performance Measures as defined below.
A) Case Mgmt Hrs B) C)
Auburn
Burien
Covington
Des Moines
II
Enumdlaw
II
Federal Way
Kent
Renton 1,400 Case Mgmt. Hrs
SeaTae 1,400 Case Mgmt. Hrs
Seattle
Tukwila 2,000 Case Mgmt. Hrs
14b. Pe rformance Measures 2009 Proposed with funds requested City Funding Only
Title: Brief explanation:
A) Case management hours Will include intake, assessment, planning, advocacy and evaluation
of results.
B)
C)
Page 11
Agency: SCSC
14 P•rformance Measures (Data Table), Cont. Program: SRFAYP
14c. Average Cost of Service
Unduplicated Clients
Served with Funds Average Cost of Service
Requested 2009 Requested 2009 per Client
(Same as last column of (Same as last column of
Question 6) Question 13) Column 1 divided by Column 2
xample: $5,000 45 $111.11
Auburn1
Burien
Covinton
Des Moines
Enumclaw
Feder4 Way
Kent
Rento7 $20,000.00 80 $250.00
SeaTaa 20,000.00 80 $250.00
Seattle
Tukwila 30,000.00 100 $300.00
Page 12
Comple e Question 15 with 2007 Actual numbers reported in column 1 of Question 13. Agency: SCSC
15. Demographics (from all funding sources) (Data Table) Program: SRFAYP
Client Residence
• cd
o
o `� .
i ., F,
O
a1 U W w rx rr cn HFEi
Unduplicated
(check one)
❑Individuals oo vD
0 0
❑Households N
Served in 2007*
Household Income Level
30%of Median or Below
50%of Median or Below
80%of Median or Below 80 80 100 260
Above 80%of Median
Unknown
I TOTAL I 80 80 100 260
Gender]
Male 36 36 45 117
Female 44 44 55 143
TOTAL 80 80 100 260
Age
0-4years
5- 12 years 3 3 4
13- 17 years 12 12 15
18-34 years 24 24 30
35-54 years 24 24 30
55-74 years 16 16 20
75+years 1 1 1
Unknown . .
TOTAL 80 80 100
Ethnicity
Asian
Black/African American 80 80 100 260
Hispanic/Latino(a)
Native
American/Alaskan
Pacific Islander
White/Caucasian
Other/Multi-Ethnic
TOTAL 80 80 100 260
Female Headed 48 48 60 156
Household
Disabli ig Condition
Limited English 80 80 100 260
Speaking
*Check Individual or Household,which should be the same as checked in Question 13. Unduplicated means count each client
only once per calendar year. This should match the number served by City in the Actual 2007 column of Question 13. The
"total"column will be different from Question 13 since the"other"column is not included due to space limitations.
Page 13
16. ROGRAM STAFF (DATA TABLE)
2007 2008 2009
(Actual) (Budgeted) (Projected)
Total Number of Staff(FTEs) 1 1 1.5
Number of Volunteer(FTEs) 0 0 0
Actual Number of Volunteers 0 0 0
Page 14
Agency: SCSC
17. PROGRAM REVENUE BUDGET (DATA TABLE) Program: SRFAYP
Revenue Source 2007 2008 2009
(Actual) (Budgeted) (Projected/
Requested)
City Funding(General Fund & CDBG)
•I Auburn
• Burien
▪ Covington
• Des Moines
▪ Enumclaw
• Federal Way
▪ Kent
. Renton $ 20,000.00
▪ SeaTac $ 5,000.00 $ 5,000.00 $ 20,000.00
▪ Seattle
• Tukwila $ 8,000.00 $ 8,000.00 $ 30,000.00
Other(Specify)
Other(Specify)
Other Government Funds
• King County
• Washington State
• Flederal Government(Specify)
• Other(Specify)
Private Sources
• United Way (grants & designated donors)
• Foundations and Corporations
• Contributions (e.g., Events, Mailings)
• Pirogram Service Fees (User Fees)
• Other(Specify)
TOTAL PROGRAM BUDGET $ 13,000.00 $ 13,000.00 $ 70,000.00
Page 15
17. PROGRAM EXPENSE BUDGET, CONT. Agency: SCSC
(DA A TABLE) Program: SRFAYP
Expenses 2007 2008 2009
(Actual) (Budgeted) (Projected)
Persinnel Costs ........ .
•
Salaries $ 13,000.00 $13,000.00 $ 46,540.00
• Benefits $ 8,377.00
• Other
• Total Personnel $13,000.00 $13,000.00 $ 54,917.00
Operating and Supplies
• Office/Program Supplies $ 2,400.00
• Rent and Utilities $ 7,200.00
• Repair and Maintenance
• Insurance
• Postage and Shipping
• Printing and Advertising
• 1ijelephone $ 720.00
• Equipment
i
• Conference/Travel/Training/Mileage
• Dues and Fees
• Professional Fees/Contracts
• Direct Asst. to Individuals
• Administrative Costs $ 4,563.00
• Other(specify)
TO'PIL PROGRAM EXPENSES $ 70,000.00
Net 1 rofit(Loss) 0
(revenue—expenses)_
Page 16
Agency: SCSC
18. UBCONTRACTS (DATA TABLE) Program: SRFAYP
List al the agencies you will be subcontracting with for this program. Provide the agency name in the first
col , a description of the contract/service in the second column, and the contract amount in the third
col . Do not list agencies you coordinate with on a referral only basis. Indicate not applicable if
you do not subcontract for any part of this program.
Subcontracting Agency Specific Subcontracted Activities Contract
in the Operation of Your Program Amount
Not subcontracting
Page 17
19. 4PPLICATION CHECKLIST
Applications missing one or more of the following components or not following these directions may not
be rev'ewed. Sign and submit the application checklist with your application.
Contents (Your application should contain each of these items in this order.)
X Application Cover Pages.The top three pages of your application must be a completed copy of the
Agency Information and Questions 1-7.
Application Narrative:
® Question 8 Organizational Experience(2 page maximum)
K1 Question 9 Need for Your Program(2 page maximum)
-0 Question 10 Proposed Program/Service(6 page maximum)
Question 11 Long Range Plan(1 page maximum)
Question 12 Budget(2 page maximum)
D.to Tables
[A Question 13 Number of Individuals/Households Served
® Question 14a-c Performance Measures and Average Cost of Service
►li Question 15 Demographics(from all funding sources)
►�� Question 16 Program Staff
Question 17 Program Revenue&Expense Budgets
Question 18 Subcontracts
Required documentation. Supply one copy of the following required documents with the signed original
application. See Part II: City Specific Supplemental Information to determine whether additional copies of the
application and required documentation need to be submitted.
® Question 19 Required Documentation, including:
• %/Proof of non-profit status
• 1/Organizational Chart
• VAgency/Organization Mission Statement
• Board resolution authorizing submittal of the application(may be submitted up to 60 days after
application).
• /List of the current governing board and local board, if applicable,(include name,position/title,
city residence, length of time on the Board, and expiration of terms. Note any vacancies.)
• Board Meeting Minutes of last three board meetings of governing board and local board as
applicable
• (Annual Budget
• Financial Audit Cover Letter 'Q 0
• Financial Audit Management Letter
• Financial Statement
• Verification of Non-Discrimination Policy
• 4'Program Intake Form
•+-Sliding Fee Scale
frli • pplication Check List. (Signed below.)
PIk ity Specific Supplemental Information.Required in Name. Ahmed Jama
Pa or applicable Ci only. Position: Executive Director
Phone#: (206) 431-3536/431-7967
‘).1.).\kof
b E-mail: Anurjama@yahoo.com
t°Signa Person Completing ecklist
DO N T SUBMIT ANY OTHER MATERIALS WITH THIS APPLICATION
Make sure that you carefully check Part II of this application
to see what additional attachments each city requires.
Page 18
25720 11/10/2001 11:58 AM
99 Return of Organization Exempt From Income Tax OMB No.1545-0047
Form Under section 501(c),527,or 4947(a)(1)of the Internal Revenue Code(except black lung 2006
• Department of the Treasury benefit trust or private foundation)
Internal Revenue ervice ► The organization may have to use a copy of this return to satisfy state reporting requirements. Open to Public Inspection,
A For the 2006 calendar year,or tax year beginning ,and ending
B Check if appl cable: Please C Name of organization D Employer identification number
use IRS
Addresschar?ge SOMALI COMMUNITY SERVICES COALITION 31-1611993
prim or C/O MOLLY MCCOLLISTER
El Namechang print or E •Telephone number
type. Number and street(or P.O.box if mail is not delivered to street address) Room/suite 20 6—7 2 2—2 314
❑ Initial return See 2039 34TH AVENUE SOUTH
F Accounting method: U Cash
El Final return Specific
Instruc- City or town,state or country,and ZIP+4 ❑X Accrual ❑ Other(specify)
❑ Amended ret rn tions. SEATTLE WA 98144 ►
❑ Application p nding •Section 501(c)(3)organizations and 4947(a)(1)nonexempt charitable H and are not applicable to section 527 organizations. I
trusts must attach a completed Schedule A(Form 990 or 990-EZ). H(a) Is this a group return for affiliates? ❑ Yes ❑X No
G Website: k N/A H(b) If"Yes;"enter number of affiliates ►
J 'Organization type H(c) Are all affiliates included? ❑ Yes ❑ No
(check only one) ►PIE 501(c) ( 3 ) 1(insert no.) n 4947(a)(1) or n 527 (If"No,"attach a list.See instructions.)
K Check here ► El if the organization is not a 509(a)(3)supporting organization and its gross H(d) Is this a separate return filed by an
receipts are normally not more than$25,000.A return is not required,but if the organization chooses organization covered by a group ruling? n Yes n No
to file a returr,be sure to file a complete return. I Group Exemption Number*
M Check ► U if the organization is not required
L Gross receipts:Add lines 6b,8b,9b,and 10b to line 12 ► 105,497 to attach Sch.B(Form 990,990-EZ,or 990-PF).
Patti Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions.)
1 Co tributions,gifts,grants,and similar amounts received:
a Co Intributions to donor advised funds 1a
b Direct public support(not included on line la) 1b 22,350,-
c Ind rect public support(not included on line 1a) 1c
d Government contributions(grants)(not included on line 1a) 1d 83,147 :,
e Total(add lines 1a through 1d)(cash $ 105,497 noncash $ ) le 105,497
2 Program service revenue including government fees and contracts(fror t�a V : ' 2
3 Mellmbership dues and assessments \�L/� v 3
�u( 3
4 Intdrest on savings and temporary cash investments 4
5 Div dends and interest from securities 5
6a Gr IIss rents I 6a
b Les :rental expenses 6b
c Net rental income or(loss).Subtract line 6b from line 6a 6c
7 7 Other investment income(describe* ) 7
c 8a Gross amount from sales of assets other (A) Securities (B) Other
• tY than inventory 8a
b Les :cost or other basis and sales expenses 8b
c Gai or(loss)(attach schedule) 8c
d Net gain or(loss).Combine line 8c,columns(A)and(B) 8d
9 Sp cial events and activities(attach schedule). If any amount is from gaming,check her* ❑
a Gros revenue(not including$ of
con ributions reported on line 1 b) 9a
b Les :direct expenses other than fundraising expenses 19b
c Net income or(loss)from special events.Subtract line 9b from line 9a 9c
10a Gro s sales of inventory,less returns and allowances 110a
b Les :cost of goods sold 10b
c Gros profit or(loss)from sales of inventory(attach schedule).Subtract line 10b from line 10a 10c
11 Othrr revenue(from Part VII, line 103) 11
12 Total revenue.Add lines le,2,3,4,5,6c,7,8d,9c, 10c,and 11 12 105,497
13 Program services(from line 44,column(B)) 13 65,832
0
y 14 Management and general(from line 44,column(C)) 14 15,208
a 15 Fundraising(from line 44,column(D)) 15 5,239
w 16 Payfnents to affiliates(attach schedule) 16
17 TotI expenses.Add lines 16 and 44,column(A) 17 86,279
y 18 Excess or(deficit)for the year.Subtract line 17 from line 12 18 19,218
• 19 Net l3ssets or fund balances at beginning of year(from line 73,column(A)) 19 —64 9
15 20 Oth r changes in net assets or fund balances(attach explanation) Y0
21 Net ssets or fund balances at end of year.Combine lines 18, 19, and 20 21 18,569
For Privacy Act and Paperwork Reduction Act Notice,see the separate Form 990(2006)
instructions.
DAA
25720 11/10/200 11:58 AM
Form 990.(200 ) SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 2
Part ll Statement of All organizations must complete column(A).Columns(B), (C),and(D)are required for section 501(c)(3)and(4)
Functional Expenses organizations and section 4947(a)(1)nonexempt charitable trusts but optional for others.(See the instructions.)
Do not include amounts reported on line (B) Program (C) Management
6b, 8b, 9b, 10b, or 16 of Part I. (A) Total services and general (D) Fundraising
22a Grants paic from donor advised funds(attach schedule)
-
(cash$ cash $ )
If this amount includes foreign grants,check here ► U 22a -
22b Other grants r nd allocations(attach schedule)
non- .,....
(cash$ cash $ )
If this amount includes foreign grants,check here ► U 22b
23 Specific assistance to individuals(attach
schedule) 28
24 Benefits paid to or for members(attach
schedule) 24
25a Compensa ion of current officers,directors,
key emplo ses,etc.listed in Part V-A(attach
•
schedule) 25a
b Compensation of former officers,directors,
key employ es,etc.listed in Part V-B(attach
schedule) 25b
c Compensatio and other distributions,not included above,to
disqualified p rsons(as defined under section 4958(f)(1))and
persons desc ibed in section 4958(c)(3)(B)(attach schedule) 25c.
26 Salaries an wages of employees not included
on lines 25I b,andc 26 40, 608 34, 608 3,500 2,500
27 Pension plan contributions not included on
lines 25a,bl,and c Y7
28 Employee benefits not included on lines
25a—27 28
29 Payroll taxes 29 4,345 3, 683 386 276
30 Profession-I fundraising fees 30
31 Accounting ees 31 2, 950 2, 950
32 Legal fees 32
33 Supplies 33 3,401 1, 148 2 ,196 57
34 Telephone 34 2, 609 . 1, 983 365 261
35 Postage an. shipping 35 172 139 33
36 Occupancy 36 21,440 16,568 2,842 2 ,030
37 Equipment ental and maintenance 37 109 • 109
38 Printing an. publications 38
39 Travel 39 152 83 69
40 Conference ,conventions,and meetings 40 332 332
41 Interest 41
42 Depreciatio ,depletion,etc.(attach schedule) 42 840 840
43 Other expenses not covered above(itemize):
a See Statement 1 43a 9,321 7,288 1, 918 115
b 43b
c 43c
d 43d
e 43e
f 43f
9 43g
44 Total functi.nal expenses.Add lines 22a
through 43g (Organizations completing
columns(B)r(D),carry these totals to lines
13-15) 44 86,279 65,832 15,208 5,239
Joint Costs.Ch6ck► U if you are following SOP 98-2.
Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B)Program services? ► 0 Yes X❑ No
If"Yes,"enter(i)th aggregate amount of these joint costs$ ;(ii)the amount allocated to Program services $ ,
(iii)the amount allocated to Management and general$ ;and(iv)the amount allocated to Fundraising$
DAA Form 990(2006)
25720 11/10/2007 11:58 AM
Form 990(2005) SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 3
%Part III ' Statement of Program Service Accomplishments (See the instructions.)
Form 990 is a+lable for public inspection and,for some people,serves as the primary or sole source of information about a
particular organization.How the public perceives an organization in such cases may be determined by the information presented
on its return.Therefore,please make sure the return is complete and accurate and fully describes,in Part III,the organization's
programs and'accomplishments.
What is the orgianization's primary exempt purpose? Program Service
► See Statement 2 Expenses
All organizations must describe their exempt purpose achievements in a clear and concise manner.State the number (Required for 501(c)(3)and
of clients served,publications issued,etc.Discuss achievements that are not measurable.(Section 501(c)(3)and(4) (4)orgs.,and optionalbut for
organizations and 4947(a)(1)nonexempt charitable trusts must also enter the amount of grants and allocations to others.) trusts;others.) for
a To deduce poverty in the Somali community through
employment training and provision of needed services such
English language instruction, educational training,
advocacy and referral services, and co-ordination with
community resources .
(Grants and allocations $ ) If this amount includes foreign grants,check here ► 11 65,832
b
(Grants an. allocations $ ) If this amount includes foreign grants,check here ► I I
c
(Grants and allocations $ ) If this amount includes foreign grants,check here ► ❑
d
(Grants and allocations $ ) If this amount includes foreign grants,check here ► ❑
e Other progr m services(attach schedule)
(Grants and allocations $ ) If this amount includes foreign grants,check here ► H.
f Total of Program Service Expenses(should equal line 44,column(B),Program services) ► 65, 832
Form 990(2006)
DAA
i
25720 11/10/2007 11:58 AM
Form990-(2006) SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 4
Part IV I Balance Sheets (See the instructions.)
Note: Whet re required,attached schedules and amounts within the description (A) (B)
col limn should be for end-of-year amounts only. Beginning of year End of year
45 Cash-non-interest-bearing 1,117 45 19, 091
46 Savings and temporary cash investments 46
47a Accounts receivable 47a
b Less:allowance for doubtful accounts 47b 47c
48a Pleldges receivable 48a
b Less:allowance for doubtful accounts 48b 48c
49 Grants receivable 49
50a Receivables from current and former officers,directors,trustees,and
key,employees(attach schedule) 50a
b Receivables from other disqualified persons(as defined under section 4958(f)(1))and
persons described in section 4958(c)(3)(B)(att.schedule) 50b
51a Other notes and loans receivable(attach
schedule) 51a
wb Lesls:allowance for doubtful accounts 151b 51c
v)
a 52 Inventories for sale or use 52
53 Prepaid expenses and deferred charges 53
54a Investments—publicly-traded — —
securities _ Cost _ FMV 54a
b Investments—other securities Cost _ FMV 54b
(attach schedule) —
55a Investments-land,buildings,and
equipment:basis 55a
b Less:accumulated depreciation(attach
schedule) 55b 55c
56 Investments-other(attach schedule) 56
57a Land,buildings,and equipment:basis 57a 12 , 931
b Less:accumulated depreciation(attach
schedule) See Statement 3 57b 10, 923 616 67c 2 , 008
58 Other assets,including program-related investments
(describe ) 58
59 Total assets(must equal line 74).Add lines 45 through 58 1 ,733 59 21,099
60 Accounts payable and accrued expenses 2,382 60 2,530
61 Gra I is payable 61
62 Deferred revenue 62
m 63 Loans from officers,directors,trustees,and key employees(attach
•_' schedule) 63
m 64a Tax exempt bond liabilities(attach schedule) 64a
'71 b Mortgages and other notes payable(attach schedule) 64b
65 Other liabilities(describe ► ) 65
66 Total liabilities.Add lines 60 through 65 2 ,382 66 2 ,530
Organizations that follow SFAS 117,check here► U and complete lines
67 through 69 and lines 73 and 74.
ai 67 Unrelstricted —649 67 18 ,569
6.)
68 Temporarily restricted 68
ca
m 69 Pernjanently restricted 69
1, Organizations that do not follow SFAS 117,check here ► 0 and
ti complete lines 70 through 74.
0 70 Capital stock,trust principal, or current funds 70
a71 Paidiin or capital surplus,or land,building,and equipment fund 71
a 72 Retained earnings,endowment,accumulated income,or other funds 72
z 73 Total,net assets or fund balances(add lines 67 through 69 or lines
70 through 72.(Column(A)must equal line 19 and column(B)must
equal line 21) —649 73 18 ,569
74 Total liabilities and net assets/fund balances.Add lines 66 and 73 1 ,733 74 21,099
Form 990(2006)
DAA
I
25720 11/10/2007 11:58 AM
Form 990`(2006) SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 5
, ' Part,_IV-A_ . Reconciliation of Revenue per Audited Financial Statements With Revenue per Return (See the
instructions.) N/A
a Total revenue,gains,and other support per audited financial statements a
b Amounts included on line a but not on Part I,line 12:
1 Net unrealized gains on investments b1
2 Donated Services and use of facilities b2
3 Recoveries of prior year grants b3
4 Other(specify):
b4
Add lines b1 through b4 b
c Subtract line b from line a c
d Amounts included on Part I, line 12,but not on line a:
1 Investment expenses not included on Part I, line 6b d1
2 Other(specify):
d2
Add lines d1 and d2 d
e Total revenue(Part I,line 12).Add lines c and d e
Part IV=B.i' Reconciliation of Expenses per Audited Financial Statements With Expenses per Return N/A
a Total expenses and losses per audited financial statements a
b Amounts jncluded on line a but not Part I, line 17:
1 Donated services and use of facilities b1
2 Prior year adjustments reported on Part I,line 20 b2
3 Losses reported on Part I,line 20 b3
4 Other(sp l cify):
b4
Add lines;IA through b4 b..,
c Subtract line b from line a c
d Amounts included on Part I,line 17,but not on line a:
1 Investment expenses not included on Part I,line 6b d1
2 Other(specify):
d2
Add lines d1 and d2 d
e Total expenses(Part I,line 17).Add lines c and d e
Part V-A Current Officers, Directors,Trustees, and Key Employees (List each person who was an officer,director,trustee,
or key employee at any time during the year even if they were not compensated.)(See the instructions.)
(B) (C)Compensation (D)p Contributions to (E)Expense
(A) Name and address Title and average hours per (If not paid,enter de e�red com eonsatioo account and other
week devoted to position _0_,) plans allowances
Abdulkahim A. Hashi Seattle President
409 SW 133th Place WA 98146 10 0 0 0
Dirie Olad Jama Seattle V-President
10903 4th P1 SW WA 98146 5 0 0 0
Mohamed D. Mohamed Federal Way Secretary
1814 S 286th Ln #P202 WA 98003 5 0 0 0
i
Abdikarim A.'Karani Seattle Treasurer
15211 Pacific Hwy S WA 98188 10 0 0 0
Ahmed Sheikh Isse Kent Member
27026 48th1P1 S #203 WA 98031 5 0 0 0
Abdirahman A. Jibril Kent Member
23401 104th Ave SE #20 WA 98018 • 5 0 0 0
Hawa A. Dalmar Renton Member
2811 NE 4tli St. #203 WA 98056 5 0 0 0
Form 990(2006)
DAA
25720 11/10/200 11:58 AM
'Form 990`(200 ) SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 6
Part V-A Current Officers, Directors,Trustees, and Key Employees (continued) Yes No
75a Enter the total number of officers,directors,and trustees permitted to vote on organization business at board
meetings ► 7 „
b Are any fficers,directors,trustees,or key employees listed in Form 990,Part V-A,or highest compensated
employe s listed in Schedule A,Part I,or highest compensated professional and other independent
contracto s listed in Schedule A,Part II-A or II-B,related to each other through family or business
relations ips?If"Yes,"attach a statement that identifies the individuals and explains the relationship(s) 75b X
c Do any o icers,directors,trustees,or key employees listed in Form 990, Part V-A,or highest
compens ted employees listed in Schedule A,Part I,or highest compensated professional and other
independ nt contractors listed in Schedule A,Part II-A or II-B,receive compensation from any other
organizations,whether tax exempt or taxable,that are related to the organization'?See the instructions for
the definition of"related organization." 75c X
If"Yes, attach a statement that includes the information described in the instructions.
d Does the organization have a written conflict of interest policy? 75d X
',,,Fart V-B. Former Officers, Directors,Trustees, and Key Employees That Received Compensation or Other Benefits
(If any former officer,director,trustee,or key employee received compensation or other benefits(described below)during the year, list that
person below and enter the amount of compensation or other benefits in the appropriate column.See the instructions.)
(C)Compensation(D)Contributions to employee (E) Expense
(A) Name and address (B)Loans and Advances' (if not paid, benefit plans&deferred account and other
enter-0-) compensation plans allowances
N/A
Part VI ; Other Information (See the instructions.) Yes No
76 Did the organization make a change in its activities or methods of conducting activities?If"Yes,"attach a
detailed statement of each change 76 X
77 Were any changes made in the organizing or governing documents but not reported to the IRS? 77 X
If"Yes,"attach a conformed copy of the changes.
78a Did the organization have unrelated business gross income of$1,000 or more during the year covered by
this return? 78a X
b If"Yes,"h'as it filed a tax return on Form 990-T for this year? 78b
79 Was ther a liquidation,dissolution,termination,or substantial contraction during the year?If"Yes,"attach
a stateme t 79 X
80a Is the org.nization related(other than by association with a statewide or nationwide organization)through
common embership,governing bodies,trustees,officers,etc.,to any other exempt or nonexempt
organizati.n? 80a X
b If"Yes,"e ter the name of the organization►
and check whether it is El exempt or 0 nonexempt
81a Enter dire t and indirect political expenditures.(See line 81 instructions.) 181a
b Did the organization file Form 1120-POL for this year? 81b X
Form 990(2006)
DM
I
25720 11/10/2007 11:58 AM
'Form 990'(20q6) SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 7
Part VI I Other Information (continued) Yes No
82a Did the organization receive donated services or the use of materials,equipment,or facilities at no charge
or at substantially less than fair rental value? 82a X
b If"Yes,"lyou may indicate the value of these items here. Do not include this
amount II s revenue in Part I or as an expense in Part II.
(See instructions in Part III.) I 82b I
83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a X
b Did the drganization comply with the disclosure requirements relating to quid pro quo contributions? N/A 83b
84a Did the organization solicit any contributions or gifts that were not tax deductible? 84a X
b If"Yes,"did the organization include with every solicitation an express statement that such contributions or
gifts were not tax deductible? N/A 84b
85 501(c)(4?,) (5),or(6)organizations.a Were substantially all dues nondeductible by members? N/A 85a
b Did the olrganization make only in-house lobbying expenditures of$2,000 or less? N/A 85b
If"Yes"was answered to either 85a or 85b,do not complete 85c through 85h below unless the organization
received a waiver for proxy tax owed for the prior year.
c Dues,a sessments,and similar amounts from members 85c
d Section 62(e)lobbying and political expenditures 85d
e Aggrega a nondeductible amount of section 6033(e)(1)(A)dues notices 85e
f Taxable amount of lobbying and political expenditures(line 85d less 85e) 85f
g Does the organization elect to pay the section 6033(e)tax on the amount on line 85f? N/A 85g
h If section 6033(e)(1)(A)dues notices were sent,does the organization agree to add the amount on line 85f
to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the
following tax year?
N/A 85h
86 501(c)(7)I orgs.Enter:a Initiation fees and capital contributions included on line 12 86a -
b Gross receipts,included on line 12,for public use of club facilities 86b
87 501(c)(12)orgs.Enter:a Gross income from members or shareholders 87a
b Gross income from other sources.(Do not net amounts due or paid to other
sources against amounts due or received from them.) 87b
88a At any time during the year,did the organization own a 50%or greater interest in a taxable corporation or
partnership,or an entity disregarded as separate from the organization under Regulations sections
301.770i-2 and 301.7701-3?If"Yes,"complete Part IX 88a X
b At any time during the year,did the organization,directly or indirectly,own a controlled entity within the
meaning of section 512(b)(13)?If"Yes,"complete Part XI ► 88b X
89a 501(c)(3)I organizations. Enter:Amount of tax imposed on the organization during the year under: - ,
section 4911 ► 0 ;section 4912 ► 0 ;section 4955 ► 0 ,
b 501(c)(3)I and 501(c)(4)orgs.Did the organization engage in any section 4958 excess benefit transaction
during th6 year or did it become aware of an excess benefit transaction from a prior year?If"Yes,"attach
a statemnt explaining each transaction 89b X
c Enter:Amount of tax imposed on the organization managers or disqualified ,
persons (during the year under sections 4912,4955,and 4958 ► 0
d Enter:Amount of tax on line 89c,above,reimbursed by the organization ► 0
e All organizations.At any time during the tax year,was the organization a party to a prohibited tax shelter
transaction?
89e X
f All organizations.l Did the organization acquire a direct or indirect interest in any applicable insurance contract? 89f X
g For supporting organizations and sponsoring organizations maintaining donor advised funds.Did the
supporting organization,or a fund maintained by a sponsoring organization,have excess business holdings
at any tirrl�e during the year? 89g X
90a List the states with which a copy of this return is filed ► WA
b Number qIlf employees employed in the pay period that includes March 12,2006(See
instructions.) 190b I 1
91a The books are in care of ► M.A. McCollister, Inc. Telephone no. ► 206-725-8101
2039 34th Ave S
Located Et ► Seattle, WA ZIP+4 ► 98144
b At any tinie during the calendar year,did the organization have an interest in or a signature or other authority
over a fin ncial account in a foreign country(such as a bank account,securities account,or other financial Yes No
account) 91b X
If"Yes,"enter the name of the foreign country►
See the instructions for exceptions and filing requirements for Form TD F 90-22.1,Report of Foreign Bank
and Financial Accounts.
DAA Form 990(2006)
25720 11/10/2007 11:58 AM
Form 990'(2006) SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 8
.:Part VI,= Other Information (continued) Yes No
c At any tine during the calendar year,did the organization maintain an office outside of the United States? 91c X
If"Yes,"enter the name of the foreign country ►
92 Section 947(a)(1)nonexempt charitable trusts filing Form 990 in lieu of Form 1041-Check here • ❑
and enter the amount of tax-exempt interest received or accrued during the tax year I 92 1
Part VII-. I Analysis of Income-Producing Activities (See the instructions.)
Note:Enter gri ss amounts unless otherwise Unrelated business income Excluded by section 512,513,or 514 (E)
indicated. (A) Related or
93 Progra service revenue: Busins code Amount Exclusion Amount exempt function
a code income
b
c
d
e
f Medicare/Medicaid payments
g Fees and contracts from government agencies
94 Membership dues and assessments
95 Interest tln savings and temporary cash investments
96 Dividends and interest from securities
97 Net rental income or(loss)from real estate: I
a debt-financed property
b not debt-financed property
98 Net rental income or(loss)from personal property
99 Other investment income
100 Gain or(foss)from sales of assets other than inventory
101 Net income or(loss)from special events
102 Gross prgfit or(loss)from sales of inventory
103 Otherrevlpnue: a
b
c
d
e
104 Subtotal(add columns(B),(D),and(E)) • 0 0 0
105 Total(add line 104,columns(B),(D),and(E)) 0
Note:Line 105 plus line le,Part I,should equal the amount on line 12,Part I.
:Part VIII I Relationship of Activities to the Accomplishment of Exempt Purposes (See the instructions.)
Line No. Explain how each activity for which income is reported in column(E)of Part VII contributed importantly to the accomplishment
• of the organization's exempt purposes(other than by providing funds for such purposes).
N/A
(:'Part IX I Information Regarding Taxable Subsidiaries and Disregarded Entities (See the instructions.)
A
Name,address,and EIN of corporation, Percentage of Nature of activities Total income End-of-year
partnership,or disregarded entity ownership interest assets
N/A o�q
Part X Information Regarding Transfers Associated with Personal Benefit Contracts (See the instructions.)
(a) Did the organization,during the year,receive any funds,directly or indirectly,to pay premiums on a personal benefit contract? _ Yes X No
(b) Did the organization,during the year,pay premiums,directly or indirectly,on a personal benefit contract? _ Yes X No
Note: If"Yes'to(b),file Form 8870 and Form 4720(see instructions).
Form 990(2006)
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25720 11/10/20Q7 11:58 AM
Form 990"(2006) SOMALI COMMUNITY SERVICES COAZITION31-1611993
Part Xl ; Information Regarding Transfers To and From Controlled Entities. Complete only if the organization Page 9
is a controlling organization as defined in section 512(b)(13).
106 Did the reporting organization make any transfers to a controlled entity as defined in section 512(b)(13)of Yes No
the Co,1e?If"Yes,"complete the schedule below for each controlled entity. X
(A) (B) (C)
Name,address,of each Employer ID Description of (D)
controlled entity Number transfer Amount of transfer
a
•
c
Totals
Yes No
107 Did the reporting organization receive any transfers from a controlled entity as defined in section
512(b)(13)of the Code?If"Yes,"complete the schedule below for each controlled entity. X
(A) (B) (C)
Name,address,of each Employer ID Description of (D)
controlled entity Number transfer Amount of transfer
a
b
c
Totals
108 Did the rganization have a binding written contract in effect on August 17,2006,covering the interest, Yes No
rents,ro alties,and annuities described in question 107 above?
nder penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge
nd belief,it is true,correct,and complete.Declaration of preparer(other than officer)is based on all information of which preparer has any knowledge.
Please
Sign
Here 1Signature of officer Date
•
Type or print name and title
Paid Preparer's (\ Date Check if Preparers SSN or PTIN
s gnature ���\"Q)( q�_ � self- (See Gen.Instr.X)
Preparer's 11/10/07 employed ► 17P00438965
Use Only Firm'sname(oryours McCorkle & Associates, CPA' s EIN ► 91-1082950
if self-employed), 319 S 3rd St
aiidress,and ZIP+4 Renton, WA 98057 Phone
no. ► 425-228-6133
Form 990(2006)
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25720 11/10/2007 11:58 AM
SCHEDULEI A Organization Exempt Under Section 501(c)(3)
(Form 990 r 990-EZ) (Except Private Foundation)and Section 501(e),501(f),501(k),501(n), OMB No.1545-0047
or 4947(a)(1)Nonexempt Charitable Trust
Supplementary Information-(See separate instructions.) 2006
Department of th Treasury
Internal Revenue'Service ► MUST be completed by the above organizations and attached to their Form 990 or 990-EZ
Name of the organization Employer identification number
SOMALI COMMUNITY SERVICES COALITION C/O MOLLY MCCOLLISTER 31-1611993
.Part I ' Compensation of the Five Highest Paid Employees Other Than Officers, Directors,and Trustees
(See page 2 of the instructions. List each one. If there are none, enter"None.")
(a)Name and address of each employee paid more (b) Title and average hours (d)Contrib.to (e) Expense
than$50,000 per week devoted to position (c)Comp. &deferbred colanp account&unceser eml.
NONE
•
Total number of other employees paid over$50,000 ► .
Part:ll-A, Compensation of the Five Highest Paid Independent Contractors for Professional Services
(See page 2 of the instructions. List each one (whether individuals or firms). If there are none, enter"None.")
(a)Name and address of each independent contractor paid more than$50,000 (b)Type of service (c)Compensation
NONE
•
Total number of others receiving over$50,000 for
professional services ►
_Part-ll-B, Compensation of the Five Highest Paid Independent Contractors for Other Services
(List each contractor who performed services other than professional services, whether individuals or
firms. If there are none, enter"None." See page 2 of the instructions.)
(a)Name and address of each independent contractor paid more than$50,000 (b)Type of service (c)Compensation
NONE
Total number ofI other contractors receiving over
$50,000 for other services ► ,
For Paperwork Reduction Act Notice,see the Instructions for Form 990 and Form 990-EZ. Schedule A(Form 990 or 990-EZ)2006
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-Schedule"A(Form 990 or 990-EZ)2006 SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 2
• • Partin Statements About Activities (See page 2 of the instructions.) Yes No
1 During the year,has the organization attempted to influence national,state,or local legislation,including any
attempt to influence public opinion on a legislative matter or referendum?If"Yes,"enter the total expenses paid
or incurred in connection with the lobbying activities► $ (Must equal amounts on line 38,
Part VI-A,or line i of Part VI-B.) 1 X
Organizations that made an election under section 501(h)by filing Form 5768 must complete Part VI-A.Other
p
organizations checking"Yes"must complete Part VI-B AND attach a statement giving a detailed description of
the lobb lying activities.
2 During the year,has the organization,either directly or indirectly,engaged in any of the following acts with any
substantial contributors,trustees,directors,officers,creators,key employees,or members of their families,or
with any taxable organization with which any such person is affiliated as an officer,director,trustee,majority
owner,or principal beneficiary?(If the answer to any question is"Yes,"attach a detailed statement explaining the , ,
transactions.)
a Sale,ex hange,or leasing of property? 2a X
b Lending f money or other extension of credit? 2b X
c Furnishing of goods,services,or facilities? 2c X
d Paymen of compensation(or payment or reimbursement of expenses if more than$1,000)? 2d X
See Statement 4
e Transfer of any part of its income or assets? 2e X
3a Did the •rganization make grants for scholarships,fellowships,student loans,etc.?(If"Yes,"attach an explanation
of how t e organization determines that recipients qualify to receive payments.) 3a X
b Did the organization have a section 403(b)annuity plan for its employees? 3b X
c Did the organization receive or hold an easement for conservation purposes,including easements to preserve open
space,thel environment,historic land areas or historic structures?If"Yes,"attach a detailed statement 3c X
d Did the organization provide credit counseling,debt management,credit repair,or debt negotiation services? 3d X
4a Did the el
ganization maintain any donor advised funds?If"Yes,"complete lines 4b through 4g.If"No,"complete
lines 4f and 4g
4a X
b Did the organization make any taxable distributions under section 4966? 4b
c Did the organization make a distribution to a donor,donor advisor,or related person? 4c
d Enter the total number of donor advised funds owned at the end of the tax year ►
e Enter the aggregate value of assets held in all donor advised funds owned at the end of the tax year ►
f Enter the total number of separate funds or accounts owned at the end of the tax year(excluding donor advised
funds included on line 4d)where donors have the right to provide advice on the distribution or investment of
amounts n such funds or accounts ► 0
g Enter the aggregate value of assets held in all funds or accounts included on line 4f at the end of the tax year ► 0
Schedule A(Form 990 or 990-EZ)2006
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Schedule A(Form 990 or 990-EZ)2006 SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 3
• Part IV Reason for Non-Private Foundation Status (See pages 4 through 7 of the instructions.)
I certify that thelI organization is not a private foundation because it is:(Please check only ONE applicable box.)
5 0 A chljrch,convention of churches,or association of churches.Section 170(b)(1)(A)(i).
6 0 A sciool.Section 170(b)(1)(A)(ii).(Also complete Part V.)
7 El A hospital or a cooperative hospital service organization.Section 170(b)(1)(A)(iii).
8 0 A federal,state,or local government or governmental unit.Section 170(b)(1)(A)(v).
9 0 A medical research organization operated in conjunction with a hospital.Section 170(b)(1)(A)(iii). Enter the hospital's name,city,
and state►
io 0 An organization operated for the benefit of a college or university owned or operated by a governmental unit.Section 170(b)(1)(A)(iv).
(Alsol complete the Support Schedule in Part IV-A.)
11a 0 An organizationlI that normally receives a substantial part of its support from a governmental unit or from the general public.Section
170(b)(1)(A)(vi).(Also complete the Support Schedule in Part IV-A.)
11b A community trust.Section 170(b)(1)(A)(vi).(Also complete the Support Schedule in Part IV-A.)
12 QX An organization that normally receives: (1)more than 33 1/3%of its support from contributions,membership fees,and gross receipts
from activities related to its charitable,etc.,functions-subject to certain exceptions,and (2)no more than 33 1/3%of its support
from gross investment income and unrelated business taxable income(less section 511 tax)from businesses acquired by the
organization after June 30, 1975.See section 509(a)(2).(Also complete the Support Schedule in Part IV-A.)
13 0 An organization that is not controlled by any disqualified persons(other than foundation managers)and otherwise meets the
requirements of section 509(a)(3).Check the box that describes the type of supporting organization:
❑ Type I 0 Type II 0 Type III-Functionally Intergrated 0 Type III-Other
Provide the following information about the supported organizations.(See page 7 of the instructions.)
(a) (b) (c) (d) (e)
Nam (s)of supported organization(s) Employer Type of Is the supported Amount of
identification organization organization listed in support
number(EIN) (described in lines the supporting
5 through 12 organization's
above or IRC governing documents?
section)
Yes No
Total 0.
14 I I An organization organized and operated to test for public safety.Section 509(a)(4).(See page 7 of the instructions.)
Schedule A(Form 990 or 990-EZ)2006
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Schedule'A(Form 990 or 990-EZ)_2006 SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 4
Part tV-A Support Schedule(Complete only if you checked a box on line 10, 11,or 12.) Use cash method of accounting.
Note:You maj
use the worksheet in the instructions for converting from the accrual to the cash method of accounting.
Calendar year( r fiscal year beginning in) ► (a)2005 (b)2004 (c)2003 (d)2002 (e)Total
15 Gifts,grants,and contributions received.(Do
not include
I unusual grants.See line 28.) 134 ,398 76, 990, 104,059 118, 627 434 ,074
16 Membership fees received 0
17 Gross receipts from admissions,merchandise
sold or services performed,or furnishing of
facilities irj any activity that is related to the
organization's charitable,etc.,purpose 0
18 Gross income from interest,dividends,
amounts received from payments on securities
loans(section 512(a)(5)),rents,royalties,and
unrelated business taxable income(less
section 51 l taxes)from businesses acquired
by the org nization after June 30,1975 ,,, 1 1
19 Net incom from unrelated business
activities not included in line 18 0
20 Tax revenues levied for the organization's
benefit and either paid to it or expended on
its behalf
0
21 The value I'Iof services or facilities furnished to
the organisation by a governmental unit
without ch rge.Do not include the value of
services o facilities generally furnished to the
public without charge 0
22 Other incokne.Attach a schedule.Do not
include ga n or(loss)from 0
sale of capital assets
23 Total of lin6s 15 through 22 134,398 76, 990 104,059 118 , 628 434,075
24 Line 23mikus line 17 134 ,398 76, 990 104,059 118 , 628 434,075
25 Enter 1%Of line 23 1,344 770 1,041
26 Organizations described on lines 10 or 11: a Enter 2%of amount in column(e),line 24 ► 26a 0
b Prepare list for your records to show the name of and amount contributed by each person(other than a
governm ntal unit or publicly supported organization)whose total gifts for 2002 through 2005 exceeded the
amount hown in line 26a. Do not file this list with your return.Enter the total of all these excess amounts ► 26b
c Total su port for section 509(a)(1)test:Enter line 24,column(e) ► 26c
d Add:Am unts from column(e)for lines: 18 19
22 26b ► 26d
e Public support(line 26c minus line 26d total) ► 26e
f Public support percentage(line 26e(numerator)divided by line 26c(denominator)) ► 26f
27 Organizations described on line 12: a For amounts included in lines 15, 16,and 17 that were received from a"disqualified
person," repare a list for your records to show the name of,and total amounts received in each year from,each"disqualified person."
Do not fi e this list with your return.Enter the sum of such amounts for each year:
(2005) 56,019 (2004) 37, 610 (2003) 27 ,339 (2002) 22 ,773
b For any mount included in line 17 that was received from each person(other than"disqualified persons"),prepare a list for your records to
show the name of,and amount received for each year,that was more than the larger of(1)the amount on line 25 for the year or(2)$5,000.
(Include i the list organizations described in lines 5 through 1.1 b,as well as individuals.) Do not file this list with your return.After computing
the differ nce between the amount received and the larger amount described in(1)or(2),enter the sum of these differences(the excess
amounts)for each year:
(2005) 0 (2004) 0 (2003) 0 (2002) 0
c Add:Am unts from column(e)for lines: 15 434, 074 16
17 20 21 ► 27c 434,074
d Add:Line 27a total 143,741 and line 27b total ► 27d 143,741
e Public support(line 27c total minus line 27d total) ► 27e 290,333
f Total support for section 509(a)(2)test:Enter amount from line 23,column(e) ► I 27f I 434,075 ; .
g Public support percentage(line 27e(numerator)divided by line 27f(denominator)) ► 27g 66. 8854
h Investment income percentage(line 18,column(e)(numerator)divided by line 27f(denominator)) ► 27h 0 . 0 0 02
28 Unusual rants: For an organization described in line 10, 11,or 12 that received any unusual grants during 2002 through 2005,
prepare a list for your records to show,for each year,the name of the contributor,the date and amount of the grant,and a brief
description of the nature of the grant. Do not file this list with your return.Do not include these grants in line 15.
Schedule A(Form 990 or 990-EZ)2006
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Schedule A(Form 990 or 990-EZ)2006 SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 5
' Part V Private School Questionnaire (See page 9 of the instructions.)
(To be completed ONLY by schools that checked the box on line 6 in Part IV)
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter,bylaws, N/A Yes No
other governing instrument,or in a resolution of its governing body? 29
30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its
brochur Is,catalogues,and other written communications with the public dealing with student admissions,
programs,and scholarships? 30
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students,or during the registration period if it has no solicitation program, in a way
that makes the policy known to all parts of the general community it serves? 31
If"Yes," :,lease describe;if"No,"please explain.(If you need more space,attach a separate statement.) • "
32 Does the organization maintain the following: ,
a Records indicating the racial composition of the student body,faculty,and administrative staff? 32a
b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory
basis?
• 32b
c Copies of all catalogues,brochures,announcements,and other written communications to the public dealing
with student admissions,programs,and scholarships? 32c
d Copies of all material used by the organization or on its behalf to solicit contributions? 32d
If you answered"No"to any of the above,please explain. (If you need more space,attach a separate statement.)
33 Does the organization discriminate by race in any way with respect to:
a Students rights or privileges? 33a
b Admissions policies?
33b
c Employment of faculty or administrative staff? 33c
d Scholars lips or other financial assistance? 33d
e Educatio al policies?
33e
f Use of facilities?
33f
g Athletic programs? 33g
h Other extracurricular activities? 33h
If you answered"Yes"to any of the above,please explain.(If you need more space,attach a separate statement.)
34a Does the organization receive any financial aid or assistance from a governmental agency? 34a
b Has the Irganization's right to such aid ever been revoked or suspended? 34b
If you answered"Yes"to either 34a or b,please explain using an attached statement.
35 Does the lorganization certify that it has complied with the applicable requirements of sections 4.01 through 4.05
of Rev.Proc.75-50, 1975-2 C.B.587,covering racial nondiscrimination?If"No,"attach an explanation 35
Schedule A(Form 990 or 990-EZ)2006
DAA
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Schedule A(Form 990 or 990-EZ)2006 SOMALI COMMUNITY SERVICES COALITION31-1611993 Page 6
_ -,Part VI-A ' Lobbying Expenditures by Electing Public Charities (See page 10 of the instructions.)
(To be completed ONLY by an eligible organization that filed Form 5768) N/A
Check ► a if the organization belongs to an affiliated group. Check ► b _ if you checked"a"and'limited contror provisions apply.
Limits on Lobb io Ex dit (b)
y. g pen ures Affiliated(a group To be completed
totals for all electing
(The term"expenditures"means amounts paid or incurred.) organizations
36 Total lobbying expenditures to influence public opinion(grassroots lobbying) 36
37 Total lobby ng expenditures to influence a legislative body(direct lobbying) 37
38 Total lobby ng expenditures(add lines 36 and 37) 38
39 Other exempt purpose expenditures 39
40 Total exempt purpose expenditures(add lines 38 and 39) 40
41 Lobbying nontaxable amount.Enter the amount from the following table-
If the amount on line 40 is- The lobbying nontaxable amount is-
Not over$500,000 20%of the amount on line 40
Over$500,000 but not over$1,000,000
$100,000 plus 15%of the excess over$500,000 • '
Over$1,000, 00 but not over$1,500,000 $175,000 plus 10%of the excess over$1,000,000 41
Over$1,500, 00 but not over$17,000,000 •, °$225,000 plus 5/°of the excess over$1,500,000
Over$17,00 ,000 $1,000,000
42 Grassroots nontaxable amount(enter 25%of line 41)
43 Subtract lin 42 from line 36. Enter-0-if line 42 is more than line 36 43
44 Subtract lint 41 from line 38.Enter-0-if line 41 is more than line 38 44
Caution: If there is an amount on either line 43 or line 44,you must file Form 4720.
4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h)election do not have to complete all of the five columns below.
See the instructions for lines 45 through 50 on page 13 of the instructions.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year(or (a) (b) (c) (d) (e)
fiscal year beginning in) ► 2006 2005 2004 2003 Total
45 Lobbying nontaxable amount
46 Lobbying ;
y g fling amount(150%of
line 45(e))
47 Total lobbyi g expenditures
48 Grassroots nontaxable amount
49 Grassroots Ceiling amount(150%of , • • ' ,
line 48(e)) •
50 Grassroots obbying expenditures
;;;Part,VI-13 Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part VI-A) (See page 13 of the instructions.)N/A
During the year,did the organization attempt to influence national,state or local legislation,including any
attempt to influe ce public opinion on a legislative matter or referendum,through the use of: Yes No Amount
a Volunteer •
b Paid staff Ior management(Include compensation in expenses reported on lines c through h.)
c Media adertisements
d Mailings t members,legislators,or the public
e Publicatio s,or published or broadcast statements
f Grants to ther organizations for lobbying purposes
g Direct conl act with legislators,their staffs,government officials,or a legislative body
h Rallies,demonstrations,seminars,conventions,speeches,lectures,or any other means
i Total lobbying expenditures(Add lines c through h.)
If"Yes"to',any of the above,also attach a statement giving a detailed description of the lobbying activities.
Schedule A(Form 990 or 990-EZ)2006
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1 •
25720 11/10/2007 11:58 AM
ScheduleA(Fbrm 990 or 990-EZ)2006 SOMALI COMMUNITY SERVICES COALIT ION 31-1611993 Page 7
Part VII Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations (See page 13 of the instructions.)
51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section
501(c)of the Code(other than section 501(c)(3)organizations)or in section 527, relating to political organizations?
a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No
(i) Cash
(ii) Other assets 51a(i) X
a(ii) X
b Other transactions:
(i) S ales or exchanges of assets with a noncharitable exempt organization b(i) X
(ii) *chases of assets from a noncharitable exempt organization b(ii) X
(iii) Rental of facilities,equipment,or other assets b(iii) X
(iv) Reimbursement arrangements
(v) Loans or loan guarantees b(iv) X
b(v) X
(vi) Performance of services or membership or fundraising solicitations b(vi) X
c Sharing of facilities,equipment,mailing lists,other assets,or paid employees c X
d If the answer to any of the above is"Yes,"complete the following schedule.Column(b)should always show the fair market value of the
goods,o her assets,or services given by the reporting organization. If the organization received less than fair market value in any
transacts n or sharing arrangement,show in column(d)the value of the goods,other assets,or services received:
(a) (b) (c) (d)
Line no. Amount involved Name of noncharitable exempt organization Description of transfers,transactions,and sharing arrangements
N/A
52a Is the organization directly or indirectly affiliated with,or related to,one or more tax-exempt organizations
described in section 501(c)of the Code(other than section 501(c)(3))or in section 527? ► 0 Yes El No
b If"Yes,"complete the following schedule:
(a) (b) (c)
Name of organization Type of organization Description of relationship
N/A
DM Schedule A(Form 990 or 990-EZ)2006
1
25720 OMALI COMMUNITY SERVICES COALITION 11/10/2007 11:57 AM
31-1611993 Federal Statements
FYE: 1 0.1/2006
Statement 1 - Form 990, Part II, Line 43 - Other Functional Expenses
Total Program Mgt & Fund-
Description Expenses Service General Raising
$ $ $ $
Expenses
Professional fees 6, 376 6, 376
Ban charges 170 170
Ins rance 748 748
Licenses and permits 45 45
Automotive 39 39
Pent lties 438 438
Aut mobile 20 . 20
Com uter services 1, 149 873 161 115
Con ract labor 336 336
T tal $ 9, 321 $ 7, 288 $ 1, 918 $ 115
•
1
25720 i. OMALI COMMUNITY SERVICES COALITION 11/10/2007 11:57 AM
31-161 993 Federal Statements
FYE: 1 /31/2006
Statement 2 - Form 990, Part III - Organization's Primary Exempt Purpose
To enhance and improve the well-being and quality of life
of both families and individuals, and to preserve the
cultural heritage of the Somali community.
2
1
1
25720 SOMALI COMMUNITY SERVICES COALITION 11/10/2007 11:57 AM
31-1611993 Federal Statements
FYE: 12/31/2006
1
Statement 3 - Form 990, Part IV, Line 57 - Land, Buildings, and Equipment
Description
Beginning Accum End of Accum
of Year Deprec Year Deprec
Comput r equipment
$ 10, 700 $ $ 12, 931 $
Reserve computer equipment
10, 084 10, 923
Total $ 10, 700 $ 10, 084 $ 12, 931 $ 10, 923
3
i
25720 OMALI COMMUNITY SERVICES COALITION 11/10/2007 11:57 AM
31-161 993 Federal Statements
FYE: 1 /31/2006
Statement 4 - Schedule A, Part III, Line 2d - Payment of Compensation / Reimbursement of
gur
Description
Reimbursement of expenses paid for personally on behalf of the
organi ation.
4
25720 11/10/2007 11:58 AM
4562 Depreciation and Amortization OMB No.1545-0172
Form (Including Information on Listed Property) 2006
Department of th Treasury
Internal Revenue�Service ►See separate instructions. ►Attach to your tax return. Attachment
equen a No. 0 t
Name(s)shown on return SOMALI COMMUNITY SERVICES COALITION Identifying number
C/O MOLLY MCCOLLISTER 31-1611993
Business or activity to which this form relates ,
IndireCt Depreciation
-.Part I :;' ' Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.
1 Maximu amount.See the instructions for a higher limit for certain businesses 1 108 ,000
2 Total co t of section 179 property placed in service(see instructions) 2
3 Thresho d cost of section 179 property before reduction in limitation 3 430,000
4 Reducti n in limitation.Subtract line 3 from line 2. If zero or less,enter-0- 4
5 Dollar limi ation for tax year.Subtract line 4 from line 1.If zero or less,enter-0-.If married filing separately,see instructions 5
(a) Description of property (b) Cost(business use only) (c) Elected cost
6 ,
7 Listed aoperty.Enter the amount from line 29 7 'p
8 Total el cted cost of section 179 property.Add amounts in column(c),lines 6 and 7 8
9 Tentativg deduction.Enter the smaller of line 5 or line 8 9
10 Carryover of disallowed deduction from line 13 of your 2005 Form 4562 10
11 Business income limitation.Enter the smaller of business income(not less than zero)or line 5(see instructions) 11
12 Section 179 expense deduction.Add lines 9 and 10,but do not enter more than line 11 12
13 Carryover of disallowed deduction to 2007.Add lines 9 and 10,less line 12 ► 13
Note:Do not rise Part it or Part III below for listed property. Instead,use Part V.
i."Part.11..: I Special Depreciation Allowance and Other Depreciation (Do not include listed property.; (See instructions.)
14 Special)allowance for qualified New York Liberty or Gulf Opportunity Zone property(other than listed
property placed in service during the tax year(see instructions) 14
15 Propert subject to section 168(f)(1)election 15
16 Other dgpreciation(including ACRS) • 16
Part'lll. I MACRS Depreciation (Do not include listed property.) (See instructions.)
I Section A
17 MACRS deductions for assets placed in service in tax years beginning before 2006 n 17 I 616
18 If you are electing to group any assets placed in service during the tax year into one or more general asset accounts,check here .► I I - '
Section B-Assets Placed in Service During 2006 Tax Year Using the General Depreciation System
(b) Month and (c) Basis for depreciation (d)Recovery
(a) Classification of property year placed in (business/investment use (e) Convention (f) Method (g) Depreciation deduction
service only-see instructions) period
19a 3-year property
b 5-year;property 1,795 5.0 MQ 200DB 177
c 7-year)hroperty 435 7 . 0 MQ 200DB 47
d 10-year property '
e 15-year property
f 20-yearlproperty
g 25-year property „" - 25 yrs. S/L •
h Reside tial rental 27.5 yrs. MM S/L
property 27.5 yrs. MM S/L
i Nonresidential real 39 yrs. MM S/L
property, MM S/L
1 Section C-Assets Placed in Service During 2006 Tax Year Using the Alternative Depreciation System
20a Class life S/L
b 12-year 12 yrs. S/L
c 40-year 40 yrs. MM S/L
:Part IV. Summary (see instructions)
21 Listed p-operty.Enter amount from line 28 21
22 Total.Add amounts from line 12, lines 14 through 17,lines 19 and 20 in column(g),and line 21.
Enter h ire and on the appropriate lines of your return.Partnerships and S corporations-see instr. 22 840
23 For ass�ts shown above and placed in service during the current year,
enter the portion of the basis attributable to section 263A costs 23
For Paperwork Reduction Act Notice,see separate instructions. Form 4562(2006)
DM There are no amounts for Page 2
25720 05/12/2006 10:14 AM
Form g$ $ Application for Extension of Time To File an
(Rev.December2004) Exempt Organization Return
OMB No.1545-1709
Department of the Treasury ►File a separate application for each return.
Internal Revenue Service
• If you are filing for an Automatic 3-Month Extension,complete only Part I and check this box ► U
• If you are filing for an Additional(not automatic)3-Month Extension,complete only Part II(on page 2 of this form).
Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed § rl,`
t Automatic 3-Month Extension of Time- Only submit original (no copies need ) r` �; J .
Form 990-T corporations requesting an automatic 6-month extension-check this box and complete Part I only '''! I° ►
All other corporations(including Form 990-C filers)must use Form 7004 to request an extension of time to file income tax returns.
Partnerships,REMICs,and trusts must use Form 8736 to request an extension of time to file Form 1065,1066,or 1041.
Electronic Filin (e-file).Form 8868 can be filed electronically if you want a 3-month automatic extension of time to file one of the
returns noted b+w(6 months for corporate Form 990-T filers).However,you cannot file it electronically if you want the additional
(not automatic) -month extension,instead you must submit the fully completed signed page 2(Part II)of Form 8868.For more
details on the electronic filing of this form,visit www.irs.gov/efile.
Type or Name of Exempt Organization Employer identification number
print SOMALI COMMUNITY SERVICES COALITION
File by the C/O MOLLY MCCOLLISTER 31-1611993
due date for umber,street,and room or suite no.If a P.O.box,see instructions.
filing your 2039 34TH AVENUE SOUTH
return.See
Instructions. pity,town or post office,state,and ZIP code.For a foreign address,see instructions.
SEATTLE WA 98144
Check type of r I turn to be filed(file a separate application for each return):
X Form 9901 _ Form 990-T(corporation) _ Form 4720
Form 990-FL — Form 990-T(sec.401(a)or 408(a)trust) _ Form 5227
Form 990-EZ _ Form 990-T(trust other than above) _ Form 6069
Form 990-PF Form 1041-A
— Form 8870
• The books are in the care of ► M.A. MCCOLLI STER, INC.
Telephone No. ► 206-725-8101 FAX No. ►
• If the organizi tion does not have an office or place of business in the United States,check this box ► ❑
• If this is for a Group Return,enter the organization's four digit Group Exemption Number(GEN) .If this
is for the whole group,check this box ► .If it is for part of the group,check this box ► ❑ and attach a list with the
names and EINs 6f all members the extension will cover.
1 I request ail automatic 3-month(6-months for a Form 990-T corporation)extension of time until 8/15/0 6,
to file the ekempt organization retum for the organization named above.The extension is for the organization's return for:
► X calLndar year 2005 or
► — tax year beginning ,and ending
2 If this tax y ar is for less than 12 months,check reason: ❑ Initial return ❑ Final return ❑ Change in accounting period
3a If this application is for Form 990-BL,990-PF,990-T,4720,or 6069,enter the tentative tax,less any
nonrefundable credits.See instructions $
b If this application is for Form 990-PF or 990-T,enter any refundable credits and estimated tax payments
made.Include any prior year overpayment allowed as a credit $
c Balance Due.Subtract line 3b from line 3a.Include your payment with this form,or,if required,deposit
with FTD coupon or,if required,by using EFTPS(Electronic Federal Tax Payment System).See
instructions
$
Caution.If you are going to make an electronic fund withdrawal with this Form 8868,see Form 8453-EO and Form 8879-EO
for payment instrutions.
For Privacy Act and Paperwork Reduction Act Notice,see Instructions. Form 8868(Rev.12-2004)
•
DAA
25720 08/18/2006 4:06 PM
Form`8868(Rej.12-2004)
• • Page If you are fil ng for an Additional(not automatic)3-Month Extension,complete only Part II and check this box ► L
Note.Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868.
• If you are fling for an Automatic 3-Month Extension,complete only Part I(on page 1).
:::;;:::.::•;::....
>:::::P; ii:`ti1< (Additional (not automatic)3-Month Extension of Time-Must File Original and.One Copy.
Type or Name of Exempt Organization Employer identification number
print SOMALI COMMUNITY SERVICES COALITION
File by the C/O MOLLY MCCOLLISTER
extended 31-1611993
Number,street,and room or suite no.If a P.O.box,see instructions.
due date for For IRS use only
filing the 2039 34TH AVENUE SOUTH
return.See Cit
y,town or
pos
t offi
ce,st
ate,e and
ZIP code
.Fo
r a
foreign
addr
ess,'
see'nstr ucti ons.'nstrucd'ons. SEATTLE WA 98
144 44
Chec
k
type
of rl etur nto
be
filed(File
Fll ea( separate application for each return): —
X Form 990 — Form 990-T(sec.401(a)or 408(a)trust) _ Form 5227
_ Form 990-BL _ Form 990-T(trust other than above) _ Form 6069
— Form 990-EZ _ Form 1041-A _ Form 8870
Form 990-PF Form 4720
STOP:Do not gomplete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868.
• The books re in the care of ► M.A. MCCOLLISTER, INC-
Telephone Pilo. ► 206-725-8101 FAX No. ►
• If the organs ation does not have an office or place of business in the United States,check this box ► ❑
• If this is for a Group Return,enter the organization's four digit Group Exemption Number(GEN) .If this is
for the whole group,check this box 0. El .If it is for part of the group,check this box ► 0 and attach a list with the
names and EINs of all members the extension is for.
4 I request en additional 3-month extension of time until 11/15/0 6 .
5 For calendar year 2005 ,or other tax year beginning_ and ending
6 If this tax year is for less than 12 months,check reason: Initial return El Final return u Change in accounting period
7 State in detail why you need the extension
ADDITIONAL TIME IS REQUIRED TO GATHER INFORMATION TO COMPLETE TAX RETURN.
8a If this application is for Form 990-BL,990-PF,990-T,4720,or 6069,enter the tentative tax,less any
nonrefund I2ble credits.See instructions $
b If this applicationl is for Form 990-PF,990-T,4720,or 6069,enter any refundable credits and estimated
tax payments made.Include any prior year overpayment allowed as a credit and any amount paid
previouslywith Form 8868 $
c Balance Due.Subtract line 8b from line 8a.Include your payment with this form,or,if required,deposit
with FTD coupon or,if required,by using EFTPS(Electronic Federal Tax Payment System).See instructions. $
Signature and Verification
Under penalties of perjury,I declare that I have examined this form,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct,and complete,and that I am authorized to prepare this form.
Signature► Title► Date► 8/18/0 6
Notice to Applicant-To Be Completed by the IRS
_ We have ap roved this application.Please attach this form to the organization's return.
_ We have no approved this application.However,we have granted a 10-day grace period from the later of the date shown below or the due
date of the organization's return(including any prior extensions).This grace period is considered to be a valid extension of time for elections
otherwise required to be made on a timely return.Please attach this form to the organization's return.
0 We have n4 approved this application.After considering the reasons stated in item 7,we cannot grant your request for an extension of time
_ to file.We ar not granting a 10-day grace period.
_ We cannot c nsider this application because it was filed after the,extended due date of the return for which an extension was requested.
Other
By:
Director Date
Alternate Mailin `Address-Enter the address if you want the copy of this application for an additional 3-month extension
returned to an ad Tress different than the one entered above.
tame •
MCCORKLE & ASSOCIATES, CPA' S
Type or Number and street(include suite,room,or apt.no.)or a P.O.box number
print 319 S 3RD ST
City or town,province or state,and country(including postal or ZIP'RENTON WA 98055
DAA
Form 8868(Rev.12-2004)
Somali Community Services Coalition
15027 Military Road South, Suites 4/5
SeaTac, WA 98188 Tel. (206) 431-7867
BUDGET PROJECTION
01/01/2008- 12/31/2008
INCOME
Government Grants and contarcts
DSHS- RIA Resettlement
-Remainig Balance'07/08 contract $25,000.00
- New contract 07/08 $25,000.00
City of Tukwila-Social Services $8,000.00
City of SeaTac-Social services 5,000.00
Total Government Grants/Contracts $63,000.00
RFSC-LEP Subcontract $25,000.00
Corporations/Others
Tukwila School District- Impact Grant $15,000.00
Total $15,000,00
Foundations/others
Refugee R ederation -Employment recr. $25,000.00
UWKC $10,000.00
Total 35,000.00
Grand Total $138,000.00
EXPENSES
PERSONEL
Exec. Director salary $36,000.00
Office Mgr.(1@ 15x40x4x12) $28,800.00
Case Worker(1 @15x24x4x12) $17,280.00
Taxes $14,112.00
Professional Accountant fee 6,000.00
Total Personel $102,192.00
Facilities
Rent $15,120.00
Utilities 4,800.00
Total Rent/Utilities $19,920.00
Equipment/Supplies
Printing/copy machine lease $3,000.00
Office Equipment,printing etc. 4,000.00
Office/melting supplies 3,000.00
Insurance 1,500.00 $11,500.00
Grand Total $133,612.00
$4,388.00
•
Somali Community Services Coalition
Intake Form
Date: / /
Name:
Last First Middle
Address: Alien# - -
SS# - -
Phone#( ) DOB
Female Male Single Married Number of Children
Reason for visit:
Clients Situation/Background:
Service Needs/Plan:
Referred to:
Comments:
•
;;71/71:1„ . .
INTERNAL REVENUE SERVICE —
P. 0. BOX 2508 DEPARTMENT OF THE TREASURY
CINCINNATI, OH 45201
Date: Y 3 ��� Employer Identification Number:
31-1611993
DLN:
B
SOMALI COMMUNITY SERVICES COALITION ContactPerson:
C/O OMAR ABDI AHMED
4 717 RAINIER AVE S EDW»D J POMERA��TTZ
SEATTLE IWAE Contact Telephone Number: ID# 31326
98118-1600 (877) 829-5500
Our Letter Dated:
February 1999
Addendum Applies:
no
Dear Applicant:
— This modifies our letter of the above date in which we stared that you
would be treated as an .Organization that is not a private foundation until the
expiration of your advance ruling period.
Your exempt status under section 501 (a) of the Internal Revenue Code as an
olrganization described in section 501(c) (3) is still in effect.
information you submitted, we have determined that you are not a private
the
organfoundation within the meaning of section 509(a) of the Code because you are
ization of the type described in section
an
Grantors and contributors70 (b) (1) (A) (v-i) .
Internal RevenueaService may rely on this determination unless the
lnse your ection er a publishes notice to the contrary. However, if you
( ) (1) status, a grantor or contributor may not rely on
thethis determination if he or she was, in part responsible for, or was aware of,
act or failure to act, or the substantial or material change on the part of
the organization that resulted in your loss of such status, or if he or she
acquired knowledge that the Internal Revenue Service hadg
would no longer be classified as a section 509• given 'notice that you
You are required to make
Form 990 or I
Form 990-EZ, available for public rin' tion spection for a three years/after the later
of the due date of the ret
urn or the date the return is filed. You are also
required to make available. for public inspection your exemption application
documany supporting documents, and your exemption letter. Copies of these
ents are also required to be provided to any '
person request without charge other than reasonable nfeesdfor copy writtenad or in
postage. You may fulfill this re eying and
Internet. requirement by placing these documents on the
Penalties may be imposed for failure to comply with these
requirement . . Additional information is available in Publication 557,
numbeTax-Exempt Status for Your Organization, or you may call our toll free
r shown above.
11 f we have indicated in the heading
applies, the addendum enclosed is an integral part of this letttt addendumer.
Letter 1050 (DO/CC)
-2-
SOMP I COMMUNITY SERVICES COALITION
Because this letter could help resolve any questions about your private
foun ation status, please keep it in your permanent records.
If you have any questions, please contact the-person whose name and
telephone number are shown above.
Sincerely yours,
<2".1N5L, ,ef? 6r;Lo,r,„.4..... .
Lois G. Lerner
Director, Exempt Organizations
Rulings and Agreements
•
•
a•
Letter 1050 (DO/Cu)
Attachment
SOMALI COMMUNITY SERVICES COALITION
MISSION STATEMENT.
The mission of the Somali Community services Coalition is to enhance and improve the
well-being and quality life of Somali Families and Individuals in King County,
Advocating and promoting self-sufficiency to whole Family through employment,
education, Social support and economic empowerment.
Somali Community Communication Network
Local Somali Community
(17,000 to 20,000)
THINGS TO DO:
1. Need to create list of Somali Community gatherinji places
(Locations of communication "Hubs")
2. Need to define networkinji stratejiv (way information is shared/exchanged)
o Who
o How
o Where
o When
(By telephone, at_store, after events, daily, weekly, through key people, etc.)
SOMALI COMMUNITY SERVICES COALITION (SCSC)
SCSC Board of Directors
Executive Board (4)+Elders/Community.Leaders (15)
SCSC Executive Director
•
SCSC Staff& Volunteers (3)
•
SCSC Clients (5-7/Day)
11- +ron
/ 69 .y_
RENTON SUPPLEMENTAL '1 {j�y�y k-
' R
0
SOMALI COMMUNITY SERVICES CO
Result#9 Connecting People to Services '�®f�
(•; s
Strategy: Increase the ability of Renton residents to access services.
Activity: Provide referral systems that increase access to services.
Provider level outcome People increase their income and/or resources
Indicator Participants increase use of community services and resources
The desired outcome for this program is that there will be an increase in clients' self-
sufficiency. The Somali Refugee Family and Youth Support program will increase the
ability of Somalis living in Renton to access needed services. It will do this by providing
case management services and referrals to appropriate service providers. Access to
services will be greatly enhanced by providing these services in Somali by a Somali case
worker who understands both the American and Somali cultures. Case Manager Provides
culturally appropriate support and referral services by assisting Clients fill out
immigration forms,housing application forms,utility assistances, health&Hospital
referrals etc .
(From Part I of the application--
10. PROPOSED PROGRAM/SERVICE
B. Performance Measures and Outcomes.
Performance measure number of case management hours provided
Outcome increase in individual/family self-sufficiency
Indicator 90% of clients will set service plan goals to increase
/maintain self sufficiency)