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Los Angeles Lakers Youth Foundation • STATE OF CA LIFORN IA DEPARTMENT OF JUSTICE BGC 204 (Orig . 01/2016 ) MAJOR LEAGUE SPORTS RAFFLE PAGE 1 of4 ELIGIBLE ORGANIZATION ANNUAL REPORT PLEASE SEND COMPLETED REPORT TO: Bureau of Gambling Control P. 0. Box 168024 Sacramento , CA 95816-8024 Phone : 916-227-3584 ; Fax (916) 227-01 70 Annual Report Period: 12/31/2016 Eligible Organization's Name: Los Angeles Lakers Youth Foundation • Eligible Organization's Registration Number: Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually thereafter with the Department of Justice a report that inciudes all of the following information for each of the eligible organization's last three fiscal years. Pursuant to Penal Code section 320.6, subdivision (o)(12)(B), failure to submit the annual report shall be grounds for denial of an annual registration . ~ ~ Year1 Year2 Year3 REGULATION/STATUTE 1/1/2016 to 12/31/16 1/1/15 to 12/31/15 1/1/14 to 12/31/14 (i) The aggregate gross receipts from the operation of raffles . I $59,669 $0 $0 (ii) The aggregate direct costs incurred by the eligible organization from the operation of raffles. 22,553 0 0 (iii) The charitable or beneficial purposes for which proceeds education, health and education, health and education, health and of the raffles were used. wellness, and sports wellness , and sports. wellness, and sports. (iv) The aggregate distributions of proceeds from the operation of raffles made to directly support beneficial or charitable purposes, other than beneficial or charitable purposes undertaken by the eligible organization , or eligible 0 0 0 recipient organizations , under Penal Code section 320.5, subdivision (c). I (v) The aggregate distributions of proceeds from 1the operation of raffles made to raffle winners. 23,622 0 0 (vi) The aggregate distributions of proceeds from the operation of raffles made to any other organizations, or for any other purposes , other than those included in items (ii), 0 0 0 (iv), and (v) above. STATE OF CALIFORN IA DEPARTMENT OF JUSTICE BGC 204 (Orig . 01/2016) MAJOR LEAGUE SPORTS RAFFLE PAGE 2 of 4 ELIGIBLE ORGANIZATION ANNUAL REPORT 1 Year1 Year2 Year3 REGULATION/STATUTE 1/1 /16 to 12/31/16 1/1 /15 to 12/31 /15 1/1 /14 to 12/31/14 (vii) A schedule of distribut ions of proceeds from the operation of raffles, by individual raffle, made to eligible recipient organizations under Penal Code section 320.5, $0 $0 $0 subdivision (c), that are not affiliated with the eligible organization . (viii) A schedule of distributions of proceeds from the operation of raffles, by individual raffle, made to eligible recipient organizations under Penal Code section 320.5, 0 0 0 subdivision (c}, that are affiliated with the eligible organization . I (ix) A schedule of distributions of proceeds from the operation of raffles, by individual raffle, made to any other organization not included under items (vii) or (viii) above, or 0 0 0 for beneficial or charitable purposes undertaken by the eligible organization . (x) The aggregate gross receipts from activities other than the operation of raffles . 896,385 960 ,710 840 ,510 (xi) The aggregate costs incurred by the eligible organization from activities other than the operation of raffles. 982 ,557 436 ,602 584 ,412 (xii) The aggregate distributions of funds other than proceeds from the operation of raffles made to directly support i beneficial or charitable purposes or eligible recipient 428 ,941 188,442 394 ,929 organizat ions under Penal Code section 320.5, subdivision (c). (xiii) The aggregate distributions of funds other than proceeds from the operation of raffles for purposes other 0 0 0 than those listed in items (xi) and (xii) above . \ STATE OF CALI FORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE PAGE 3of4 ELIGIBLE ORGANIZATION ANNUAL REPORT I Year1 Year2 Year3 REGULATION/STATUTE ' 1/1/16 to 12/31/16 1/1 /15 to 12/31/15 1/1 /14 to 12/31/14 (xiv) A schedule of distributions of funds other than proceeds from the operation of raffles made to eligible recipient organizations under Penal Code section 320.5, subdivision $428 ,941 $188,442 $394,929 (c), that are not affiliated with the eligible organizqtion . (xv) A schedule of distributions of funds other than proceeds from the operation of raffles made to any other organization not included under item (xiv) above , or for beneficial or 0 0 0 charitable purposes undertaken by the eligible organization . ' I' NOTE : The department shall make the repprts required by this paragraph available to the public via the online search portal of the Attorney General's Registry of Charitable l1rusts maintained pursuant to Section 12584 of the Government Code. CERTIFICATION I declare under penalty of perjury under the laws of the State of California that the foregoing information is true , correct , and complete. Date AJANI HARRIS Feb 6, 2017 MAJOR LEAGUE SPORTS RAFFLE ELIGIBLE ORGANIZATION ANNUAL REPORT Los Angeles LakersYouth Foundation December 31, 20 16 Check# Check Date Calendar Year Organizati on Address Amount 501 (c)(3) Name EIN# 438 2/13/14 2014 CaliforniaWildlife Center PO Box 2022 Malibu CA 90265 5,000.00 95-4580790 451 4/4/14 2014 Tia Family Service Center 2202 S Figueroa St #455 Los Angeles CA 90007 5,000 .00 27-0912862 482 6/24/14 2014 Staples Center Foundation 800 West Olympic Blvd Ste 305 Los Angeles CA 90015 3,667 .41 95-1647810 505 9/4/ 14 2014 Boys& Gir1sClub of the West Valley 7245 Remmel Ave , Canoga Park CA 91303 7,000.00 95-4419365 506 9/4/ 14 2014 Boys& Girls Club of Carson 1950 E 220th St Ste 102, Carson CA 90810 10,000.00 33-0475452 507 9/4/ 14 2014 Cancer SupportCommunity Redondo 109 WTorrance Blvd Ste 100, Redondo Beach CA 90277 2 ,500.00 95-40761 31 508 9/4/ 14 2014 Casa Colina Centers for Rehabilitation 255 E Bonita Ave , Pomona CA 91767 3,000 .00 95-3655255 509 9/4/14 2014 The Children'sLifesaving Foundation 1112 Montana Ave #534 , Santa Monica CA 90403 5,000.00 95-4371286 510 9/4/ 14 2014 HollywoodPolice ActivitiesLeague 1358 N Wilcox Ave, Los Angeles CA 90028 5,000.00 95-4596172 511 9/4/14 2014 LACER AfterschoolPrograms 1277 N Wilcox Ave Ste 2, Los Angeles CA 90038 10,000.00 95-3890819 512 9/4/14 2014 Los AngelesYouth Network 7033 W Sunset Blvd Ste 225, Los Angeles CA 90025 2,500 .00 95-3953979 513 9/4/14 2014 Page Youth Center 4540 Hollister Ave , Santa Barbara CA 93110 5,000.00 77-0085672 514 9/4/14 2014 Special Olympics Southern California 1600 Forbes Way Ste 200 , Long Beach CA 90810 20,000.00 95-4538450 515 9/4/ 14 2014 J. F. Shea Therapeutic Riding Center 26284 Oso Rd, San Juan Capistrano CA 92675 2,500.00 95-3351363 516 9/4/14 2014 H.0 .0 .P. Foundat ion 1137 E Redondo Blvd, Inglewood CA 90302 2,000 .00 80-0228843 517 9/9/ 14 2014 Proyecto Pastoral at Dolores Mission 135 S Mission Rd, Los Angeles CA 90033 15,000.00 Proyecto Pastoral 95-3213968 518 9/9/ 14 2014 Social & Environmental Entrepreneur 313 N Genesee Ave #7 , Los Angeles CA 90036 5,000.00 95-4116679 519 9/9/ 14 2014 Staples Center Foundation 800 West Olympic Blvd. Suite 305 , Los Angeles, CA 90015 761.09 95-1647810 520 9/9/ 14 2014 Youth Speak Collective 444 S Brand Blvd, Ste 201 San Fernando CA 91406 5,000.00 27-0126980 521 9/ 15/ 14 2014 Community Partners 1000 N Alameda St Ste 240, Los Angeles CA 90012 5,000.00 95-4302067 527 9/15/14 2014 California Aquatic Therapy & Wellness 6801 Long Beach Blvd, Long Beach CA 90805 5,000.00 95-2382016 528 9/ 15/ 14 2014 Exceptional Children's Foundation 8740 W Washington Blvd, Culver City CA 90232 10,000.00 95-1690988 529 9/15/14 2014 Infinite Leaming 214 Main Street Ste 104 , El Segundo CA 90245 5,000.00 27-3543622 530 9/15/14 2014 Pediatric Therapy Network 1815 W 213th St Ste100 , Torrance CA 90501 5,000.00 33-0706273 531 9/15/ 14 2014 Taking The Reins 3919 1/2 Rigali Ave , Los Angeles 2,500.00 95-468865 7 532 9/15/14 2014 Team Prime T ime, Inc. PO Box 241496 , Los Angeles CA 90024 3,000.00 95-4846644 523 9/18/ 14 2014 Citystage 1926 Rodney Drive , Los Angeles CA 90027 2,500.00 27-1684448 524 9/18/14 2014 Connections For Children 2701 Ocean Pan< Blvd Ste 253, Santa Monica CA 90405 2,500 .00 95-3839796 525 9/18/14 2014 The Frostig Center 971 N Altadena Drive, Pasadena CA 91107 5,000 .00 Marianne Frostig Center of Educational Therapy 95-2098575 526 9/18/14 2014 No Limits For Deaf Children 9801 Washington Blvd, Culver City CA 90232 5,000.00 No Limits Theater Group, Inc. 95-4603048 Advancement Through Opportunity & Knowledge 533 9/22/14 2014 Children Youth and Family Collaborative 1200 W 37th Place , Los Angeles CA 90007 5,000.00 Incorporated 95-4415 115 534 9/22 /14 2014 Special Spirit Inc. 9889 Helen Ave , Shadow Hills 5,000.00 26-2504871 535 9/24/14 2014 Community Partners 1000 N Alameda St Ste 240 , Los Angeles CA 90012 15,000.00 95-4302067 540 9/26/14 2014 YMCA of Metropolitan Los Ange les 625 S New Hampshire Ave , Los Angeles CA 90005· 1342 80,000.00 95-1644052 542 10/3/ 14 2014 Inner.City Filmmakers 3000 W Olympic Blvd, Ste 2366, Santa Monica CA 90404 5,000.00 91-1769585 544 10/ 16/ 14 2014 Camp Laurel Foundation 75 S Grand Ave , Pasadena CA 91105 5,000.00 95-4429260 548 10/24/ 14 2014 Positive Coaching Alliance 1001 N Rengstorff Ave #100, Mountain View CA 94043 10,000.00 77-0485946 549 10/24/14 2014 Thousand Oaks Girls Softball Association PMD 249·2060D Avenida De Los Arboles, Thousand Oaks CA 901362 1,000.00 77-0369172 557 11/5/ 14 2014 Boys & Girls Club of Hollywood 850 N Cahuenga Blvd, Hollywood CA 90038 20,000.00 95-1775142 558 11/5/ 14 2014 Foundation for Second Chances 37 34 W Slauson Ave , Los Angeles CA 90043 5,000.00 43-2067664 559 11/5/ 14 2014 Foundation for Interscholastic 4120 Benyman Ave , Los Angeles CA 90066 5,000.00 45-3514221 560 11/5/ 14 2014 KARE Youth League 5150 Fama Ave, Arcadia CA 91066-2080 10,000.00 95-1869644 561 11/5/ 14 2014 Optimist Youth Homes & Family Service s 6957 N Figueroa St, Los Angeles CA 90041-1076 5,600.00 Optimist Boys' Home and Ranch Inc.
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