FORM 1023-EZ for ALLENS ADULT CARE FACILITY INC

Field Data
EIN 85-0883463
Case Number EO-2021277-000729
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ALLENS ADULT CARE FACILITY INC
Organization’s Mailing Address 1712 N GRAPE AVE
City COMPTON
State CA
ZIP 90222
Accounting period End 12
Primary contact name LATRICE WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LEROY ALLEN III
CEO
1712 N GRAPE AVE
COMPTON CA 90222

Officer/Director/Trustee Two

LATRICE WILLIAMS
SECRETARY
1712 N GRAPE AVE
COMPTON CA 90222

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/25/2019
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, Multipurpose
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LEROY ALLEN III
Signature Title CEO
Signature Date 10/2/2021

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