FORM 1023-EZ for SOUTHERN CALIFORNIA BRAINSPOTTING INSTITUTE

Field Data
EIN 84-2651711
Case Number EO-2019221-000262
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SOUTHERN CALIFORNIA BRAINSPOTTING INSTITUTE
Organization’s Mailing Address 15431 ANACAPA RD SUITE H
City VICTORVILLE
State CA
ZIP 92392
Accounting period End 12
Primary contact name LAMA SALAMA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MAYADA MARZOUK
PRESIDENT
15431 ANACPA RD SUITE H
VICTORVILLE CA 92392

Officer/Director/Trustee Two

LAMA SALAMA
TREASURER/SECRETARY
15431 ANACAPA RD SUITE H
VICTORVILLE CA 92392

Officer/Director/Trustee Three

JOSEPH SALAMA
DIRECTOR
15431 ANACAPA RD SUITE H
VICTORVILLE CA 92392

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/30/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F30 - Mental Health Treatment - Multipurpose and N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
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 LAMA SALAMA
Signature Title TREASURER/SECRETARY
Signature Date 8/7/19

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