FORM 1023-EZ for THE PLAYROOM THE ALTERNATIVE THERAPY CENTER FOR CHILDREN

Field Data
EIN 20-2201521
Case Number EO-2018128-000538
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE PLAYROOM THE ALTERNATIVE THERAPY CENTER FOR CHILDREN
Organization’s Mailing Address 11248 BORDEN AVENUE
City PACOIMA
State CA
ZIP 91331
Accounting period End 6
Primary contact name LAURICE CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CRYSTAL MANDRIGAL
DIRECTOR
330 HURST AVENUE
VENTURA CA 93001

Officer/Director/Trustee Two

CARMALE BERRIDON
SECRETARY
9210 WELLHAVEN STREET
SANTA CLARITA CA 91351

Officer/Director/Trustee Three

DERRAINE CLARK
TREASURER
11661 KISMET AVENUE
SYLMAR CA 91342

Officer/Director/Trustee Four

LAURICE CLARK
OWNER/MGT
11661 KISMET AVENUE
SYLMAR CA 91342

Organization’s website WWW.THEPLAYROOM.ATCC@WIXSITE.COM/OURSITE
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/7/15
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LAURICE CLARK
Signature Title OWNER/MGT
Signature Date 5/1/18
EIN 20-2201521
Case Number EO-2016036-000116
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE PLAYROOM ALTERNATIVE THERAPY CENTER FOR CHILDREN
Organization’s Mailing Address 11248 BORDEN AVENUE
City PACOIMA
State CA
ZIP 91331
Accounting period End 6
Primary contact name CRYSTAL CLARK MADRIGAL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CRYSTAL CLARK-MADRIGAL
DIRECTOR
330 HURST AVENUE
VENTURA CA 93001

Officer/Director/Trustee Two

DERRAINE CLARK
ASST DIRECTOR
11661 KISMET AVENUE
LAKE VIEW TERRACE AZ 91342

Officer/Director/Trustee Three

LAURICE CLARK
SECRETARY
11248 BORDEN AVENUE
PACOIMA CA 91331

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/7/2015
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
Donation of funds Yes
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 Yes
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
Signature Title
Signature Date

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