10
----------------------------- STATE OF CALIFORNIA BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE 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 -0170 Annual Report Period: January 1, 2016- December 31, 2016 Eligible Organization's Name: Anaheim Ducks Foundation Eligible Organization's Registration Number: 17-000005 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 includes 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 Year 3 REGULATION/STATUTE 1 /1/16 to 12/31/16 to to (i) The aggregate gross receipts from the operation of raffles. $285,785 (ii) The aggregate direct costs incurred by the eligible organization from the operation of raffles. $52,025 (iii) The charitable or beneficial purposes for which proceeds of the raffles were used. S.C.O.R.E. AND LTP (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 N/A recipient organizations. under Penal Code section 320 .5, subdivision (c). (v) The aggregate distributions of proceeds from the operation of raffles made to raffle winners. $142,892.50 (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), $216,547 (iv) , and (v) above.

BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

  • Upload
    others

  • View
    0

  • Download
    0

Embed Size (px)

Citation preview

Page 1: BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

-----------------------------

STATE OF CALIFORNIA BGC 204 (Orig 012016) MAJOR LEAGUE SPORTS RAFFLE

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 -0170

Annual Report Period January 1 2016- December 31 2016

Eligible Organizations Name Anaheim Ducks Foundation

Eligible Organizations Registration Number 17-000005

Pursuant to Penal Code section 3206 subdivision (o)(12)(A) once registered an eligible organization shall file annually thereafter with the Department of Justice a report that includes all of the following information for each of the eligible organizations last three fiscal years Pursuant to Penal Code section 3206 subdivision (o)(12)(B) failure to submit the annual report shall be grounds for denial of an annual registration

Year1 Year2 Year 3 REGULATIONSTATUTE

1 116 to 123116 to to (i) The aggregate gross receipts from the operation of raffles

$285785

(ii) The aggregate direct costs incurred by the eligible organization from the operation of raffles $52025

(iii) The charitable or beneficial purposes for which proceeds of the raffles were used SCORE AND LTP

(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 NA recipient organizations under Penal Code section 3205 subdivision (c)

(v) The aggregate distributions of proceeds from the operation of raffles made to raffle winners $14289250

(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) $216547 (iv) and (v) above

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE 2 of 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

1 1 16 to 123116 to to (vii) A schedule of distributions of proceeds from the operation of raffles by individual raffle made to eligible recipient organizations under Penal Code section 3205 subdivision (c) that are not affiliated with the eligible

NA

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 3205 subdivision (c) that are affiliated with the eligible

NA

organization

(ix) A schedu le 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 for beneficial or charitable purposes undertaken by the

NA

eligible organization

(x) The aggregate gross receipts from activities other than the operation of raffles NA

(xi) The aggregate costs incurred by the eligible organization from activities other than the operation of raffles NA

(xii) The aggregate distributions of funds other than proceedsfrom the operation of raffles made to directly support beneficial or charitable purposes or eligible recipient NIA organizations under Penal Code sect ion 3205 subdivision (c)

(xiii) The aggregate distributions of funds other than proceeds from the operation of raffles for purposes other than those fisted in items (xi) and (xii) above

NA

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE 3of 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

1116 to 123116 to to (xiv)A schedule of distributions of funds other than proceedsfrom the operation of raffles made to eligible recipient organizations under Penal Code section 3205 subdivision NA (c) that are not affiliated with the eligible organization

(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 NA charitable purposes undertaken by the eligible organization

NOTE The department shall make the reports required by this paragraph available to the public via the online search portal of the Attorney Generals Registry of Charitable Trusts 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

I ROSANNA SITZMAN

Date

232017

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE 4 of 4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Codesect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information)

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

Amiddot MAR092011~~~~ar~~~

-- - --- ii JO______

STATEOF CALIFORNIA DEPARTMENTOFJUSTICE BGC204(Orig 012016) PAGE1014MAJOR LEAGUE SPORT S RAFFLE

ELIGIBLE ORGANIZATION AN NUAL REPORT PLEASE SEND COMPLETED REPORT TO Bureau of Gambling Control P 0 Box 168024 Sacramento CA 95816-8024

Phone 916-227-3584 Fax (916) 227-0170

Print Form Save Form I Reset FormI I WCEWBD ~middotAnnual Report Period July 1 2016 December 31 2016

Eligible Organizations Name Anaheim Ducks Foundation

17-000005Eligible Organizations Registration Number

Pursuant to Penal Code section 3206 subdivision (o)(12)(A) once registered an eligible organization shall file annually thereafter with the Department of Justice a report that includes all of the following information for each of the eligible organizations last three fiscal years Pursuant to Penal Code section 3206 subdivision (o)(12)(B) failure to submit the annual report shall be grounds for denial of an annual registration

REGULATIONSTATUTE

(i) The aggregate gross receipts from the operation of raffles

7116

Year1

to 123116

$285785

7115

Year2

to 63015

NIA

7114

Year3

to

NIA

63015

(ii) The aggregate direct costs incurred by the eligible organization from the operation of raffles

$53025 NIA NIA

(iii) The charitable or beneficial purposes for which proceeds of the raffles were used

pSCORE AND LT NIA NIA

(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

NIA NIA recipient organizations under Penal Code section 3205 subdivision (c)

(v) The aggregate distributions of proceeds from the $14289250 NIA operation of raffles made to raffle winners Jfr (vi) The aggregate distributions of proceeds from the operation of raffles made to any other organizations or for Iff NIANIAany other purposes other than those included in Items (ii) (iv) and (v) above

I

II

I I

STATE OF CALIFORNIA middotoEPARTMENT OF JUSTICE BGC 204 (O~g 012016) PAGE2of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

7116 to 123116 7115 to 63016 7114 to 63015(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 3205 0 NA NA 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 3205 0 NA NA subdivision (c) that are affiliated with the eligible organization

(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 NA NA for beneficial or charitable purposes undertaken by the eligible organization

(x) The aggregate gross receipts from activities other than the operat ion of raffles

$766319 $1678005 $1706835

(xi) The aggregate costs incurred by the eligible organization from activities other than the operation of raffles

$193856 $475961 $453299

(xii)The aggregate distributions of funds other than proceeds from the operation of raffles made to directly support beneficial or charitable purposes or eligible recipient $253686 $1259283 $1218953 organizations under Penal Code section 3205 subdivision (c)

(xiii)The aggregate distributions of funds other than proceeds from the operation of raffles for purposes other than those listed in items (xi) and (xii) above 0 0 0

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE3of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

711116 to 1213111 711115 to 613011 711114 to 613011(xiv) A schedule of distributions of funds other than proceedsfrom the operation of raffles made to eligible recipient organizations under Penal Code section 3205 subdivision NIA See List See List (c) that are not affiliated with the eligible organization

(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 NIA NIA NIA charitable purposes undertaken by the eligible organization

6 I

6 5

NOTE The department shall make the reports required by this paragraph available to the public via the online search portal of the Attorney Generals Registry of Charitable Trusts 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

Fiducia~sSign ~ t~ ~~

DateFiduciarys Printed Name

AvCJ e_v i) 33gtt7~

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orfg 0112016) PAGE4o f 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Code sect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information )

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

ADF Inc Charitable Contributions

Fiscal Year Ending 63015

FY 2015 Event Date Amount

Youth Charities

Selanne Youth Sports Foundation Selanne Screening 22815 29052

Orangewood Childrens Foundation 1415 Jubilee (Casino Night) Net Proceeds 62515 72728

Orangewood Childrens Foundatlon Academy T-Shirt 61715 140

Jr Ducks Nationals - Team Support 32615 10000

Act II Anaheim 52815 111000

222920

Health Charities

CHOC Foundation for Children Lady Ducks Fashion Show 62515 212808

CHOC Foundation for Children Ducks CHOC Night 62515 39835

Movember Inc Movember Fundraising 22515 1012

Pancreatic Cancer Network Hockey Fights Cancer Skate 113014 2140

Loma Linda University Cancer Center Hockey Fights Cancer 21815 20000

275795

Community Charities

Defending the Blue Line Military Appreciation Night 62515 20136

County of Orange OC Animal Care Night 61715 3417

Veterans First Military appreciation Night 2014 61715 1500

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4815 3570

28623

Total for Fiscal Year 2015 5273381

FY 2015 Event Date ~

Youth Charities

Orangewood Foundation Casino Night 62216 117405

Act II Anaheim 51316 111000

228405

Health Charities bull

CHOC Foundation lor Children Lady Ducks Fashion Show 62116 211012

CHOC Foundation for Children Ducks CHOC Night 6n116 48422

Movember Inc Movember Fundraising 31016 8177

Pancreatic Cancer Network Hockey Fights Cancer Skate 31016 7449

Loma Linda University Cancer Center Hockey Fights Cancer 31016 12905

Hydrocephalus Association Pre-season Jersey Donation 111615 8852

CHOC Foundation for Children 1415 Lady Ducks Fashion Show 12121115 5467

City or Hope SD Gulls Hockey for Hope 68116 2757

University or Wisconsin Foundation SD Gulls Hockey lor Hope 618116 2757

307799

Community Charities

Defending the Blue Line Military Appreciation Night 3110116 14597

County or Orange DC Animal Care Night 61916 4194

Veterans First Military appreciation Night 2015 3110116 2000

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4115116 1290

Special Olympics or So Cal Pre-Season Jersey Donation 1116115 9920

Bum Institute SD Gulls First Responders 2516 5190

Angels Baseball LLP 2016 Angels Night Online Auction 62316 3164

40355

Total for Fiscal Year 2015 s1ssss1

ADF Inc Charitable Contributions

Fiscal Year Ending 63016

Page 2: BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE 2 of 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

1 1 16 to 123116 to to (vii) A schedule of distributions of proceeds from the operation of raffles by individual raffle made to eligible recipient organizations under Penal Code section 3205 subdivision (c) that are not affiliated with the eligible

NA

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 3205 subdivision (c) that are affiliated with the eligible

NA

organization

(ix) A schedu le 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 for beneficial or charitable purposes undertaken by the

NA

eligible organization

(x) The aggregate gross receipts from activities other than the operation of raffles NA

(xi) The aggregate costs incurred by the eligible organization from activities other than the operation of raffles NA

(xii) The aggregate distributions of funds other than proceedsfrom the operation of raffles made to directly support beneficial or charitable purposes or eligible recipient NIA organizations under Penal Code sect ion 3205 subdivision (c)

(xiii) The aggregate distributions of funds other than proceeds from the operation of raffles for purposes other than those fisted in items (xi) and (xii) above

NA

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE 3of 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

1116 to 123116 to to (xiv)A schedule of distributions of funds other than proceedsfrom the operation of raffles made to eligible recipient organizations under Penal Code section 3205 subdivision NA (c) that are not affiliated with the eligible organization

(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 NA charitable purposes undertaken by the eligible organization

NOTE The department shall make the reports required by this paragraph available to the public via the online search portal of the Attorney Generals Registry of Charitable Trusts 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

I ROSANNA SITZMAN

Date

232017

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE 4 of 4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Codesect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information)

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

Amiddot MAR092011~~~~ar~~~

-- - --- ii JO______

STATEOF CALIFORNIA DEPARTMENTOFJUSTICE BGC204(Orig 012016) PAGE1014MAJOR LEAGUE SPORT S RAFFLE

ELIGIBLE ORGANIZATION AN NUAL REPORT PLEASE SEND COMPLETED REPORT TO Bureau of Gambling Control P 0 Box 168024 Sacramento CA 95816-8024

Phone 916-227-3584 Fax (916) 227-0170

Print Form Save Form I Reset FormI I WCEWBD ~middotAnnual Report Period July 1 2016 December 31 2016

Eligible Organizations Name Anaheim Ducks Foundation

17-000005Eligible Organizations Registration Number

Pursuant to Penal Code section 3206 subdivision (o)(12)(A) once registered an eligible organization shall file annually thereafter with the Department of Justice a report that includes all of the following information for each of the eligible organizations last three fiscal years Pursuant to Penal Code section 3206 subdivision (o)(12)(B) failure to submit the annual report shall be grounds for denial of an annual registration

REGULATIONSTATUTE

(i) The aggregate gross receipts from the operation of raffles

7116

Year1

to 123116

$285785

7115

Year2

to 63015

NIA

7114

Year3

to

NIA

63015

(ii) The aggregate direct costs incurred by the eligible organization from the operation of raffles

$53025 NIA NIA

(iii) The charitable or beneficial purposes for which proceeds of the raffles were used

pSCORE AND LT NIA NIA

(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

NIA NIA recipient organizations under Penal Code section 3205 subdivision (c)

(v) The aggregate distributions of proceeds from the $14289250 NIA operation of raffles made to raffle winners Jfr (vi) The aggregate distributions of proceeds from the operation of raffles made to any other organizations or for Iff NIANIAany other purposes other than those included in Items (ii) (iv) and (v) above

I

II

I I

STATE OF CALIFORNIA middotoEPARTMENT OF JUSTICE BGC 204 (O~g 012016) PAGE2of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

7116 to 123116 7115 to 63016 7114 to 63015(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 3205 0 NA NA 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 3205 0 NA NA subdivision (c) that are affiliated with the eligible organization

(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 NA NA for beneficial or charitable purposes undertaken by the eligible organization

(x) The aggregate gross receipts from activities other than the operat ion of raffles

$766319 $1678005 $1706835

(xi) The aggregate costs incurred by the eligible organization from activities other than the operation of raffles

$193856 $475961 $453299

(xii)The aggregate distributions of funds other than proceeds from the operation of raffles made to directly support beneficial or charitable purposes or eligible recipient $253686 $1259283 $1218953 organizations under Penal Code section 3205 subdivision (c)

(xiii)The aggregate distributions of funds other than proceeds from the operation of raffles for purposes other than those listed in items (xi) and (xii) above 0 0 0

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE3of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

711116 to 1213111 711115 to 613011 711114 to 613011(xiv) A schedule of distributions of funds other than proceedsfrom the operation of raffles made to eligible recipient organizations under Penal Code section 3205 subdivision NIA See List See List (c) that are not affiliated with the eligible organization

(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 NIA NIA NIA charitable purposes undertaken by the eligible organization

6 I

6 5

NOTE The department shall make the reports required by this paragraph available to the public via the online search portal of the Attorney Generals Registry of Charitable Trusts 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

Fiducia~sSign ~ t~ ~~

DateFiduciarys Printed Name

AvCJ e_v i) 33gtt7~

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orfg 0112016) PAGE4o f 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Code sect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information )

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

ADF Inc Charitable Contributions

Fiscal Year Ending 63015

FY 2015 Event Date Amount

Youth Charities

Selanne Youth Sports Foundation Selanne Screening 22815 29052

Orangewood Childrens Foundation 1415 Jubilee (Casino Night) Net Proceeds 62515 72728

Orangewood Childrens Foundatlon Academy T-Shirt 61715 140

Jr Ducks Nationals - Team Support 32615 10000

Act II Anaheim 52815 111000

222920

Health Charities

CHOC Foundation for Children Lady Ducks Fashion Show 62515 212808

CHOC Foundation for Children Ducks CHOC Night 62515 39835

Movember Inc Movember Fundraising 22515 1012

Pancreatic Cancer Network Hockey Fights Cancer Skate 113014 2140

Loma Linda University Cancer Center Hockey Fights Cancer 21815 20000

275795

Community Charities

Defending the Blue Line Military Appreciation Night 62515 20136

County of Orange OC Animal Care Night 61715 3417

Veterans First Military appreciation Night 2014 61715 1500

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4815 3570

28623

Total for Fiscal Year 2015 5273381

FY 2015 Event Date ~

Youth Charities

Orangewood Foundation Casino Night 62216 117405

Act II Anaheim 51316 111000

228405

Health Charities bull

CHOC Foundation lor Children Lady Ducks Fashion Show 62116 211012

CHOC Foundation for Children Ducks CHOC Night 6n116 48422

Movember Inc Movember Fundraising 31016 8177

Pancreatic Cancer Network Hockey Fights Cancer Skate 31016 7449

Loma Linda University Cancer Center Hockey Fights Cancer 31016 12905

Hydrocephalus Association Pre-season Jersey Donation 111615 8852

CHOC Foundation for Children 1415 Lady Ducks Fashion Show 12121115 5467

City or Hope SD Gulls Hockey for Hope 68116 2757

University or Wisconsin Foundation SD Gulls Hockey lor Hope 618116 2757

307799

Community Charities

Defending the Blue Line Military Appreciation Night 3110116 14597

County or Orange DC Animal Care Night 61916 4194

Veterans First Military appreciation Night 2015 3110116 2000

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4115116 1290

Special Olympics or So Cal Pre-Season Jersey Donation 1116115 9920

Bum Institute SD Gulls First Responders 2516 5190

Angels Baseball LLP 2016 Angels Night Online Auction 62316 3164

40355

Total for Fiscal Year 2015 s1ssss1

ADF Inc Charitable Contributions

Fiscal Year Ending 63016

Page 3: BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE 3of 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

1116 to 123116 to to (xiv)A schedule of distributions of funds other than proceedsfrom the operation of raffles made to eligible recipient organizations under Penal Code section 3205 subdivision NA (c) that are not affiliated with the eligible organization

(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 NA charitable purposes undertaken by the eligible organization

NOTE The department shall make the reports required by this paragraph available to the public via the online search portal of the Attorney Generals Registry of Charitable Trusts 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

I ROSANNA SITZMAN

Date

232017

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE 4 of 4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Codesect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information)

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

Amiddot MAR092011~~~~ar~~~

-- - --- ii JO______

STATEOF CALIFORNIA DEPARTMENTOFJUSTICE BGC204(Orig 012016) PAGE1014MAJOR LEAGUE SPORT S RAFFLE

ELIGIBLE ORGANIZATION AN NUAL REPORT PLEASE SEND COMPLETED REPORT TO Bureau of Gambling Control P 0 Box 168024 Sacramento CA 95816-8024

Phone 916-227-3584 Fax (916) 227-0170

Print Form Save Form I Reset FormI I WCEWBD ~middotAnnual Report Period July 1 2016 December 31 2016

Eligible Organizations Name Anaheim Ducks Foundation

17-000005Eligible Organizations Registration Number

Pursuant to Penal Code section 3206 subdivision (o)(12)(A) once registered an eligible organization shall file annually thereafter with the Department of Justice a report that includes all of the following information for each of the eligible organizations last three fiscal years Pursuant to Penal Code section 3206 subdivision (o)(12)(B) failure to submit the annual report shall be grounds for denial of an annual registration

REGULATIONSTATUTE

(i) The aggregate gross receipts from the operation of raffles

7116

Year1

to 123116

$285785

7115

Year2

to 63015

NIA

7114

Year3

to

NIA

63015

(ii) The aggregate direct costs incurred by the eligible organization from the operation of raffles

$53025 NIA NIA

(iii) The charitable or beneficial purposes for which proceeds of the raffles were used

pSCORE AND LT NIA NIA

(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

NIA NIA recipient organizations under Penal Code section 3205 subdivision (c)

(v) The aggregate distributions of proceeds from the $14289250 NIA operation of raffles made to raffle winners Jfr (vi) The aggregate distributions of proceeds from the operation of raffles made to any other organizations or for Iff NIANIAany other purposes other than those included in Items (ii) (iv) and (v) above

I

II

I I

STATE OF CALIFORNIA middotoEPARTMENT OF JUSTICE BGC 204 (O~g 012016) PAGE2of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

7116 to 123116 7115 to 63016 7114 to 63015(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 3205 0 NA NA 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 3205 0 NA NA subdivision (c) that are affiliated with the eligible organization

(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 NA NA for beneficial or charitable purposes undertaken by the eligible organization

(x) The aggregate gross receipts from activities other than the operat ion of raffles

$766319 $1678005 $1706835

(xi) The aggregate costs incurred by the eligible organization from activities other than the operation of raffles

$193856 $475961 $453299

(xii)The aggregate distributions of funds other than proceeds from the operation of raffles made to directly support beneficial or charitable purposes or eligible recipient $253686 $1259283 $1218953 organizations under Penal Code section 3205 subdivision (c)

(xiii)The aggregate distributions of funds other than proceeds from the operation of raffles for purposes other than those listed in items (xi) and (xii) above 0 0 0

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE3of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

711116 to 1213111 711115 to 613011 711114 to 613011(xiv) A schedule of distributions of funds other than proceedsfrom the operation of raffles made to eligible recipient organizations under Penal Code section 3205 subdivision NIA See List See List (c) that are not affiliated with the eligible organization

(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 NIA NIA NIA charitable purposes undertaken by the eligible organization

6 I

6 5

NOTE The department shall make the reports required by this paragraph available to the public via the online search portal of the Attorney Generals Registry of Charitable Trusts 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

Fiducia~sSign ~ t~ ~~

DateFiduciarys Printed Name

AvCJ e_v i) 33gtt7~

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orfg 0112016) PAGE4o f 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Code sect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information )

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

ADF Inc Charitable Contributions

Fiscal Year Ending 63015

FY 2015 Event Date Amount

Youth Charities

Selanne Youth Sports Foundation Selanne Screening 22815 29052

Orangewood Childrens Foundation 1415 Jubilee (Casino Night) Net Proceeds 62515 72728

Orangewood Childrens Foundatlon Academy T-Shirt 61715 140

Jr Ducks Nationals - Team Support 32615 10000

Act II Anaheim 52815 111000

222920

Health Charities

CHOC Foundation for Children Lady Ducks Fashion Show 62515 212808

CHOC Foundation for Children Ducks CHOC Night 62515 39835

Movember Inc Movember Fundraising 22515 1012

Pancreatic Cancer Network Hockey Fights Cancer Skate 113014 2140

Loma Linda University Cancer Center Hockey Fights Cancer 21815 20000

275795

Community Charities

Defending the Blue Line Military Appreciation Night 62515 20136

County of Orange OC Animal Care Night 61715 3417

Veterans First Military appreciation Night 2014 61715 1500

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4815 3570

28623

Total for Fiscal Year 2015 5273381

FY 2015 Event Date ~

Youth Charities

Orangewood Foundation Casino Night 62216 117405

Act II Anaheim 51316 111000

228405

Health Charities bull

CHOC Foundation lor Children Lady Ducks Fashion Show 62116 211012

CHOC Foundation for Children Ducks CHOC Night 6n116 48422

Movember Inc Movember Fundraising 31016 8177

Pancreatic Cancer Network Hockey Fights Cancer Skate 31016 7449

Loma Linda University Cancer Center Hockey Fights Cancer 31016 12905

Hydrocephalus Association Pre-season Jersey Donation 111615 8852

CHOC Foundation for Children 1415 Lady Ducks Fashion Show 12121115 5467

City or Hope SD Gulls Hockey for Hope 68116 2757

University or Wisconsin Foundation SD Gulls Hockey lor Hope 618116 2757

307799

Community Charities

Defending the Blue Line Military Appreciation Night 3110116 14597

County or Orange DC Animal Care Night 61916 4194

Veterans First Military appreciation Night 2015 3110116 2000

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4115116 1290

Special Olympics or So Cal Pre-Season Jersey Donation 1116115 9920

Bum Institute SD Gulls First Responders 2516 5190

Angels Baseball LLP 2016 Angels Night Online Auction 62316 3164

40355

Total for Fiscal Year 2015 s1ssss1

ADF Inc Charitable Contributions

Fiscal Year Ending 63016

Page 4: BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE 4 of 4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Codesect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information)

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

Amiddot MAR092011~~~~ar~~~

-- - --- ii JO______

STATEOF CALIFORNIA DEPARTMENTOFJUSTICE BGC204(Orig 012016) PAGE1014MAJOR LEAGUE SPORT S RAFFLE

ELIGIBLE ORGANIZATION AN NUAL REPORT PLEASE SEND COMPLETED REPORT TO Bureau of Gambling Control P 0 Box 168024 Sacramento CA 95816-8024

Phone 916-227-3584 Fax (916) 227-0170

Print Form Save Form I Reset FormI I WCEWBD ~middotAnnual Report Period July 1 2016 December 31 2016

Eligible Organizations Name Anaheim Ducks Foundation

17-000005Eligible Organizations Registration Number

Pursuant to Penal Code section 3206 subdivision (o)(12)(A) once registered an eligible organization shall file annually thereafter with the Department of Justice a report that includes all of the following information for each of the eligible organizations last three fiscal years Pursuant to Penal Code section 3206 subdivision (o)(12)(B) failure to submit the annual report shall be grounds for denial of an annual registration

REGULATIONSTATUTE

(i) The aggregate gross receipts from the operation of raffles

7116

Year1

to 123116

$285785

7115

Year2

to 63015

NIA

7114

Year3

to

NIA

63015

(ii) The aggregate direct costs incurred by the eligible organization from the operation of raffles

$53025 NIA NIA

(iii) The charitable or beneficial purposes for which proceeds of the raffles were used

pSCORE AND LT NIA NIA

(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

NIA NIA recipient organizations under Penal Code section 3205 subdivision (c)

(v) The aggregate distributions of proceeds from the $14289250 NIA operation of raffles made to raffle winners Jfr (vi) The aggregate distributions of proceeds from the operation of raffles made to any other organizations or for Iff NIANIAany other purposes other than those included in Items (ii) (iv) and (v) above

I

II

I I

STATE OF CALIFORNIA middotoEPARTMENT OF JUSTICE BGC 204 (O~g 012016) PAGE2of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

7116 to 123116 7115 to 63016 7114 to 63015(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 3205 0 NA NA 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 3205 0 NA NA subdivision (c) that are affiliated with the eligible organization

(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 NA NA for beneficial or charitable purposes undertaken by the eligible organization

(x) The aggregate gross receipts from activities other than the operat ion of raffles

$766319 $1678005 $1706835

(xi) The aggregate costs incurred by the eligible organization from activities other than the operation of raffles

$193856 $475961 $453299

(xii)The aggregate distributions of funds other than proceeds from the operation of raffles made to directly support beneficial or charitable purposes or eligible recipient $253686 $1259283 $1218953 organizations under Penal Code section 3205 subdivision (c)

(xiii)The aggregate distributions of funds other than proceeds from the operation of raffles for purposes other than those listed in items (xi) and (xii) above 0 0 0

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE3of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

711116 to 1213111 711115 to 613011 711114 to 613011(xiv) A schedule of distributions of funds other than proceedsfrom the operation of raffles made to eligible recipient organizations under Penal Code section 3205 subdivision NIA See List See List (c) that are not affiliated with the eligible organization

(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 NIA NIA NIA charitable purposes undertaken by the eligible organization

6 I

6 5

NOTE The department shall make the reports required by this paragraph available to the public via the online search portal of the Attorney Generals Registry of Charitable Trusts 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

Fiducia~sSign ~ t~ ~~

DateFiduciarys Printed Name

AvCJ e_v i) 33gtt7~

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orfg 0112016) PAGE4o f 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Code sect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information )

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

ADF Inc Charitable Contributions

Fiscal Year Ending 63015

FY 2015 Event Date Amount

Youth Charities

Selanne Youth Sports Foundation Selanne Screening 22815 29052

Orangewood Childrens Foundation 1415 Jubilee (Casino Night) Net Proceeds 62515 72728

Orangewood Childrens Foundatlon Academy T-Shirt 61715 140

Jr Ducks Nationals - Team Support 32615 10000

Act II Anaheim 52815 111000

222920

Health Charities

CHOC Foundation for Children Lady Ducks Fashion Show 62515 212808

CHOC Foundation for Children Ducks CHOC Night 62515 39835

Movember Inc Movember Fundraising 22515 1012

Pancreatic Cancer Network Hockey Fights Cancer Skate 113014 2140

Loma Linda University Cancer Center Hockey Fights Cancer 21815 20000

275795

Community Charities

Defending the Blue Line Military Appreciation Night 62515 20136

County of Orange OC Animal Care Night 61715 3417

Veterans First Military appreciation Night 2014 61715 1500

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4815 3570

28623

Total for Fiscal Year 2015 5273381

FY 2015 Event Date ~

Youth Charities

Orangewood Foundation Casino Night 62216 117405

Act II Anaheim 51316 111000

228405

Health Charities bull

CHOC Foundation lor Children Lady Ducks Fashion Show 62116 211012

CHOC Foundation for Children Ducks CHOC Night 6n116 48422

Movember Inc Movember Fundraising 31016 8177

Pancreatic Cancer Network Hockey Fights Cancer Skate 31016 7449

Loma Linda University Cancer Center Hockey Fights Cancer 31016 12905

Hydrocephalus Association Pre-season Jersey Donation 111615 8852

CHOC Foundation for Children 1415 Lady Ducks Fashion Show 12121115 5467

City or Hope SD Gulls Hockey for Hope 68116 2757

University or Wisconsin Foundation SD Gulls Hockey lor Hope 618116 2757

307799

Community Charities

Defending the Blue Line Military Appreciation Night 3110116 14597

County or Orange DC Animal Care Night 61916 4194

Veterans First Military appreciation Night 2015 3110116 2000

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4115116 1290

Special Olympics or So Cal Pre-Season Jersey Donation 1116115 9920

Bum Institute SD Gulls First Responders 2516 5190

Angels Baseball LLP 2016 Angels Night Online Auction 62316 3164

40355

Total for Fiscal Year 2015 s1ssss1

ADF Inc Charitable Contributions

Fiscal Year Ending 63016

Page 5: BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

Amiddot MAR092011~~~~ar~~~

-- - --- ii JO______

STATEOF CALIFORNIA DEPARTMENTOFJUSTICE BGC204(Orig 012016) PAGE1014MAJOR LEAGUE SPORT S RAFFLE

ELIGIBLE ORGANIZATION AN NUAL REPORT PLEASE SEND COMPLETED REPORT TO Bureau of Gambling Control P 0 Box 168024 Sacramento CA 95816-8024

Phone 916-227-3584 Fax (916) 227-0170

Print Form Save Form I Reset FormI I WCEWBD ~middotAnnual Report Period July 1 2016 December 31 2016

Eligible Organizations Name Anaheim Ducks Foundation

17-000005Eligible Organizations Registration Number

Pursuant to Penal Code section 3206 subdivision (o)(12)(A) once registered an eligible organization shall file annually thereafter with the Department of Justice a report that includes all of the following information for each of the eligible organizations last three fiscal years Pursuant to Penal Code section 3206 subdivision (o)(12)(B) failure to submit the annual report shall be grounds for denial of an annual registration

REGULATIONSTATUTE

(i) The aggregate gross receipts from the operation of raffles

7116

Year1

to 123116

$285785

7115

Year2

to 63015

NIA

7114

Year3

to

NIA

63015

(ii) The aggregate direct costs incurred by the eligible organization from the operation of raffles

$53025 NIA NIA

(iii) The charitable or beneficial purposes for which proceeds of the raffles were used

pSCORE AND LT NIA NIA

(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

NIA NIA recipient organizations under Penal Code section 3205 subdivision (c)

(v) The aggregate distributions of proceeds from the $14289250 NIA operation of raffles made to raffle winners Jfr (vi) The aggregate distributions of proceeds from the operation of raffles made to any other organizations or for Iff NIANIAany other purposes other than those included in Items (ii) (iv) and (v) above

I

II

I I

STATE OF CALIFORNIA middotoEPARTMENT OF JUSTICE BGC 204 (O~g 012016) PAGE2of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

7116 to 123116 7115 to 63016 7114 to 63015(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 3205 0 NA NA 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 3205 0 NA NA subdivision (c) that are affiliated with the eligible organization

(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 NA NA for beneficial or charitable purposes undertaken by the eligible organization

(x) The aggregate gross receipts from activities other than the operat ion of raffles

$766319 $1678005 $1706835

(xi) The aggregate costs incurred by the eligible organization from activities other than the operation of raffles

$193856 $475961 $453299

(xii)The aggregate distributions of funds other than proceeds from the operation of raffles made to directly support beneficial or charitable purposes or eligible recipient $253686 $1259283 $1218953 organizations under Penal Code section 3205 subdivision (c)

(xiii)The aggregate distributions of funds other than proceeds from the operation of raffles for purposes other than those listed in items (xi) and (xii) above 0 0 0

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE3of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

711116 to 1213111 711115 to 613011 711114 to 613011(xiv) A schedule of distributions of funds other than proceedsfrom the operation of raffles made to eligible recipient organizations under Penal Code section 3205 subdivision NIA See List See List (c) that are not affiliated with the eligible organization

(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 NIA NIA NIA charitable purposes undertaken by the eligible organization

6 I

6 5

NOTE The department shall make the reports required by this paragraph available to the public via the online search portal of the Attorney Generals Registry of Charitable Trusts 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

Fiducia~sSign ~ t~ ~~

DateFiduciarys Printed Name

AvCJ e_v i) 33gtt7~

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orfg 0112016) PAGE4o f 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Code sect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information )

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

ADF Inc Charitable Contributions

Fiscal Year Ending 63015

FY 2015 Event Date Amount

Youth Charities

Selanne Youth Sports Foundation Selanne Screening 22815 29052

Orangewood Childrens Foundation 1415 Jubilee (Casino Night) Net Proceeds 62515 72728

Orangewood Childrens Foundatlon Academy T-Shirt 61715 140

Jr Ducks Nationals - Team Support 32615 10000

Act II Anaheim 52815 111000

222920

Health Charities

CHOC Foundation for Children Lady Ducks Fashion Show 62515 212808

CHOC Foundation for Children Ducks CHOC Night 62515 39835

Movember Inc Movember Fundraising 22515 1012

Pancreatic Cancer Network Hockey Fights Cancer Skate 113014 2140

Loma Linda University Cancer Center Hockey Fights Cancer 21815 20000

275795

Community Charities

Defending the Blue Line Military Appreciation Night 62515 20136

County of Orange OC Animal Care Night 61715 3417

Veterans First Military appreciation Night 2014 61715 1500

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4815 3570

28623

Total for Fiscal Year 2015 5273381

FY 2015 Event Date ~

Youth Charities

Orangewood Foundation Casino Night 62216 117405

Act II Anaheim 51316 111000

228405

Health Charities bull

CHOC Foundation lor Children Lady Ducks Fashion Show 62116 211012

CHOC Foundation for Children Ducks CHOC Night 6n116 48422

Movember Inc Movember Fundraising 31016 8177

Pancreatic Cancer Network Hockey Fights Cancer Skate 31016 7449

Loma Linda University Cancer Center Hockey Fights Cancer 31016 12905

Hydrocephalus Association Pre-season Jersey Donation 111615 8852

CHOC Foundation for Children 1415 Lady Ducks Fashion Show 12121115 5467

City or Hope SD Gulls Hockey for Hope 68116 2757

University or Wisconsin Foundation SD Gulls Hockey lor Hope 618116 2757

307799

Community Charities

Defending the Blue Line Military Appreciation Night 3110116 14597

County or Orange DC Animal Care Night 61916 4194

Veterans First Military appreciation Night 2015 3110116 2000

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4115116 1290

Special Olympics or So Cal Pre-Season Jersey Donation 1116115 9920

Bum Institute SD Gulls First Responders 2516 5190

Angels Baseball LLP 2016 Angels Night Online Auction 62316 3164

40355

Total for Fiscal Year 2015 s1ssss1

ADF Inc Charitable Contributions

Fiscal Year Ending 63016

Page 6: BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

STATE OF CALIFORNIA middotoEPARTMENT OF JUSTICE BGC 204 (O~g 012016) PAGE2of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

7116 to 123116 7115 to 63016 7114 to 63015(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 3205 0 NA NA 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 3205 0 NA NA subdivision (c) that are affiliated with the eligible organization

(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 NA NA for beneficial or charitable purposes undertaken by the eligible organization

(x) The aggregate gross receipts from activities other than the operat ion of raffles

$766319 $1678005 $1706835

(xi) The aggregate costs incurred by the eligible organization from activities other than the operation of raffles

$193856 $475961 $453299

(xii)The aggregate distributions of funds other than proceeds from the operation of raffles made to directly support beneficial or charitable purposes or eligible recipient $253686 $1259283 $1218953 organizations under Penal Code section 3205 subdivision (c)

(xiii)The aggregate distributions of funds other than proceeds from the operation of raffles for purposes other than those listed in items (xi) and (xii) above 0 0 0

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE3of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

711116 to 1213111 711115 to 613011 711114 to 613011(xiv) A schedule of distributions of funds other than proceedsfrom the operation of raffles made to eligible recipient organizations under Penal Code section 3205 subdivision NIA See List See List (c) that are not affiliated with the eligible organization

(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 NIA NIA NIA charitable purposes undertaken by the eligible organization

6 I

6 5

NOTE The department shall make the reports required by this paragraph available to the public via the online search portal of the Attorney Generals Registry of Charitable Trusts 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

Fiducia~sSign ~ t~ ~~

DateFiduciarys Printed Name

AvCJ e_v i) 33gtt7~

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orfg 0112016) PAGE4o f 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Code sect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information )

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

ADF Inc Charitable Contributions

Fiscal Year Ending 63015

FY 2015 Event Date Amount

Youth Charities

Selanne Youth Sports Foundation Selanne Screening 22815 29052

Orangewood Childrens Foundation 1415 Jubilee (Casino Night) Net Proceeds 62515 72728

Orangewood Childrens Foundatlon Academy T-Shirt 61715 140

Jr Ducks Nationals - Team Support 32615 10000

Act II Anaheim 52815 111000

222920

Health Charities

CHOC Foundation for Children Lady Ducks Fashion Show 62515 212808

CHOC Foundation for Children Ducks CHOC Night 62515 39835

Movember Inc Movember Fundraising 22515 1012

Pancreatic Cancer Network Hockey Fights Cancer Skate 113014 2140

Loma Linda University Cancer Center Hockey Fights Cancer 21815 20000

275795

Community Charities

Defending the Blue Line Military Appreciation Night 62515 20136

County of Orange OC Animal Care Night 61715 3417

Veterans First Military appreciation Night 2014 61715 1500

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4815 3570

28623

Total for Fiscal Year 2015 5273381

FY 2015 Event Date ~

Youth Charities

Orangewood Foundation Casino Night 62216 117405

Act II Anaheim 51316 111000

228405

Health Charities bull

CHOC Foundation lor Children Lady Ducks Fashion Show 62116 211012

CHOC Foundation for Children Ducks CHOC Night 6n116 48422

Movember Inc Movember Fundraising 31016 8177

Pancreatic Cancer Network Hockey Fights Cancer Skate 31016 7449

Loma Linda University Cancer Center Hockey Fights Cancer 31016 12905

Hydrocephalus Association Pre-season Jersey Donation 111615 8852

CHOC Foundation for Children 1415 Lady Ducks Fashion Show 12121115 5467

City or Hope SD Gulls Hockey for Hope 68116 2757

University or Wisconsin Foundation SD Gulls Hockey lor Hope 618116 2757

307799

Community Charities

Defending the Blue Line Military Appreciation Night 3110116 14597

County or Orange DC Animal Care Night 61916 4194

Veterans First Military appreciation Night 2015 3110116 2000

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4115116 1290

Special Olympics or So Cal Pre-Season Jersey Donation 1116115 9920

Bum Institute SD Gulls First Responders 2516 5190

Angels Baseball LLP 2016 Angels Night Online Auction 62316 3164

40355

Total for Fiscal Year 2015 s1ssss1

ADF Inc Charitable Contributions

Fiscal Year Ending 63016

Page 7: BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orig 012016) PAGE3of4MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Year1 Year2 Year3 REGULATIONSTATUTE

711116 to 1213111 711115 to 613011 711114 to 613011(xiv) A schedule of distributions of funds other than proceedsfrom the operation of raffles made to eligible recipient organizations under Penal Code section 3205 subdivision NIA See List See List (c) that are not affiliated with the eligible organization

(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 NIA NIA NIA charitable purposes undertaken by the eligible organization

6 I

6 5

NOTE The department shall make the reports required by this paragraph available to the public via the online search portal of the Attorney Generals Registry of Charitable Trusts 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

Fiducia~sSign ~ t~ ~~

DateFiduciarys Printed Name

AvCJ e_v i) 33gtt7~

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orfg 0112016) PAGE4o f 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Code sect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information )

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

ADF Inc Charitable Contributions

Fiscal Year Ending 63015

FY 2015 Event Date Amount

Youth Charities

Selanne Youth Sports Foundation Selanne Screening 22815 29052

Orangewood Childrens Foundation 1415 Jubilee (Casino Night) Net Proceeds 62515 72728

Orangewood Childrens Foundatlon Academy T-Shirt 61715 140

Jr Ducks Nationals - Team Support 32615 10000

Act II Anaheim 52815 111000

222920

Health Charities

CHOC Foundation for Children Lady Ducks Fashion Show 62515 212808

CHOC Foundation for Children Ducks CHOC Night 62515 39835

Movember Inc Movember Fundraising 22515 1012

Pancreatic Cancer Network Hockey Fights Cancer Skate 113014 2140

Loma Linda University Cancer Center Hockey Fights Cancer 21815 20000

275795

Community Charities

Defending the Blue Line Military Appreciation Night 62515 20136

County of Orange OC Animal Care Night 61715 3417

Veterans First Military appreciation Night 2014 61715 1500

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4815 3570

28623

Total for Fiscal Year 2015 5273381

FY 2015 Event Date ~

Youth Charities

Orangewood Foundation Casino Night 62216 117405

Act II Anaheim 51316 111000

228405

Health Charities bull

CHOC Foundation lor Children Lady Ducks Fashion Show 62116 211012

CHOC Foundation for Children Ducks CHOC Night 6n116 48422

Movember Inc Movember Fundraising 31016 8177

Pancreatic Cancer Network Hockey Fights Cancer Skate 31016 7449

Loma Linda University Cancer Center Hockey Fights Cancer 31016 12905

Hydrocephalus Association Pre-season Jersey Donation 111615 8852

CHOC Foundation for Children 1415 Lady Ducks Fashion Show 12121115 5467

City or Hope SD Gulls Hockey for Hope 68116 2757

University or Wisconsin Foundation SD Gulls Hockey lor Hope 618116 2757

307799

Community Charities

Defending the Blue Line Military Appreciation Night 3110116 14597

County or Orange DC Animal Care Night 61916 4194

Veterans First Military appreciation Night 2015 3110116 2000

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4115116 1290

Special Olympics or So Cal Pre-Season Jersey Donation 1116115 9920

Bum Institute SD Gulls First Responders 2516 5190

Angels Baseball LLP 2016 Angels Night Online Auction 62316 3164

40355

Total for Fiscal Year 2015 s1ssss1

ADF Inc Charitable Contributions

Fiscal Year Ending 63016

Page 8: BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BGC 204 (Orfg 0112016) PAGE4o f 4 MAJOR LEAGUE SPORTS RAFFLE

ELIGIBLE ORGANIZATION ANNUAL REPORT

Privacy Notice As Required by Civil Code sect 179817

Collection and Use of Personal Information The Bureau of Gambling Control in the Department of Justice collects the information requested on this form as authorized by Penal Code section 3206 The Bureau uses this information to establish grounds for the license permit or other approval indicated on this application form In addition any personal information collected by state agencies is subject to the limitations in the Information Practice Act and state policy The Department of Justice general privacy policy is available at httpoagcagovprivacy-policy

Providing Personal Information All the personal information requested in this form must be provided If you do not provide this information your application will be denied

Access to Your Information You may review the records maintained by the Bureau in the Department of Justice that contain your personal information as permitted by the Information Practices Act (See below for contact information )

Possible Disclosure of Personal Information In order to process your application we may need to share the information you give to us with law enforcement or regulatory agencies for investigation of unlawful activity or for licensing or regulatory purposes

The information you provide may also be disclosed in the following circumstances bull In response to a Public Records Act request as allowed by the Information Practices Act bull To another government agency as required by state or federal law or bull In response to a court or administrative order a subpoena or a search warrant

Contact Information For questions about this notice or access to your records you may contact the Department of Justice Bureau of Gambling Control at PO Box 168024 Sacramento CA 95816-8024 phone 916-227-3584 or e-mail at GamblingControldojcagov

ADF Inc Charitable Contributions

Fiscal Year Ending 63015

FY 2015 Event Date Amount

Youth Charities

Selanne Youth Sports Foundation Selanne Screening 22815 29052

Orangewood Childrens Foundation 1415 Jubilee (Casino Night) Net Proceeds 62515 72728

Orangewood Childrens Foundatlon Academy T-Shirt 61715 140

Jr Ducks Nationals - Team Support 32615 10000

Act II Anaheim 52815 111000

222920

Health Charities

CHOC Foundation for Children Lady Ducks Fashion Show 62515 212808

CHOC Foundation for Children Ducks CHOC Night 62515 39835

Movember Inc Movember Fundraising 22515 1012

Pancreatic Cancer Network Hockey Fights Cancer Skate 113014 2140

Loma Linda University Cancer Center Hockey Fights Cancer 21815 20000

275795

Community Charities

Defending the Blue Line Military Appreciation Night 62515 20136

County of Orange OC Animal Care Night 61715 3417

Veterans First Military appreciation Night 2014 61715 1500

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4815 3570

28623

Total for Fiscal Year 2015 5273381

FY 2015 Event Date ~

Youth Charities

Orangewood Foundation Casino Night 62216 117405

Act II Anaheim 51316 111000

228405

Health Charities bull

CHOC Foundation lor Children Lady Ducks Fashion Show 62116 211012

CHOC Foundation for Children Ducks CHOC Night 6n116 48422

Movember Inc Movember Fundraising 31016 8177

Pancreatic Cancer Network Hockey Fights Cancer Skate 31016 7449

Loma Linda University Cancer Center Hockey Fights Cancer 31016 12905

Hydrocephalus Association Pre-season Jersey Donation 111615 8852

CHOC Foundation for Children 1415 Lady Ducks Fashion Show 12121115 5467

City or Hope SD Gulls Hockey for Hope 68116 2757

University or Wisconsin Foundation SD Gulls Hockey lor Hope 618116 2757

307799

Community Charities

Defending the Blue Line Military Appreciation Night 3110116 14597

County or Orange DC Animal Care Night 61916 4194

Veterans First Military appreciation Night 2015 3110116 2000

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4115116 1290

Special Olympics or So Cal Pre-Season Jersey Donation 1116115 9920

Bum Institute SD Gulls First Responders 2516 5190

Angels Baseball LLP 2016 Angels Night Online Auction 62316 3164

40355

Total for Fiscal Year 2015 s1ssss1

ADF Inc Charitable Contributions

Fiscal Year Ending 63016

Page 9: BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

ADF Inc Charitable Contributions

Fiscal Year Ending 63015

FY 2015 Event Date Amount

Youth Charities

Selanne Youth Sports Foundation Selanne Screening 22815 29052

Orangewood Childrens Foundation 1415 Jubilee (Casino Night) Net Proceeds 62515 72728

Orangewood Childrens Foundatlon Academy T-Shirt 61715 140

Jr Ducks Nationals - Team Support 32615 10000

Act II Anaheim 52815 111000

222920

Health Charities

CHOC Foundation for Children Lady Ducks Fashion Show 62515 212808

CHOC Foundation for Children Ducks CHOC Night 62515 39835

Movember Inc Movember Fundraising 22515 1012

Pancreatic Cancer Network Hockey Fights Cancer Skate 113014 2140

Loma Linda University Cancer Center Hockey Fights Cancer 21815 20000

275795

Community Charities

Defending the Blue Line Military Appreciation Night 62515 20136

County of Orange OC Animal Care Night 61715 3417

Veterans First Military appreciation Night 2014 61715 1500

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4815 3570

28623

Total for Fiscal Year 2015 5273381

FY 2015 Event Date ~

Youth Charities

Orangewood Foundation Casino Night 62216 117405

Act II Anaheim 51316 111000

228405

Health Charities bull

CHOC Foundation lor Children Lady Ducks Fashion Show 62116 211012

CHOC Foundation for Children Ducks CHOC Night 6n116 48422

Movember Inc Movember Fundraising 31016 8177

Pancreatic Cancer Network Hockey Fights Cancer Skate 31016 7449

Loma Linda University Cancer Center Hockey Fights Cancer 31016 12905

Hydrocephalus Association Pre-season Jersey Donation 111615 8852

CHOC Foundation for Children 1415 Lady Ducks Fashion Show 12121115 5467

City or Hope SD Gulls Hockey for Hope 68116 2757

University or Wisconsin Foundation SD Gulls Hockey lor Hope 618116 2757

307799

Community Charities

Defending the Blue Line Military Appreciation Night 3110116 14597

County or Orange DC Animal Care Night 61916 4194

Veterans First Military appreciation Night 2015 3110116 2000

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4115116 1290

Special Olympics or So Cal Pre-Season Jersey Donation 1116115 9920

Bum Institute SD Gulls First Responders 2516 5190

Angels Baseball LLP 2016 Angels Night Online Auction 62316 3164

40355

Total for Fiscal Year 2015 s1ssss1

ADF Inc Charitable Contributions

Fiscal Year Ending 63016

Page 10: BGC 204 (Orig. 01/2016) MAJOR LEAGUE SPORTS RAFFLE ... · Pursuant to Penal Code section 320.6, subdivision (o)(12)(A), once registered, an eligible organization shall file annually

FY 2015 Event Date ~

Youth Charities

Orangewood Foundation Casino Night 62216 117405

Act II Anaheim 51316 111000

228405

Health Charities bull

CHOC Foundation lor Children Lady Ducks Fashion Show 62116 211012

CHOC Foundation for Children Ducks CHOC Night 6n116 48422

Movember Inc Movember Fundraising 31016 8177

Pancreatic Cancer Network Hockey Fights Cancer Skate 31016 7449

Loma Linda University Cancer Center Hockey Fights Cancer 31016 12905

Hydrocephalus Association Pre-season Jersey Donation 111615 8852

CHOC Foundation for Children 1415 Lady Ducks Fashion Show 12121115 5467

City or Hope SD Gulls Hockey for Hope 68116 2757

University or Wisconsin Foundation SD Gulls Hockey lor Hope 618116 2757

307799

Community Charities

Defending the Blue Line Military Appreciation Night 3110116 14597

County or Orange DC Animal Care Night 61916 4194

Veterans First Military appreciation Night 2015 3110116 2000

Ben Carlson Memorial Scholarship Silent AuctionBeach Party 4115116 1290

Special Olympics or So Cal Pre-Season Jersey Donation 1116115 9920

Bum Institute SD Gulls First Responders 2516 5190

Angels Baseball LLP 2016 Angels Night Online Auction 62316 3164

40355

Total for Fiscal Year 2015 s1ssss1

ADF Inc Charitable Contributions

Fiscal Year Ending 63016