Schedule C. Notice in terms of Rule 5(10) of the Capital Gains Rules, 1993

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Daniel Crawford
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1 (Rul 5(10)) Shul C Noti in trms o Rul 5(10) o th Cpitl Gins Ruls, 1993 Sttmnt to sumitt y trnsror o shrs whr thr is trnsr o ontrolling intrst Prt 1 - Dtils o Trnsror Nm Arss ROC No (ompnis only) Inom Tx Rgistrtion No: Stt th numr o shrs hl y trnsror immitly prior to th trnsr: Typ Clss Vots Nom Vlu Numr Dt o pr shr pr shr quisition Prt 2 - Dtils o Compny in whih shrs r ing trnsrr Compny Nm Inom Tx Rgistrtion No Compny yr n Dt o inorportion ROC No Authoris shr pitl Issu shr pitl Stt whthr: (Ys or No) g Th Compny hols shrs irtly or inirtly in othr ompnis. (i Ys tth tils) Th Compny or ny ompnis spii in () ov own immovl proprty t th t o th shr trnsr. (i Ys tth tils) An inrs or rution in th shr pitl o th ompny took pl within ightn months prior to th t o th shr trnsr. (i Ys tth tils) Any shrs hv n trnsrr y th trnsror or rlt prty within ightn months prior to th t o th shr trnsr. (i Ys tth tils) Th ompny m into xistn s rsult o rstruturing. (i Ys tth tils spiying th t n whthr mrgr, ivision, t) Suh shrs r hl y ompny whos shrholrs, irtly or inirtly, r ll not rsint in Mlt, Th trnsr is trnsr to whih rt 5(3)() o th t pplis. Pg 1 o 5

Rgistrtion No Compny yr n Dt o inorportion ROC No Authoris shr pitl Issu shr pitl Stt whthr: (Ys or No) g Th Compny hols shrs irtly or inirtly in othr ompnis.

2 Prt 3 - Dtils o shr trnsr Dt o shr trnsr Numr o shrs hl t t o trnsr Numr o shrs trnsrr Consirtion or shrs trnsrr Giv tils o th shrs trnsrr: Typ Clss Vots Nom Vlu Numr Dt o pr shr pr shr quisition Prt 4 - Computtion o th mrkt vlu o th shrs trnsrr Th mrkt vlu o th shrs ing trnsrr is to trmin s ollows: Mrkt vlu o shrs trnsrr / glol trnsr S I : Dtrmintion o th % o th mrkt vlu o th ompny s rprsnt y suh shrs Typ Clss Nominl Voting Nom Vlu Voting rights Vlu rights o shrs o shrs Issu shr pitl trnsrr trnsrr Totl (A) (B) (C) (D) Prntg o th Mrkt Vlu o ompny (C/A) (D/B) Stt whthr thr hs n hng in th issu shr pitl o th ompny uring th prio o ightn months pring th trnsr. I th nswr to "" is "ys", stt whthr th prntg o th shrholing or voting rights o th trnsrror in th pitl or voting rights o th ompny hs n rs s rsult o suh hng. I th nswr to "" is "ys", giv tils o th pitl stutur o th ompny s xisting t th tim immitly pring tht hng. Typ Clss Nominl Voting Nom Vlu Voting rights Vlu rights o shrs o shrs Issu shr pitl trnsrr trnsrr Totl (E) (F) (G) (H) Prntg o th Mrkt Vlu o ompny Prntg o th MV o th ompny to tkn into ount (highr o G/E or H/F) (G/E) (H/F) (Z) Pg 2 o 5

suh shrs Typ Clss Nominl Voting Nom Vlu Voting rights Vlu rights o shrs o shrs Issu shr pitl trnsrr trnsrr Totl (A) (B) (C) (D) Prntg o th Mrkt Vlu o ompny (C/A) (D/B) Stt whthr thr hs n hng in th

3 S II : Computtion o Mrkt vlu o ompny; Totl Nt Asst Vlu o th ompny: Mrkt Vlu o shrs hl in nothr ompny rprsnting t lst 10% o th nominl vlu o th issu shr pitl o tht othr ompny, trmin in orn with rul 5. Compny Inom Tx no. Mrkt Vlu Dut ook vlu o shrs hl in th ompny (s stt in th innil sttmnts) Totl mrkt vlu o immovl proprty s stt in th Arhitt's Vlution (s pr Prt 6) lss Totl ook vlu o immovl proprty Ajustmnt to th vlu o immovl proprty: Vlu o goowill: (s lult in S IV low) Dut ook vlu o th shrs rrr to in Rul 5(6)(): Totl just mrkt vlu o th ompny: S III : Mrkt vlu o shrs trnsrr: g Ajust mrkt vlu o th ompny (S II) % o mrkt vlu s rprsnt y shrs trnsrr or glol trnsr (highr o C/A, D/B or Z in S I) Mrkt vlu o shrs trnsrr or glol trnsr ( X ) Totl vlu tkn into ount or th purpos o trmining th hrgl gin rising rom h o th rlvnt trnstions pring this trnsr Mrkt vlu o shrs trnsrr ( - ) Vlu o th onsirtion o shrs trnsrr (Prt 3) Vlu to tkn into ount or th purpos o lulting ny gin or loss rom th shr trnsr (highr o or ) Pg 3 o 5

Mrkt Vlu Dut ook vlu o shrs hl in th ompny (s stt in th innil sttmnts) Totl mrkt vlu o immovl proprty s stt in th Arhitt's Vlution (s pr Prt 6) lss Totl ook vlu o immovl proprty Ajustmnt to th vlu o

4 S IV : Clultion o th mount rprsnting th vlu o goowill: Whr ompny ws in xistn or th iv innil yrs immitly pring th yr in whih th trnsr is m: Yr n Proit or tx Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Totl Vlu o goowill: Not: Whr th trnsr is m uring th ompny's irst or son innil yr th vlu o goowill ov shll zro. Whr th ompny hs quir its usinss or prt thro rom nothr prson uring th ompny's irst thr innil yrs: Stt t whn usinss ws quir: Stt onsirtion pi or th quisition o th goowill o suh usinss: Proits o th ompny xluing proits ttriutl to usinss quir; Yr n Proit or tx Yr 1 Yr 2 Yr 3 Totl Vlu o goowill: Proits ttriutl to usinss quir rom nothr prson; Yr n Proit or tx Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Totl Vlu o goowill ttriutl to usinss quir Consirtion pi or th quisition o suh goowill A B Vlu o th goowill o th usinss so quir (highr o A n B ) Totl mount rprsnting th vlu o goowill: Not: Whr th ssts o th ompny inlu shrs in nothr ompny, n suh shrs rprsnt t lst tn prnt o th nominl vlu o th issu shr pitl o th othr ompny, th omputtions in Prt 5 must m or h suh shrholing. Prt 5 - Arhitt's vlution I th ompny owns immovl proprty t th t o th shr trnsr, tth n rhitt's vlution o th mrkt vlu o th immovl proprty tkn into ount in trmining th vlu o th si shrs. Pg 4 o 5

Whr th ompny hs quir its usinss or prt thro rom nothr prson uring th ompny's irst thr innil yrs: Stt t whn usinss ws quir: Stt onsirtion pi or th quisition o th goowill o suh usinss: Proits o th

5 Prt 6 Dlrtion I o hry lr tht th inormtion sumitt through this orm is tru n omplt: Trnsror's signtur Trnsror's nm This Shul shll ompni y n uitor s sign rport whih shll orm n intgrl prt o th shul, giving ssurn s to () th t tht th trnsr is trnsr o ontrolling intrst (inluing th grouns on whih suh sttmnt is s) n () whthr th omputtion o th mrkt vlu o th shrs ing trnsrr hs n proprly prpr in orn with th Cpitl Gins Ruls. Pg 5 o 5

ssurn s to () th t tht th trnsr is trnsr o ontrolling intrst (inluing th grouns on whih suh sttmnt is s)

Hospitals. Internal Revenue Service Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

Hospitals. Internal Revenue Service Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990. SCHEDULE H Hospitls OMB No. 1545-0047 (Form 990) Complt if th orgniztion nswr "Ys" to Form 990, Prt IV, qustion 20. Atth to Form 990. Opn to Puli Dprtmnt of th Trsury Intrnl Rvnu Srvi Informtion out Shul