PUBLIC INSPECTION COPY. Return of Organization Exempt From Income Tax

Transcription

1 Form Deprtment of the Tresury Internl Revenue Servie Uner setion 0(), 7, or 7()() of the Internl Revenue Coe (exept lk lung enefit trust or privte fountion) The orgniztion my hve to use opy of this return to stisfy stte reporting requirements. A For the 0 lenr yer, or tx yer eginning n ening OMB B Chek if C Nme of orgniztion D Employer ientifition numer pplile: Aress hnge Nme hnge Initil return Terminte Doing Business As Numer n street (or P.O. ox if mil is not elivere to street ress) Room/suite E Amene return City, town, or post offie, stte, n ZIP oe G Gross reeipts $ Open to Puli Inspetion Telephone numer ST ELMO AVENUE ,,. Applition BETHESDA, MD 0 H() Is this group return pening F Nme n ress of prinipl offier: DIANE ZIPURSKY QUALE for ffilites? SAME AS C ABOVE H() Are ll ffilites inlue? I Tx-exempt sttus: 0()() 0() ( ) (insert no.) 7()() or 7 If "," tth list. (see instrutions) J Wesite: H() Group exemption numer K Form of orgniztion: Corportion Trust Assoition Other L Yer of formtion: 00 M Stte of legl omiile: MD Prt I Summry Briefly esrie the orgniztion s mission or most signifint tivities: TO INCREASE PUBLIC AWARENESS ABOUT BLADDER CANCER; TO ADVANCE BLADDER CANCER RESEARCH; AND TO Ativities & Governne Revenue Expenses Net Assets or Fun Blnes Sign Here PUBLIC INSPECTION COPY 0 Return of Orgniztion Exempt From Inome Tx 0 0 Chek this ox if the orgniztion isontinue its opertions or ispose of more thn % of its net ssets. Numer of voting memers of the governing oy (Prt VI, line ) Numer of inepenent voting memers of the governing oy (Prt VI, line ) ~~~~~~~~~~~~~~ Totl numer of iniviuls employe in lenr yer 0 (Prt V, line ) ~~~~~~~~~~~~~~~~ Net unrelte usiness txle inome from Form 0-T, line Professionl funrising fees (Prt I, olumn (A), line e) ~~~~~~~~~~~~~~ Totl funrising expenses (Prt I, olumn (D), line ),7. true, orret, n omplete. Delrtion of preprer (other thn offier) is se on ll informtion of whih preprer hs ny knowlege. Signture of offier DIANE ZIPURSKY QUALE, DIRECTOR/PRESIDENT Type or print nme n title ~~~~~~~~~~~~~~~~~~~~ Totl numer of volunteers (estimte if neessry) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7 Totl unrelte usiness revenue from Prt VIII, olumn (C), line ~~~~~~~~~~~~~~~~~~~~ Contriutions n grnts (Prt VIII, line h) ~~~~~~~~~~~~~~~~~~~~~ Progrm servie revenue (Prt VIII, line g) ~~~~~~~~~~~~~~~~~~~~~ Investment inome (Prt VIII, olumn (A), lines,, n 7) ~~~~~~~~~~~~~ Other revenue (Prt VIII, olumn (A), lines,,,, 0, n e) ~~~~~~~~ Totl revenue - lines through (must equl Prt VIII, olumn (A), line ) Grnts n similr mounts pi (Prt I, olumn (A), lines -) Benefits pi to or for memers (Prt I, olumn (A), line ) ~~~~~~~~~~~ ~~~~~~~~~~~~~ Slries, other ompenstion, employee enefits (Prt I, olumn (A), lines -0) ~~~ = = BLADDER CANCER ADVOCACY NETWORK, INC. 7 7 Prior Yer Current Yer 77,7.,7,.,7.,.., ,0.,,.,000., ,., Print/Type preprer s nme Preprer s signture Dte Chek PTIN if Pi CLINT LEHMAN self-employe P000 Preprer Firm s nme SQUIRE, LEMKIN + COMPANY LLP Firm s EIN -00 Use Only Firm s ress ROCKVILLE PIKE, SUITE 7 ROCKVILLE, MD 00 Phone no My the IRS isuss this return with the preprer shown ove? (see instrutions) LHA For Pperwork Reution At tie, see the seprte instrutions. Form 0 (0) SEE SCHEDULE O FOR ORGANIZATION MISSION STATEMENT CONTINUATION Dte Other expenses (Prt I, olumn (A), lines -, f-e) ~~~~~~~~~~~~~,.,7. Totl expenses. A lines -7 (must equl Prt I, olumn (A), line ) ~~~~~~~ 7,.,0. Revenue less expenses. Sutrt line from line,. 0,0. Beginning of Current Yer En of Yer 0 Totl ssets (Prt, line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7,.,. Totl liilities (Prt, line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~~,00.,. Net ssets or fun lnes. Sutrt line from line 0 7,7. 77,. Prt II Signture Blok Uner penlties of perjury, I elre tht I hve exmine this return, inluing ompnying sheules n sttements, n to the est of my knowlege n elief, it is

2 Form 0 (0) INC Prt III Sttement of Progrm Servie Aomplishments Chek if Sheule O ontins response to ny question in this Prt III Briefly esrie the orgniztion s mission: TO INCREASE PUBLIC AWARENESS ABOUT BLADDER CANCER; TO ADVOCATE BLADDER CANCER RESEARCH; AND TO PROVIDE EDUCATIONAL AND SUPPORT SERVICES FOR THE BLADDER CANCER COMMUNITY. Pge Di the orgniztion unertke ny signifint progrm servies uring the yer whih were not liste on the prior Form 0 or 0-EZ? If "," esrie these new servies on Sheule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion ese onuting, or mke signifint hnges in how it onuts, ny progrm servies? ~~~~~~ If "," esrie these hnges on Sheule O. Desrie the orgniztion s progrm servie omplishments for eh of its three lrgest progrm servies, s mesure y expenses. Setion 0()() n 0()() orgniztions re require to report the mount of grnts n llotions to others, the totl expenses, n revenue, if ny, for eh progrm servie reporte. ( Coe: ) ( Expenses $ 7,. inluing grnts of $ ) ( Revenue $ 0. ) OUTREACH AND ADVOCACY- BCAN PROVIDES INFORMATION, RESOURCES AND SUPPORT TO BLADDER CANCER SURVIVORS, THEIR FAMILIES AND CAREGIVERS, AND THE MEDICAL COMMUNITY THROUGH OUR INTERACTIVE WEBSITE WHICH OFFERS A USER-FRIENDLY RESOURCE FOR PATIENTS, CLINICIANS AND CAREGIVERS AS WELL AS INSPIRATIONAL STORIES FROM SURVIVORS AND AN ONLINE COMMUNITY WHERE PATIENTS AND CAREGIVERS CAN FIND SUPPORT AND INFORMATION FROM OTHERS WHO ARE LIVING WITH THE DISEASE. THE STAFF RESPONDS TO REQUESTS FOR INFORMATION WHICH COMES THROUGH OUR OFFICE. BCAN STAFF, ALONG WITH LOCAL VOLUNTEERS, FACILITATED THE DEVELOPMENT OF SUPPORT GROUPS IN ROCHESTER, NY, INDIANAPOLIS, IN, AND MILWAUKEE, WI. MEMBERS OF OUR GROWING VOLUNTEER NETWORK HAVE PERSONALLY SPOKEN WITH OVER 70 UROLOGY PRACTICES AND CANCER CENTERS IN OVER 0 STATES TO DISTRIBUTE BCAN S ( Coe: ) ( Expenses $,00. inluing grnts of $ ) ( Revenue $,. ) EDUCATION AND INFORMATION - BCAN HELD THREE REGIONAL PATIENT FORUMS AT DIFFERENT VENUES IN THE COUNTRY WHICH GAVE PATIENTS AND THEIR CAREGIVERS AN OPPORTUNITY TO LEARN MORE ABOUT THEIR DISEASE FROM RECOGNIZED MEDICAL EPERTS. CLOSE TO 00 SURVIVORS AND CAREGIVERS HEARD PRESENTATIONS ON BLADDER CANCER FROM EPERTS IN THE FIELD AT PATIENT FORUMS IN LOS ANGELES, DENVER AND HOUSTON. THESE PRESENTATIONS ARE NOW AVAILABLE ON THE BCAN WEBSITE. BCAN CONTINUES TO DEVELOP ADDITIONAL EDUCATIONAL RESOURCES FOR SURVIVORS, CAREGIVERS, AND THE MEDICAL COMMUNITY.,., RESEARCH - BCAN WORKS TO ADVANCE BLADDER CANCER RESEARCH. BCAN HOSTS THE ONLY ANNUAL SCIENTIFIC CONFERENCE IN NORTH AMERICA SOLELY FOCUSED ON BLADDER CANCER RESEARCH, THE BLADDER CANCER THINK TANK. THIS YEAR, BCAN RAISED $,000 FOR OUR ANNUAL BCAN AWARD FOR BLADDER CANCER RESEARCH. THE GRANT PERIOD RUNS FROM JULY THROUGH JUNE OF THE FOLLOWING YEAR. FOR THE 0 GRANT PERIOD, JULY 0 - JUNE 0, THE AWARD SUPPORTED DR. GIL REDELMAN-SIDI OF THE MEMORIAL SLOAN-KETTERING CANCER CENTER. FOR THE 0 GRANT PERIOD, JULY 0 - JUNE 0, THE AWARD SUPPORTED DR. AMI S. BHATT OF THE DANA FARBER CANCER INSTITUTE AND BROAD INSTITUTE. ( Coe: ) ( Expenses $ inluing grnts of $ ) ( Revenue $ ) e Other progrm servies (Desrie in Sheule O.) ( Expenses $ inluing grnts of $ ) ( Revenue $ ) Totl progrm servie expenses J,7. Form 0 (0) SEE SCHEDULE O FOR CONTINUATION(S)

3 Form 0 (0) INC Prt IV Cheklist of Require Sheules e f 0 Is the orgniztion esrie in setion 0()() or 7()() (other thn privte fountion)? If "," omplete Sheule A~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the orgniztion require to omplete Sheule B, Sheule of Contriutors? ~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion engge in iret or iniret politil mpign tivities on ehlf of or in opposition to nites for puli offie? If "," omplete Sheule C, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Setion 0()() orgniztions. Di the orgniztion engge in loying tivities, or hve setion 0(h) eletion in effet uring the tx yer? If "," omplete Sheule C, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the orgniztion setion 0()(), 0()(), or 0()() orgniztion tht reeives memership ues, ssessments, or similr mounts s efine in Revenue Proeure -? If "," omplete Sheule C, Prt III ~~~~~~~~~~~~~~ Di the orgniztion mintin ny onor vise funs or ny similr funs or ounts for whih onors hve the right to provie vie on the istriution or investment of mounts in suh funs or ounts? If "," omplete Sheule D, Prt I Di the orgniztion reeive or hol onservtion esement, inluing esements to preserve open spe, the environment, histori ln res, or histori strutures? If "," omplete Sheule D, Prt II~~~~~~~~~~~~~~ Di the orgniztion mintin olletions of works of rt, historil tresures, or other similr ssets? If "," omplete Sheule D, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report n mount in Prt, line, for esrow or ustoil ount liility; serve s ustoin for mounts not liste in Prt ; or provie reit ounseling, et mngement, reit repir, or et negotition servies? If "," omplete Sheule D, Prt IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion, iretly or through relte orgniztion, hol ssets in temporrily restrite enowments, permnent enowments, or qusi-enowments? If "," omplete Sheule D, Prt V ~~~~~~~~~~~~~~~~~~~~~~~~ If the orgniztion s nswer to ny of the following questions is "," then omplete Sheule D, Prts VI, VII, VIII, I, or s pplile. Di the orgniztion report n mount for ln, uilings, n equipment in Prt, line 0? If "," omplete Sheule D, Prt VI ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report n mount for investments - other seurities in Prt, line tht is % or more of its totl ssets reporte in Prt, line? If "," omplete Sheule D, Prt VII ~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report n mount for investments - progrm relte in Prt, line tht is % or more of its totl ssets reporte in Prt, line? If "," omplete Sheule D, Prt VIII ~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report n mount for other ssets in Prt, line tht is % or more of its totl ssets reporte in Prt, line? If "," omplete Sheule D, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report n mount for other liilities in Prt, line? If "," omplete Sheule D, Prt ~~~~~~ Di the orgniztion s seprte or onsolite finnil sttements for the tx yer inlue footnote tht resses the orgniztion s liility for unertin tx positions uner FIN (ASC 70)? If "," omplete Sheule D, Prt ~~~~ Di the orgniztion otin seprte, inepenent uite finnil sttements for the tx yer? If "," omplete Sheule D, Prts I n II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ws the orgniztion inlue in onsolite, inepenent uite finnil sttements for the tx yer? If "," n if the orgniztion nswere "" to line, then ompleting Sheule D, Prts I n II is optionl ~~~~~ Is the orgniztion shool esrie in setion 70()()(A)(ii)? If "," omplete Sheule E ~~~~~~~~~~~~~~ Di the orgniztion mintin n offie, employees, or gents outsie of the Unite Sttes? ~~~~~~~~~~~~~~~~ Di the orgniztion hve ggregte revenues or expenses of more thn $0,000 from grntmking, funrising, usiness, investment, n progrm servie tivities outsie the Unite Sttes, or ggregte foreign investments vlue t $00,000 or more? If "," omplete Sheule F, Prts I n IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report on Prt I, olumn (A), line, more thn $,000 of grnts or ssistne to ny orgniztion or entity lote outsie the Unite Sttes? If "," omplete Sheule F, Prts II n IV ~~~~~~~~~~~~~~~~~ Di the orgniztion report on Prt I, olumn (A), line, more thn $,000 of ggregte grnts or ssistne to iniviuls lote outsie the Unite Sttes? If "," omplete Sheule F, Prts III n IV ~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report totl of more thn $,000 of expenses for professionl funrising servies on Prt I, olumn (A), lines n e? If "," omplete Sheule G, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report more thn $,000 totl of funrising event gross inome n ontriutions on Prt VIII, lines n? If "," omplete Sheule G, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report more thn $,000 of gross inome from gming tivities on Prt VIII, line? If "," omplete Sheule G, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion operte one or more hospitl filities? If "," omplete Sheule H ~~~~~~~~~~~~~~~~ If "" to line 0, i the orgniztion tth opy of its uite finnil sttements to this return? 7 0 e f 7 0 Pge 0 Form 0 (0) 00-0-

4 Form 0 (0) INC Prt IV Cheklist of Require Sheules (ontinue) Setion 0()() n 0()() orgniztions. Di the orgniztion engge in n exess enefit trnstion with isqulifie person uring the yer? If "," omplete Sheule L, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report more thn $,000 of grnts n other ssistne to ny government or orgniztion in the Unite Sttes on Prt I, olumn (A), line? If "," omplete Sheule I, Prts I n II ~~~~~~~~~~~~~~~~~~ Di the orgniztion report more thn $,000 of grnts n other ssistne to iniviuls in the Unite Sttes on Prt I, olumn (A), line? If "," omplete Sheule I, Prts I n III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion nswer "" to Prt VII, Setion A, line,, or out ompenstion of the orgniztion s urrent n former offiers, iretors, trustees, key employees, n highest ompenste employees? If "," omplete Sheule J ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion hve tx-exempt on issue with n outstning prinipl mount of more thn $00,000 s of the lst y of the yer, tht ws issue fter Deemer, 00? If "," nswer lines through n omplete Sheule K. If "", go to line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion invest ny proees of tx-exempt ons eyon temporry perio exeption? ~~~~~~~~~~~ Di the orgniztion mintin n esrow ount other thn refuning esrow t ny time uring the yer to efese ny tx-exempt ons? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion t s n "on ehlf of" issuer for ons outstning t ny time uring the yer? ~~~~~~~~~~~ Is the orgniztion wre tht it engge in n exess enefit trnstion with isqulifie person in prior yer, n tht the trnstion hs not een reporte on ny of the orgniztion s prior Forms 0 or 0-EZ? If "," omplete Sheule L, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ws lon to or y urrent or former offier, iretor, trustee, key employee, highest ompenste employee, or isqulifie person outstning s of the en of the orgniztion s tx yer? If "," omplete Sheule L, Prt II ~~~~~~~~~~~ Di the orgniztion provie grnt or other ssistne to n offier, iretor, trustee, key employee, sustntil ontriutor or employee thereof, grnt seletion ommittee memer, or to % ontrolle entity or fmily memer of ny of these persons? If "," omplete Sheule L, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ws the orgniztion prty to usiness trnstion with one of the following prties (see Sheule L, Prt IV instrutions for pplile filing threshols, onitions, n exeptions): A urrent or former offier, iretor, trustee, or key employee? If "," omplete Sheule L, Prt IV ~~~~~~~~~~~ A fmily memer of urrent or former offier, iretor, trustee, or key employee? If "," omplete Sheule L, Prt IV ~~ An entity of whih urrent or former offier, iretor, trustee, or key employee (or fmily memer thereof) ws n offier, iretor, trustee, or iret or iniret owner? If "," omplete Sheule L, Prt IV~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion reeive more thn $,000 in non-sh ontriutions? If "," omplete Sheule M ~~~~~~~~~ Di the orgniztion reeive ontriutions of rt, historil tresures, or other similr ssets, or qulifie onservtion ontriutions? If "," omplete Sheule M ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion liquite, terminte, or issolve n ese opertions? If "," omplete Sheule N, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion sell, exhnge, ispose of, or trnsfer more thn % of its net ssets? If "," omplete Sheule N, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion own 00% of n entity isregre s seprte from the orgniztion uner Regultions setions n ? If "," omplete Sheule R, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~ Ws the orgniztion relte to ny tx-exempt or txle entity? If "," omplete Sheule R, Prt II, III, or IV, n Prt V, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion hve ontrolle entity within the mening of setion ()()? ~~~~~~~~~~~~~~~~~~ If "" to line, i the orgniztion reeive ny pyment from or engge in ny trnstion with ontrolle entity within the mening of setion ()()? If "," omplete Sheule R, Prt V, line ~~~~~~~~~~~~~~~~~~~ Setion 0()() orgniztions. Di the orgniztion mke ny trnsfers to n exempt non-hritle relte orgniztion? If "," omplete Sheule R, Prt V, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion onut more thn % of its tivities through n entity tht is not relte orgniztion n tht is trete s prtnership for feerl inome tx purposes? If "," omplete Sheule R, Prt VI ~~~~~~~~ Di the orgniztion omplete Sheule O n provie explntions in Sheule O for Prt VI, lines n? te. All Form 0 filers re require to omplete Sheule O Pge Form 0 (0) 00-0-

5 Form 0 (0) INC Pge Prt V Sttements Regring Other IRS Filings n Tx Compline Chek if Sheule O ontins response to ny question in this Prt V Enter the numer reporte in Box of Form 0. Enter -0- if not pplile ~~~~~~~~~~~ Enter the numer of Forms W-G inlue in line. Enter -0- if not pplile ~~~~~~~~~~ Di the orgniztion omply with kup withholing rules for reportle pyments to venors n reportle gming If t lest one is reporte on line, i the orgniztion file ll require feerl employment tx returns? ~~~~~~~~~~ te. If the sum of lines n is greter thn 0, you my e require to e-file (see instrutions) 7 Orgniztions tht my reeive eutile ontriutions uner setion 70(). Di the orgniztion reeive pyment in exess of $7 me prtly s ontriution n prtly for goos n servies provie to the pyor? e f g h If the orgniztion reeive ontriution of rs, ots, irplnes, or other vehiles, i the orgniztion file Form 0-C? Sponsoring orgniztions mintining onor vise funs n setion 0()() supporting orgniztions. Di the supporting orgniztion, or onor vise fun mintine y sponsoring orgniztion, hve exess usiness holings t ny time uring the yer? 0 Sponsoring orgniztions mintining onor vise funs. Setion 0()(7) orgniztions. Enter: Setion 0()() orgniztions. Enter: Setion 7()() non-exempt hritle trusts. Is the orgniztion filing Form 0 in lieu of Form 0? (gmling) winnings to prize winners? Enter the numer of employees reporte on Form W-, Trnsmittl of Wge n Tx Sttements, file for the lenr yer ening with or within the yer overe y this return ~~~~~~~~~~ Di the orgniztion hve unrelte usiness gross inome of $,000 or more uring the yer? ~~~~~~~~~~~~~~ If "," hs it file Form 0-T for this yer? If "," provie n explntion in Sheule O ~~~~~~~~~~~~~~~ At ny time uring the lenr yer, i the orgniztion hve n interest in, or signture or other uthority over, finnil ount in foreign ountry (suh s nk ount, seurities ount, or other finnil ount)?~~~~~~~ If "," enter the nme of the foreign ountry: J See instrutions for filing requirements for Form TD F 0-., Report of Foreign Bnk n Finnil Aounts. Ws the orgniztion prty to prohiite tx shelter trnstion t ny time uring the tx yer? ~~~~~~~~~~~~ Di ny txle prty notify the orgniztion tht it ws or is prty to prohiite tx shelter trnstion? ~~~~~~~~~ If "," to line or, i the orgniztion file Form -T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Does the orgniztion hve nnul gross reeipts tht re normlly greter thn $00,000, n i the orgniztion soliit ny ontriutions tht were not tx eutile s hritle ontriutions? If "," i the orgniztion inlue with every soliittion n express sttement tht suh ontriutions or gifts were not tx eutile? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," i the orgniztion notify the onor of the vlue of the goos or servies provie? Setion 0()() qulifie nonprofit helth insurne issuers. te. See the instrutions for itionl informtion the orgniztion must report on Sheule O. Di the orgniztion reeive ny pyments for inoor tnning servies uring the tx yer? ~~~~~~~~~~~~~~~~ If "," hs it file Form 70 to report these pyments? If "," provie n explntion in Sheule O ~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion sell, exhnge, or otherwise ispose of tngile personl property for whih it ws require to file Form? ~~~~~~~~~~~~~~~ If "," inite the numer of Forms file uring the yer ~~~~~~~~~~~~~~~~ Di the orgniztion reeive ny funs, iretly or iniretly, to py premiums on personl enefit ontrt? Di the orgniztion, uring the yer, py premiums, iretly or iniretly, on personl enefit ontrt? ~~~~~~~ ~~~~~~~~~ If the orgniztion reeive ontriution of qulifie intelletul property, i the orgniztion file Form s require? ~ Di the orgniztion mke ny txle istriutions uner setion? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion mke istriution to onor, onor visor, or relte person? ~~~~~~~~~~~~~~~~~~~ Initition fees n pitl ontriutions inlue on Prt VIII, line ~~~~~~~~~~~~~~~ Gross reeipts, inlue on Form 0, Prt VIII, line, for puli use of lu filities ~~~~~~ Gross inome from memers or shreholers ~~~~~~~~~~~~~~~~~~~~~~~~~~ Gross inome from other soures (Do not net mounts ue or pi to other soures ginst mounts ue or reeive from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," enter the mount of tx-exempt interest reeive or rue uring the yer Is the orgniztion liense to issue qulifie helth plns in more thn one stte? ~~~~~~~~~~~~~~~~~~~~~ Enter the mount of reserves the orgniztion is require to mintin y the sttes in whih the orgniztion is liense to issue qulifie helth plns ~~~~~~~~~~~~~~~~~~~~~~ Enter the mount of reserves on hn~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e 7f 7g 7h Form 0 (0) 00-0-

6 Form 0 (0) INC Pge Prt VI Governne, Mngement, n Dislosure For eh "" response to lines through 7 elow, n for "" response to line,, or 0 elow, esrie the irumstnes, proesses, or hnges in Sheule O. See instrutions. Chek if Sheule O ontins response to ny question in this Prt VI Setion A. Governing Boy n Mngement Enter the numer of voting memers of the governing oy t the en of the tx yer ~~~~~~ If there re mteril ifferenes in voting rights mong memers of the governing oy, or if the governing Is there ny offier, iretor, trustee, or key employee liste in Prt VII, Setion A, who nnot e rehe t the orgniztion s miling ress? If "," provie the nmes n resses in Sheule O Setion B. Poliies (This Setion B requests informtion out poliies not require y the Internl Revenue Coe.) exempt sttus with respet to suh rrngements? Setion C. Dislosure 7 List the sttes with whih opy of this Form 0 is require to e file JMD,IL,CA,CT,FL,MA,MI,MO,NJ,NY,OH,PA oy elegte ro uthority to n exeutive ommittee or similr ommittee, explin in Sheule O. Enter the numer of voting memers inlue in line, ove, who re inepenent ~~~~~~ Di ny offier, iretor, trustee, or key employee hve fmily reltionship or usiness reltionship with ny other offier, iretor, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion elegte ontrol over mngement uties ustomrily performe y or uner the iret supervision of offiers, iretors, or trustees, or key employees to mngement ompny or other person? ~~~~~~~~~~~~~~ Di the orgniztion mke ny signifint hnges to its governing ouments sine the prior Form 0 ws file? ~~~~~ Di the orgniztion eome wre uring the yer of signifint iversion of the orgniztion s ssets? ~~~~~~~~~ Di the orgniztion hve memers or stokholers? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7 Di the orgniztion hve memers, stokholers, or other persons who h the power to elet or ppoint one or more memers of the governing oy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Are ny governne eisions of the orgniztion reserve to (or sujet to pprovl y) memers, stokholers, or persons other thn the governing oy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion ontemporneously oument the meetings hel or written tions unertken uring the yer y the following: The governing oy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Eh ommittee with uthority to t on ehlf of the governing oy? Desrie in Sheule O the proess, if ny, use y the orgniztion to review this Form 0. Di the orgniztion hve written onflit of interest poliy? If "," go to line ~~~~~~~~~~~~~~~~~~~~ Were offiers, iretors, or trustees, n key employees require to islose nnully interests tht oul give rise to onflits? ~~~~~~ Di the orgniztion regulrly n onsistently monitor n enfore ompline with the poliy? If "," esrie in Sheule O how this ws one ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ for puli inspetion. Inite how you me these ville. Chek ll tht pply. Own wesite Another s wesite Upon request Other (explin in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 0 Di the orgniztion hve lol hpters, rnhes, or ffilites? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," i the orgniztion hve written poliies n proeures governing the tivities of suh hpters, ffilites, n rnhes to ensure their opertions re onsistent with the orgniztion s exempt purposes? ~~~~~~~~~~~~~ Hs the orgniztion provie omplete opy of this Form 0 to ll memers of its governing oy efore filing the form? Di the orgniztion hve written whistlelower poliy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion hve written oument retention n estrution poliy? ~~~~~~~~~~~~~~~~~~~~~~ Di the proess for etermining ompenstion of the following persons inlue review n pprovl y inepenent persons, omprility t, n ontemporneous sustntition of the eliertion n eision? The orgniztion s CEO, Exeutive Diretor, or top mngement offiil Other offiers or key employees of the orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "" to line or, esrie the proess in Sheule O (see instrutions). ~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion invest in, ontriute ssets to, or prtiipte in joint venture or similr rrngement with txle entity uring the yer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," i the orgniztion follow written poliy or proeure requiring the orgniztion to evlute its prtiiption in joint venture rrngements uner pplile feerl tx lw, n tke steps to sfegur the orgniztion s Setion 0 requires n orgniztion to mke its Forms 0 (or 0 if pplile), 0, n 0-T (Setion 0()()s only) ville Desrie in Sheule O whether (n if so, how), the orgniztion me its governing ouments, onflit of interest poliy, n finnil sttements ville to the puli uring the tx yer. Stte the nme, physil ress, n telephone numer of the person who possesses the ooks n reors of the orgniztion: THE ORGANIZATION ST ELMO AVENUE, NO. 0, BETHESDA, MD 0 SEE SCHEDULE O FOR FULL LIST OF STATES Form 0 (0)

7 Form 0 (0) INC Pge 7 Prt VII Compenstion of Offiers, Diretors, Trustees, Key Employees, Highest Compenste Employees, n Inepenent Contrtors Chek if Sheule O ontins response to ny question in this Prt VII Setion A. Offiers, Diretors, Trustees, Key Employees, n Highest Compenste Employees Complete this tle for ll persons require to e liste. Report ompenstion for the lenr yer ening with or within the orgniztion s tx yer. List ll of the orgniztion s urrent offiers, iretors, trustees (whether iniviuls or orgniztions), regrless of mount of ompenstion. Enter -0- in olumns (D), (E), n (F) if no ompenstion ws pi. List ll of the orgniztion s urrent key employees, if ny. See instrutions for efinition of "key employee." List the orgniztion s five urrent highest ompenste employees (other thn n offier, iretor, trustee, or key employee) who reeive reportle ompenstion (Box of Form W- n/or Box 7 of Form 0-MISC) of more thn $00,000 from the orgniztion n ny relte orgniztions. List ll of the orgniztion s former offiers, key employees, n highest ompenste employees who reeive more thn $00,000 of reportle ompenstion from the orgniztion n ny relte orgniztions. List ll of the orgniztion s former iretors or trustees tht reeive, in the pity s former iretor or trustee of the orgniztion, more thn $0,000 of reportle ompenstion from the orgniztion n ny relte orgniztions. List persons in the following orer: iniviul trustees or iretors; institutionl trustees; offiers; key employees; highest ompenste employees; n former suh persons. Chek this ox if neither the orgniztion nor ny relte orgniztion ompenste ny urrent offier, iretor, or trustee. (A) (B) (C) (D) (E) (F) Nme n Title Averge hours per week (list ny hours for relte orgniztions elow line) Position (o not hek more thn one ox, unless person is oth n offier n iretor/trustee) Iniviul trustee or iretor Institutionl trustee Offier Key employee Highest ompenste employee Former Reportle ompenstion from the orgniztion (W-/0-MISC) Reportle ompenstion from relte orgniztions (W-/0-MISC) Estimte mount of other ompenstion from the orgniztion n relte orgniztions () DIANE ZIPURSKY QUALE.00 DIRECTOR/PRESIDENT, () JANICE ASHLEY.00 DIRECTOR () SETH LERNER.00 DIRECTOR () DAVID PULVER.00 DIRECTOR () MACE ROSENSTEIN.00 DIRECTOR/TREASURER () RICHARD SCOLIO.00 DIRECTOR (7) JARED SHER.00 DIRECTOR/SECRETARY () ROBERT LEVIN.00 DIRECTOR () WILLIAM SHIPLEY.00 DIRECTOR (0) LAWRENCE RZEPKA 0.00 EECUTIVE DIRECTOR 0, Form 0 (0)

8 INC Form 0 (0) Pge Prt VII Setion A. Offiers, Diretors, Trustees, Key Employees, n Highest Compenste Employees (ontinue) (A) (B) (C) (D) (E) (F) Nme n title Averge Position (o not hek more thn one Reportle Reportle Estimte hours per ox, unless person is oth n ompenstion ompenstion mount of week offier n iretor/trustee) from from relte other (list ny the orgniztions ompenstion hours for orgniztion (W-/0-MISC) from the relte (W-/0-MISC) orgniztion orgniztions n relte elow orgniztions line) Iniviul trustee or iretor Institutionl trustee Offier Key employee Highest ompenste employee Former Su-totl~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl from ontinution sheets to Prt VII, Setion A ~~~~~~~~ Totl ( lines n ) Di the orgniztion list ny former offier, iretor, or trustee, key employee, or highest ompenste employee on line? If "," omplete Sheule J for suh iniviul ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di ny person liste on line reeive or rue ompenstion from ny unrelte orgniztion or iniviul for servies renere to the orgniztion? If "," omplete Sheule J for suh person Setion B. Inepenent Contrtors Totl numer of iniviuls (inluing ut not limite to those liste ove) who reeive more thn $00,000 of reportle ompenstion from the orgniztion For ny iniviul liste on line, is the sum of reportle ompenstion n other ompenstion from the orgniztion n relte orgniztions greter thn $0,000? If "," omplete Sheule J for suh iniviul~~~~~~~~~~~~~ Complete this tle for your five highest ompenste inepenent ontrtors tht reeive more thn $00,000 of ompenstion from the orgniztion. Report ompenstion for the lenr yer ening with or within the orgniztion s tx yer., , (A) (B) (C) Nme n usiness ress NONE Desription of servies Compenstion Totl numer of inepenent ontrtors (inluing ut not limite to those liste ove) who reeive more thn $00,000 of ompenstion from the orgniztion 0 Form 0 (0)

9 Form 0 (0) INC Prt VIII Sttement of Revenue Contriutions, Gifts, Grnts n Other Similr Amounts Progrm Servie Revenue Other Revenue e f g nsh ontriutions inlue in lines -f: $ e f g 0 Government grnts (ontriutions) All other ontriutions, gifts, grnts, n similr mounts not inlue ove ~~ e Totl. A lines -f e Totl. A lines - ~~~~~~~~~~~~~~~ Totl revenue. See instrutions. Pge Chek if Sheule O ontins response to ny question in this Prt VIII (A) (B) (C) (D) Totl revenue Relte or Unrelte Revenue exlue exempt funtion usiness from tx uner setions, revenue revenue, or Feerte mpigns Memership ues ~~~~~~ ~~~~~~~~ Funrising events ~~~~~~~~ Relte orgniztions ~~~~~~ All other progrm servie revenue ~~~~~ Investment inome (inluing iviens, interest, n other similr mounts) ~~~~~~~~~~~~~~~~~ Inome from investment of tx-exempt on proees Roylties Gross rents ~~~~~~~ Less: rentl expenses~~~ Rentl inome or (loss) ~~ Net rentl inome or (loss) 7 Gross mount from sles of ssets other thn inventory Less: ost or other sis n sles expenses ~~~ Gin or (loss) ~~~~~~~ (i) Rel (ii) Personl (i) Seurities (ii) Other Net gin or (loss) Gross inome from funrising events (not inluing $ of ontriutions reporte on line ). See Prt IV, line ~~~~~~~~~~~~~ Less: iret expenses~~~~~~~~~~ Net inome or (loss) from funrising events Gross inome from gming tivities. See Prt IV, line ~~~~~~~~~~~~~ Less: iret expenses ~~~~~~~~~ Net inome or (loss) from gming tivities Gross sles of inventory, less returns n llownes ~~~~~~~~~~~~~ Less: ost of goos sol ~~~~~~~~ Net inome or (loss) from sles of inventory Misellneous Revenue All other revenue ~~~~~~~~~~~~~ f,7,. h Totl. A lines -f,7,. Business Coe CONFERENCE INCOME 000,7.,7. OTHER INCOME 000,.,. Business Coe,.,.,.,,.,. 0.,. Form 0 (0)

10 Form 0 (0) INC Prt I Sttement of Funtionl Expenses Setion 0()() n 0()() orgniztions must omplete ll olumns. All other orgniztions must omplete olumn (A). Chek if Sheule O ontins response to ny question in this Prt I Do not inlue mounts reporte on lines, (A) (B) (C) (D) Totl expenses Progrm servie Mngement n Funrising 7,,, n 0 of Prt VIII. expenses generl expenses expenses Grnts n other ssistne to governments n orgniztions in the Unite Sttes. See Prt IV, line e f g Grnts n other ssistne to iniviuls in the Unite Sttes. See Prt IV, line ~~~ Grnts n other ssistne to governments, orgniztions, n iniviuls outsie the Unite Sttes. See Prt IV, lines n ~ Benefits pi to or for memers ~~~~~~~ Compenstion of urrent offiers, iretors, trustees, n key employees ~~~~~~~~ Compenstion not inlue ove, to isqulifie persons (s efine uner setion (f)()) n persons esrie in setion ()()(B) Other slries n wges ~~~~~~~~~~ Pension pln ruls n ontriutions (inlue setion 0(k) n 0() employer ontriutions) Loying ~~~~~~~~~~~~~~~~~~ Professionl funrising servies. See Prt IV, line 7 Investment mngement fees ~~~~~~~~ Other. (If line g mount exees 0% of line, olumn (A) mount, list line g expenses on Sh O.) Insurne ~~~~~~~~~~~~~~~~~ Other expenses. Itemize expenses not overe ove. (List misellneous expenses in line e. If line e mount exees 0% of line, olumn (A) e All other expenses Totl funtionl expenses. A lines through e Joint osts. Complete this line only if the orgniztion reporte in olumn (B) joint osts from omine eutionl mpign n funrising soliittion. Chek here if following SOP - (ASC -70) ~~~ Other employee enefits ~~~~~~~~~~ Pyroll txes ~~~~~~~~~~~~~~~~ Fees for servies (non-employees): Mngement ~~~~~~~~~~~~~~~~ Legl ~~~~~~~~~~~~~~~~~~~~ Aounting ~~~~~~~~~~~~~~~~~ Avertising n promotion ~~~~~~~~~ Offie expenses~~~~~~~~~~~~~~~ Informtion tehnology ~~~~~~~~~~~ Roylties ~~~~~~~~~~~~~~~~~~ Oupny ~~~~~~~~~~~~~~~~~ Trvel ~~~~~~~~~~~~~~~~~~~ Pyments of trvel or entertinment expenses for ny feerl, stte, or lol puli offiils Conferenes, onventions, n meetings ~~ Interest ~~~~~~~~~~~~~~~~~~ Pyments to ffilites ~~~~~~~~~~~~ Depreition, epletion, n mortiztion ~~,000.,000. Pge 0,00.,0.,7.,.,.,0.,77.,.,7.,00.,.,. 7,.,.,.,0.,7..,. 0,. 0,.,.,.,.,7.,0. 0,. 7,.,0.,.,7.,0. 0,7.,.,.,7. 7,. 7,.,7.,7. 7,.,. 7,. 7,.,.,7., ,0.,... mount, list line e expenses on Sheule O.) ~~ LICENSES & PERMITS, ,. DUES AND MEMBERSHIP,.,000.,7. 0. BOARD EPENSES,.,. BANK FEES, ,0.,7. 0,.,7. 0 Form 0 (0)

11 Form 0 (0) INC Prt Blne Sheet Assets Liilities Net Assets or Fun Blnes Chek if Sheule O ontins response to ny question in this Prt Csh - non-interest-ering ~~~~~~~~~~~~~~~~~~~~~~~~~ Svings n temporry sh investments ~~~~~~~~~~~~~~~~~~ Pleges n grnts reeivle, net Totl ssets. A lines through (must equl line ) Totl liilities. A lines 7 through Orgniztions tht follow SFAS 7 (ASC ), hek here n 0 0 omplete lines 7 through, n lines n. Orgniztions tht o not follow SFAS 7 (ASC ), hek here n omplete lines 0 through. ~~~~~~~~~~~~~~~~~~~~~ Aounts reeivle, net ~~~~~~~~~~~~~~~~~~~~~~~~~~ Lons n other reeivles from urrent n former offiers, iretors, trustees, key employees, n highest ompenste employees. Complete Prt II of Sheule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Lons n other reeivles from other isqulifie persons (s efine uner setion (f)()), persons esrie in setion ()()(B), n ontriuting employers n sponsoring orgniztions of setion 0()() voluntry employees enefiiry orgniztions (see instr). Complete Prt II of Sh L ~~ tes n lons reeivle, net ~~~~~~~~~~~~~~~~~~~~~~~ Inventories for sle or use ~~~~~~~~~~~~~~~~~~~~~~~~~~ Prepi expenses n eferre hrges 0 Ln, uilings, n equipment: ost or other sis. Complete Prt VI of Sheule D Less: umulte epreition ~~~~~~~~~~~~~~~~~~ ~~~ ~~~~~~ Investments - pulily tre seurities ~~~~~~~~~~~~~~~~~~~ Investments - other seurities. See Prt IV, line ~~~~~~~~~~~~~~ Investments - progrm-relte. See Prt IV, line ~~~~~~~~~~~~~ Intngile ssets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other ssets. See Prt IV, line ~~~~~~~~~~~~~~~~~~~~~~ Aounts pyle n rue expenses ~~~~~~~~~~~~~~~~~~ Grnts pyle ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Deferre revenue ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tx-exempt on liilities ~~~~~~~~~~~~~~~~~~~~~~~~~ Esrow or ustoil ount liility. Complete Prt IV of Sheule D (A) (B) Beginning of yer En of yer 7,.,7. 0,. 0,.,70. 7,.,.,.,7. 7,.,7. 0,7. ~~~~ Lons n other pyles to urrent n former offiers, iretors, trustees, key employees, highest ompenste employees, n isqulifie persons. Complete Prt II of Sheule L ~~~~~~~~~~~~~~~~~~~~~~~ Seure mortgges n notes pyle to unrelte thir prties ~~~~~~ Unseure notes n lons pyle to unrelte thir prties ~~~~~~~~ Other liilities (inluing feerl inome tx, pyles to relte thir prties, n other liilities not inlue on lines 7-). Complete Prt of Sheule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Unrestrite net ssets ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Temporrily restrite net ssets Permnently restrite net ssets ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~ Cpitl stok or trust prinipl, or urrent funs ~~~~~~~~~~~~~~~ Pi-in or pitl surplus, or ln, uiling, or equipment fun ~~~~~~~~ Retine ernings, enowment, umulte inome, or other funs ~~~~ Totl net ssets or fun lnes ~~~~~~~~~~~~~~~~~~~~~~ Totl liilities n net ssets/fun lnes 7,. 7,. 7,.,.,00. 7,. 7,00. 0,000. 0,000. 0, ,00.,00.,. 7,7. 7 7,70.,. 0 Pge 7,7. 77,. 7,.,. Form 0 (0) 0-0-

12 Form 0 (0) INC Pge Prt I Reonilition of Net Assets Chek if Sheule O ontins response to ny question in this Prt I 7 0 Net ssets or fun lnes t en of yer. Comine lines through (must equl Prt, line, olumn (B)) 0 77,. Prt II Finnil Sttements n Reporting Chek if Sheule O ontins response to ny question in this Prt II Aounting metho use to prepre the Form 0: Csh Arul Other Totl revenue (must equl Prt VIII, olumn (A), line ) Totl expenses (must equl Prt I, olumn (A), line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~ Revenue less expenses. Sutrt line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Net ssets or fun lnes t eginning of yer (must equl Prt, line, olumn (A)) ~~~~~~~~~~ Net unrelize gins (losses) on investments Donte servies n use of filities Investment expenses Prior perio justments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other hnges in net ssets or fun lnes (explin in Sheule O) ~~~~~~~~~~~~~~~~~~~ If the orgniztion hnge its metho of ounting from prior yer or heke "Other," explin in Sheule O. Were the orgniztion s finnil sttements ompile or reviewe y n inepenent ountnt? ~~~~~~~~~~~~ If "," hek ox elow to inite whether the finnil sttements for the yer were ompile or reviewe on seprte sis, onsolite sis, or oth: Seprte sis Consolite sis Both onsolite n seprte sis Were the orgniztion s finnil sttements uite y n inepenent ountnt? ~~~~~~~~~~~~~~~~~~~ If "," hek ox elow to inite whether the finnil sttements for the yer were uite on seprte sis, onsolite sis, or oth: Seprte sis Consolite sis Both onsolite n seprte sis If "" to line or, oes the orgniztion hve ommittee tht ssumes responsiility for oversight of the uit, review, or ompiltion of its finnil sttements n seletion of n inepenent ountnt?~~~~~~~~~~~~~~~ If the orgniztion hnge either its oversight proess or seletion proess uring the tx yer, explin in Sheule O. As result of feerl wr, ws the orgniztion require to unergo n uit or uits s set forth in the Single Auit At n OMB Cirulr A-? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," i the orgniztion unergo the require uit or uits? If the orgniztion i not unergo the require uit or uits, explin why in Sheule O n esrie ny steps tken to unergo suh uits 7,,.,0. 0,0. 7,7. 0. Form 0 (0) 0-0-

13 SCHEDULE A (Form 0 or 0-EZ) Deprtment of the Tresury Internl Revenue Servie Complete if the orgniztion is setion 0()() orgniztion or setion 7()() nonexempt hritle trust. Atth to Form 0 or Form 0-EZ. See seprte instrutions. BLADDER CANCER ADVOCACY NETWORK, OMB Open to Puli Inspetion Nme of the orgniztion Employer ientifition numer INC Prt I Reson for Puli Chrity Sttus (All orgniztions must omplete this prt.) See instrutions. The orgniztion is not privte fountion euse it is: (For lines through, hek only one ox.) 7 0 e f g h A hurh, onvention of hurhes, or ssoition of hurhes esrie in setion 70()()(A)(i). A shool esrie in setion 70()()(A)(ii). (Atth Sheule E.) A hospitl or oopertive hospitl servie orgniztion esrie in setion 70()()(A)(iii). A meil reserh orgniztion operte in onjuntion with hospitl esrie in setion 70()()(A)(iii). Enter the hospitl s nme, ity, n stte: An orgniztion operte for the enefit of ollege or university owne or operte y governmentl unit esrie in setion 70()()(A)(iv). (Complete Prt II.) A feerl, stte, or lol government or governmentl unit esrie in setion 70()()(A)(v). An orgniztion tht normlly reeives sustntil prt of its support from governmentl unit or from the generl puli esrie in setion 70()()(A)(vi). (Complete Prt II.) A ommunity trust esrie in setion 70()()(A)(vi). (Complete Prt II.) An orgniztion tht normlly reeives: () more thn /% of its support from ontriutions, memership fees, n gross reeipts from tivities relte to its exempt funtions - sujet to ertin exeptions, n () no more thn /% of its support from gross investment inome n unrelte usiness txle inome (less setion tx) from usinesses quire y the orgniztion fter June 0, 7. See setion 0()(). (Complete Prt III.) An orgniztion orgnize n operte exlusively to test for puli sfety. See setion 0()(). An orgniztion orgnize n operte exlusively for the enefit of, to perform the funtions of, or to rry out the purposes of one or more pulily supporte orgniztions esrie in setion 0()() or setion 0()(). See setion 0()(). Chek the ox tht esries the type of supporting orgniztion n omplete lines e through h. Type I Type II Type III - Funtionlly integrte Type III - n-funtionlly integrte By heking this ox, I ertify tht the orgniztion is not ontrolle iretly or iniretly y one or more isqulifie persons other thn fountion mngers n other thn one or more pulily supporte orgniztions esrie in setion 0()() or setion 0()(). If the orgniztion reeive written etermintion from the IRS tht it is Type I, Type II, or Type III supporting orgniztion, hek this ox Sine August 7, 00, hs the orgniztion epte ny gift or ontriution from ny of the following persons? (i) (ii) (iii) Puli Chrity Sttus n Puli Support ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ A person who iretly or iniretly ontrols, either lone or together with persons esrie in (ii) n (iii) elow, the governing oy of the supporte orgniztion? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ A fmily memer of person esrie in (i) ove? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ A % ontrolle entity of person esrie in (i) or (ii) ove? ~~~~~~~~~~~~~~~~~~~~~~~~ Provie the following informtion out the supporte orgniztion(s). 0 g(i) g(ii) g(iii) (i) Nme of supporte (ii) EIN (iii) Type of orgniztion (iv) Is the orgniztion (v) Di you notify the (vi) Is the (vii) (esrie on lines - in ol. (i) liste in your orgniztion in ol. orgniztion in ol. Amount of monetry orgniztion (i) orgnize in the support ove or IRC setion governing oument? (i) of your support? U.S.? (see instrutions) ) Totl LHA For Pperwork Reution At tie, see the Instrutions for Form 0 or 0-EZ. Sheule A (Form 0 or 0-EZ)

14 Sheule A (Form 0 or 0-EZ) 0 INC Pge Prt II Support Sheule for Orgniztions Desrie in Setions 70()()(A)(iv) n 70()()(A)(vi) (Complete only if you heke the ox on line, 7, or of Prt I or if the orgniztion file to qulify uner Prt III. If the orgniztion fils to qulify uner the tests liste elow, plese omplete Prt III.) Setion A. Puli Support Clenr yer (or fisl yer eginning in) Totl. A lines through ~~~ Puli support. Sutrt line from line. Clenr yer (or fisl yer eginning in) 7 0 ssets (Explin in Prt IV.) ~~~~ Totl support. A lines 7 through 0 () 00 () 00 () 00 () 0 (e) 0 (f) Totl () 00 () 00 () 00 () 0 (e) 0 (f) Totl 7,.,0. 7,. 77,7.,7,.,,0. First five yers. If the Form 0 is for the orgniztion s first, seon, thir, fourth, or fifth tx yer s setion 0()() 7 0% -fts-n-irumstnes test - 0. If the orgniztion i not hek ox on line,, or, n line is 0% or more, Gifts, grnts, ontriutions, n memership fees reeive. (Do not inlue ny "unusul grnts.") ~~ Tx revenues levie for the orgniztion s enefit n either pi to or expene on its ehlf ~~~~ The vlue of servies or filities furnishe y governmentl unit to the orgniztion without hrge ~ The portion of totl ontriutions y eh person (other thn governmentl unit or pulily supporte orgniztion) inlue on line tht exees % of the mount shown on line, olumn (f) ~~~~~~~~~~~~ Setion B. Totl Support Amounts from line ~~~~~~~ Gross inome from interest, iviens, pyments reeive on seurities lons, rents, roylties n inome from similr soures ~ Net inome from unrelte usiness tivities, whether or not the usiness is regulrly rrie on ~ Other inome. Do not inlue gin or loss from the sle of pitl 7,.,0. 7,. 77,7.,7,.,,0. 7,.,0. 7,. 77,7.,7,.,,0. Gross reeipts from relte tivities, et. (see instrutions) ~~~~~~~~~~~~~~~~~~~~~~~ /% support test - 0. If the orgniztion i not hek ox on line or, n line is /% or more, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ n if the orgniztion meets the "fts-n-irumstnes" test, hek this ox n stop here. Explin in Prt IV how the orgniztion meets the "fts-n-irumstnes" test. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~~~~~~ 0% -fts-n-irumstnes test - 0. If the orgniztion i not hek ox on line,,, or 7, n line is 0% or more, n if the orgniztion meets the "fts-n-irumstnes" test, hek this ox n stop here. Explin in Prt IV how the orgniztion meets the "fts-n-irumstnes" test. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~ Privte fountion. If the orgniztion i not hek ox on line,,, 7, or 7, hek this ox n see instrutions,0.,,.,0.,0...,.,.,,7. 77,0. orgniztion, hek this ox n stop here Setion C. Computtion of Puli Support Perentge Puli support perentge for 0 (line, olumn (f) ivie y line, olumn (f)) ~~~~~~~~~~~~ 7.7 Puli support perentge from 0 Sheule A, Prt II, line ~~~~~~~~~~~~~~~~~~~~~ 7. /% support test - 0. If the orgniztion i not hek the ox on line, n line is /% or more, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sheule A (Form 0 or 0-EZ) 0 % % 0-0-

15 Sheule A (Form 0 or 0-EZ) 0 Prt III Support Sheule for Orgniztions Desrie in Setion 0()() Clenr yer (or fisl yer eginning in) The vlue of servies or filities furnishe y governmentl unit to the orgniztion without hrge ~ Totl. A lines through ~~~ 7 Amounts inlue on lines,, n reeive from isqulifie persons Amounts inlue on lines n reeive from other thn isqulifie persons tht exee the greter of $,000 or % of the mount on line for the yer ~~~~~~ A lines 7 n 7 ~~~~~~~ Puli support (Sutrt line 7 from line.) Clenr yer (or fisl yer eginning in) Amounts from line ~~~~~~~ 0 Gross inome from interest, iviens, pyments reeive on seurities lons, rents, roylties n inome from similr soures ~ Unrelte usiness txle inome (less setion txes) from usinesses quire fter June 0, 7 ~~~~ 0-0- () 00 () 00 () 00 () 0 (e) 0 (f) Totl () 00 () 00 () 00 () 0 (e) 0 (f) Totl First five yers. If the Form 0 is for the orgniztion s first, seon, thir, fourth, or fifth tx yer s setion 0()() orgniztion, hek this ox n stop here Setion C. Computtion of Puli Support Perentge Puli support perentge from 0 Sheule A, Prt III, line Setion D. Computtion of Investment Inome Perentge 7 Pge Puli support perentge for 0 (line, olumn (f) ivie y line, olumn (f)) ~~~~~~~~~~~~ % /% support tests - 0. If the orgniztion i not hek the ox on line, n line is more thn /%, n line 7 is not 0 (Complete only if you heke the ox on line of Prt I or if the orgniztion file to qulify uner Prt II. If the orgniztion fils to qulify uner the tests liste elow, plese omplete Prt II.) Setion A. Puli Support Gifts, grnts, ontriutions, n memership fees reeive. (Do not inlue ny "unusul grnts.") ~~ Gross reeipts from missions, merhnise sol or servies performe, or filities furnishe in ny tivity tht is relte to the orgniztion s tx-exempt purpose Gross reeipts from tivities tht re not n unrelte tre or usiness uner setion ~~~~~ Tx revenues levie for the orgniztion s enefit n either pi to or expene on its ehlf ~~~~ Setion B. Totl Support A lines 0 n 0 ~~~~~~ Net inome from unrelte usiness tivities not inlue in line 0, whether or not the usiness is regulrly rrie on ~~~~~~~ Other inome. Do not inlue gin or loss from the sle of pitl ssets (Explin in Prt IV.) ~~~~ Totl support. (A lines, 0,, n.) Investment inome perentge for 0 (line 0, olumn (f) ivie y line, olumn (f)) Investment inome perentge from 0 Sheule A, Prt III, line 7 ~~~~~~~~~~~~~~~~~~ ~~~~~~~~ 7 % more thn /%, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~ /% support tests - 0. If the orgniztion i not hek ox on line or line, n line is more thn /%, n line is not more thn /%, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion~~~~ Privte fountion. If the orgniztion i not hek ox on line,, or, hek this ox n see instrutions % % Sheule A (Form 0 or 0-EZ) 0

16 Sheule B (Form 0, 0-EZ, or 0-PF) Deprtment of the Tresury Internl Revenue Servie Atth to Form 0, Form 0-EZ, or Form 0-PF. OMB Nme of the orgniztion Employer ientifition numer BLADDER CANCER ADVOCACY NETWORK, INC Orgniztion type(hek one): Sheule of Contriutors 0 Filers of: Setion: Form 0 or 0-EZ 0()( ) (enter numer) orgniztion 7()() nonexempt hritle trust not trete s privte fountion 7 politil orgniztion Form 0-PF 0()() exempt privte fountion 7()() nonexempt hritle trust trete s privte fountion 0()() txle privte fountion Chek if your orgniztion is overe y the Generl Rule or Speil Rule. te. Only setion 0()(7), (), or (0) orgniztion n hek oxes for oth the Generl Rule n Speil Rule. See instrutions. Generl Rule For n orgniztion filing Form 0, 0-EZ, or 0-PF tht reeive, uring the yer, $,000 or more (in money or property) from ny one ontriutor. Complete Prts I n II. Speil Rules For setion 0()() orgniztion filing Form 0 or 0-EZ tht met the /% support test of the regultions uner setions 0()() n 70()()(A)(vi) n reeive from ny one ontriutor, uring the yer, ontriution of the greter of () $,000 or () % of the mount on (i) Form 0, Prt VIII, line h, or (ii) Form 0-EZ, line. Complete Prts I n II. For setion 0()(7), (), or (0) orgniztion filing Form 0 or 0-EZ tht reeive from ny one ontriutor, uring the yer, totl ontriutions of more thn $,000 for use exlusively for religious, hritle, sientifi, literry, or eutionl purposes, or the prevention of ruelty to hilren or nimls. Complete Prts I, II, n III. For setion 0()(7), (), or (0) orgniztion filing Form 0 or 0-EZ tht reeive from ny one ontriutor, uring the yer, ontriutions for use exlusively for religious, hritle, et., purposes, ut these ontriutions i not totl to more thn $,000. If this ox is heke, enter here the totl ontriutions tht were reeive uring the yer for n exlusively religious, hritle, et., purpose. Do not omplete ny of the prts unless the Generl Rule pplies to this orgniztion euse it reeive nonexlusively religious, hritle, et., ontriutions of $,000 or more uring the yer ~~~~~~~~~~~~~~~~~ $ Cution. An orgniztion tht is not overe y the Generl Rule n/or the Speil Rules oes not file Sheule B (Form 0, 0-EZ, or 0-PF), ut it must nswer "" on Prt IV, line, of its Form 0; or hek the ox on line H of its Form 0-EZ or on Prt I, line of its Form 0-PF, to ertify tht it oes not meet the filing requirements of Sheule B (Form 0, 0-EZ, or 0-PF). LHA For Pperwork Reution At tie, see the Instrutions for Form 0, 0-EZ, or 0-PF. Sheule B (Form 0, 0-EZ, or 0-PF) (0) --

17 Sheule B (Form 0, 0-EZ, or 0-PF) (0) Pge Nme of orgniztion Employer ientifition numer BLADDER CANCER ADVOCACY NETWORK, INC Prt III Exlusively religious, hritle, et., iniviul ontriutions to setion 0()(7), (), or (0) orgniztions tht totl more thn $,000 for the yer. Complete olumns () through (e) n the following line entry. For orgniztions ompleting Prt III, enter the totl of exlusively religious, hritle, et., ontriutions of $,000 or less for the yer. (Enter this informtion one.) $ Use uplite opies of Prt III if itionl spe is neee. (). from Prt I () Purpose of gift () Use of gift () Desription of how gift is hel (e) Trnsfer of gift Trnsferee s nme, ress, n ZIP + Reltionship of trnsferor to trnsferee (). from Prt I () Purpose of gift () Use of gift () Desription of how gift is hel (e) Trnsfer of gift Trnsferee s nme, ress, n ZIP + Reltionship of trnsferor to trnsferee (). from Prt I () Purpose of gift () Use of gift () Desription of how gift is hel (e) Trnsfer of gift Trnsferee s nme, ress, n ZIP + Reltionship of trnsferor to trnsferee (). from Prt I () Purpose of gift () Use of gift () Desription of how gift is hel (e) Trnsfer of gift Trnsferee s nme, ress, n ZIP + Reltionship of trnsferor to trnsferee -- Sheule B (Form 0, 0-EZ, or 0-PF) (0)

18 SCHEDULE D (Form 0) Complete if the orgniztion nswere "," to Form 0, Prt IV, line, 7,,, 0,,,,, e, f,, or. Deprtment of the Tresury Internl Revenue Servie Atth to Form 0. See seprte instrutions. Nme of the orgniztion BLADDER CANCER ADVOCACY NETWORK, Prt I 7 (i) (ii) OMB Open to Puli Inspetion Employer ientifition numer INC Orgniztions Mintining Donor Avise Funs or Other Similr Funs or Aounts. Complete if the orgniztion nswere "" to Form 0, Prt IV, line. () Donor vise funs () Funs n other ounts Totl numer t en of yer ~~~~~~~~~~~~~~~ Aggregte ontriutions to (uring yer) Aggregte grnts from (uring yer) Aggregte vlue t en of yer ~~~~~~~~ ~~~~~~~~~~ ~~~~~~~~~~~~~ Di the orgniztion inform ll onors n onor visors in writing tht the ssets hel in onor vise funs re the orgniztion s property, sujet to the orgniztion s exlusive legl ontrol?~~~~~~~~~~~~~~~~~~ Di the orgniztion inform ll grntees, onors, n onor visors in writing tht grnt funs n e use only for hritle purposes n not for the enefit of the onor or onor visor, or for ny other purpose onferring impermissile privte enefit? Prt II Conservtion Esements. Complete if the orgniztion nswere "" to Form 0, Prt IV, line 7. Purpose(s) of onservtion esements hel y the orgniztion (hek ll tht pply). Preservtion of ln for puli use (e.g., reretion or eution) Protetion of nturl hitt Preservtion of open spe Preservtion of n historilly importnt ln re Preservtion of ertifie histori struture Complete lines through if the orgniztion hel qulifie onservtion ontriution in the form of onservtion esement on the lst y of the tx yer. Totl numer of onservtion esements ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl rege restrite y onservtion esements ~~~~~~~~~~~~~~~~~~~~~~~~~~ Numer of onservtion esements on ertifie histori struture inlue in () ~~~~~~~~~~~~ Numer of onservtion esements inlue in () quire fter /7/0, n not on histori struture liste in the Ntionl Register ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Hel t the En of the Tx Yer Numer of onservtion esements moifie, trnsferre, relese, extinguishe, or terminte y the orgniztion uring the tx yer Numer of sttes where property sujet to onservtion esement is lote Does the orgniztion hve written poliy regring the perioi monitoring, inspetion, hnling of violtions, n enforement of the onservtion esements it hols? ~~~~~~~~~~~~~~~~~~~~~~~~~ Stff n volunteer hours evote to monitoring, inspeting, n enforing onservtion esements uring the yer Amount of expenses inurre in monitoring, inspeting, n enforing onservtion esements uring the yer $ Does eh onservtion esement reporte on line () ove stisfy the requirements of setion 70(h)()(B)(i) n setion 70(h)()(B)(ii)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ In Prt III, esrie how the orgniztion reports onservtion esements in its revenue n expense sttement, n lne sheet, n inlue, if pplile, the text of the footnote to the orgniztion s finnil sttements tht esries the orgniztion s ounting for onservtion esements. Prt III Orgniztions Mintining Colletions of Art, Historil Tresures, or Other Similr Assets. Complete if the orgniztion nswere "" to Form 0, Prt IV, line. If the orgniztion elete, s permitte uner SFAS (ASC ), not to report in its revenue sttement n lne sheet works of rt, historil tresures, or other similr ssets hel for puli exhiition, eution, or reserh in furtherne of puli servie, provie, in Prt III, the text of the footnote to its finnil sttements tht esries these items. If the orgniztion elete, s permitte uner SFAS (ASC ), to report in its revenue sttement n lne sheet works of rt, historil tresures, or other similr ssets hel for puli exhiition, eution, or reserh in furtherne of puli servie, provie the following mounts relting to these items: Revenues inlue in Form 0, Prt VIII, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $ Assets inlue in Form 0, Prt ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the orgniztion reeive or hel works of rt, historil tresures, or other similr ssets for finnil gin, provie the following mounts require to e reporte uner SFAS (ASC ) relting to these items: Revenues inlue in Form 0, Prt VIII, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $ Assets inlue in Form 0, Prt Supplementl Finnil Sttements ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $ $ 0 LHA For Pperwork Reution At tie, see the Instrutions for Form 0. Sheule D (Form 0)

19 Sheule D (Form 0) 0 INC Pge Prt III Orgniztions Mintining Colletions of Art, Historil Tresures, or Other Similr Assets (ontinue) Using the orgniztion s quisition, ession, n other reors, hek ny of the following tht re signifint use of its olletion items e f e If "," explin the rrngement in Prt III. Chek here if the explntion hs een provie in Prt III Prt V Enowment Funs. Complete if the orgniztion nswere "" to Form 0, Prt IV, line 0. e f g (i) (ii) Desrie in Prt III the intene uses of the orgniztion s enowment funs. Prt VI Ln, Builings, n Equipment. See Form 0, Prt, line 0. (hek ll tht pply): Puli exhiition Sholrly reserh Preservtion for future genertions Lon or exhnge progrms Provie esription of the orgniztion s olletions n explin how they further the orgniztion s exempt purpose in Prt III. During the yer, i the orgniztion soliit or reeive ontions of rt, historil tresures, or other similr ssets to e sol to rise funs rther thn to e mintine s prt of the orgniztion s olletion? Prt IV Esrow n Custoil Arrngements. Complete if the orgniztion nswere "" to Form 0, Prt IV, line, or reporte n mount on Form 0, Prt, line. Is the orgniztion n gent, trustee, ustoin or other intermeiry for ontriutions or other ssets not inlue on Form 0, Prt? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ () Current yer () Prior yer () Two yers k () Three yers k (e) Four yers k e f (i) (ii) () Cost or other () Cost or other () Aumulte () Book vlue sis (investment) sis (other) epreition e Other Totl. A lines through e. (Column () must equl Form 0, Prt, olumn (B), line 0().) Other If "," explin the rrngement in Prt III n omplete the following tle: Beginning lne Aitions uring the yer ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Distriutions uring the yer ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ening lne ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion inlue n mount on Form 0, Prt, line? ~~~~~~~~~~~~~~~~~~~~~~~~~ Beginning of yer lne Contriutions ~~~~~~~~~~~~~~ Net investment ernings, gins, n losses Grnts or sholrships Other expenitures for filities n progrms Aministrtive expenses En of yer lne ~~~~~~~ ~~~~~~~~~ ~~~~~~~~~~~~~ ~~~~~~~~ ~~~~~~~~~~ Provie the estimte perentge of the urrent yer en lne (line g, olumn ()) hel s: Bor esignte or qusi-enowment % Permnent enowment % Temporrily restrite enowment % The perentges in lines,, n shoul equl 00%. Are there enowment funs not in the possession of the orgniztion tht re hel n ministere for the orgniztion y: unrelte orgniztions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ relte orgniztions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "" to (ii), re the relte orgniztions liste s require on Sheule R? ~~~~~~~~~~~~~~~~~~~~~~ Desription of property Ln ~~~~~~~~~~~~~~~~~~~~ Builings ~~~~~~~~~~~~~~~~~~ Lesehol improvements ~~~~~~~~~~ Equipment ~~~~~~~~~~~~~~~~~ Amount,7. 7,.,7.,7. Sheule D (Form 0)

20 Sheule D (Form 0) 0 Pge Prt VII Investments - Other Seurities. See Form 0, Prt, line. () Desription of seurity or tegory (inluing nme of seurity) () Book vlue () Metho of vlution: Cost or en-of-yer mrket vlue () () () (I) Totl. (Col. () must equl Form 0, Prt, ol. (B) line.) Prt VIII Investments - Progrm Relte. See Form 0, Prt, line. () Desription of investment type () Book vlue () Metho of vlution: Cost or en-of-yer mrket vlue (0) Totl. (Col. () must equl Form 0, Prt, ol. (B) line.) Prt I Other Assets. See Form 0, Prt, line. () Desription (0) Totl. (Column () must equl Form 0, Prt, ol. (B) line.) Prt Other Liilities. See Form 0, Prt, line.. () Desription of liility () Book vlue () Totl. (Column () must equl Form 0, Prt, ol. (B) line.) Finnil erivtives Closely-hel equity interests Other (A) (B) (C) (D) (E) (F) (G) (H) () () () () () () (7) () () () () () () () () (7) () () () () () () () () (7) () () (0) BLADDER CANCER ADVOCACY NETWORK, INC ~~~~~~~~~~~~~~~ ~~~~~~~~~~~ Feerl inome txes DEFERRED LEASE BENEFIT,00. () Book vlue FIN (ASC 70) Footnote. In Prt III, provie the text of the footnote to the orgniztion s finnil sttements tht reports the orgniztion s liility for unertin tx positions uner FIN (ASC 70). Chek here if the text of the footnote hs een provie in Prt III,00. Sheule D (Form 0) 0