efile GRAPHIC rint - DO NOT PROCESS AS Filed Data - DLN: Return of Organization Exempt From Income Tax

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1 For Privacy Act and Paperwork Reduction Act tice, see the separate instructions. C at N Y Form 99 ( 9) efile GRAPHIC rint - DO NOT PROCESS AS Filed Data - DLN: M99 *E Return of Organization Exempt From Income Tax OMB Under section 51(c), enefit 57, or trust 4947(a)(1) or private foundation) of the Internal Revenue Code (except lack lung Deparlmenloflhe Treasury Open tg Pulic Imemamevenuesewlce ll-the organization may have to use a copy ofthis return to satisfy state reporting requirements Inspection A For the 9 calendar year, or tax year eginning and ending C Name of organization D Employer identification numer B Check if applicale Please TLC HEALTH NETWORK I- Address change Use IRS lael or Doing Business As E Telephone numer I- Name change Print Ol" type. See I- Initial return (716) specific Numer and street (or P O ox if mail is not delivered to street address) Room/suite Inst"-IC" 1644 SENECA RD G GFOSS FGCGIDIS $ 5,54,945 I- Terminated tions. I- Amended return I- Application pending City or town, state or country, and ZIP + 4 IRVING, NY F Name and address ofprincipal officer H(a) IS thrs a group return for Jo NATHAN 1 LAWRENCE arf,,,ates6 I-Yes VNC, 1644 SENECA ROAD IRI/ING*NY H() Are all affiliates included? I-Yes I- If"," attach a list (see instructions) I Tax-exempt status I7 51(c) ( 3) 1 rinsen no) I- 4947(a)(1) or I- 57 Hrc) Group exemrmon numer h, J Wesite: ll- www tlc health org IEIII K Form of organization I7 Corporation I- Trust I- Association I- Other ll- I L Year of formation I M State of legal domicile NY Summary 1 Briefly descrie the organizationfs mission or most significant activities PROVIDE THE COMMUNITY WITH AN ARRAY OF QUALITY HEALTHCARE SERVICES INCLUDING HOSPITAL, EMERGENCY, PRIMARY CARE, LONG TERM, HOME HEALTH, DENTAL, MENTAL HEALTH AND CHEMICAL DEPENDENCY SERVICES Sign Here Paid Check this ox P1- ifthe organization discontinued its operations or disposed of more than 5% ofits net 3 Numer ofvoting memers ofthe governing ody (Part VI, line la) assets116 4 Numer ofindependent voting memers ofthe governing ody (Part VI, line 1) 7a 5 Total numer ofemployees (Part V, line a) Total numer ofvolunteers (estimate if necessary).... 7a Total gross unrelated usiness revenue from Part VIII, column (C), line 1. in Net unrelated usiness taxale income from Form 99-T, line 34.. i-37, a Preparer"s Use Only Contriutions and grants (Part VIII, line 1h). Program service revenue (PartVIII,line g)..... Investment income (Part VIII, column (A), lines 3, 4, and 7d)... Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 1c, and 11e) Total revenue-add lines 8 through 11 (must equal Part VIII, column (A), line Grants and similar amounts paid (Part I, column (A), lines 1-3). Benefits paid to orfor memers (Part I, column (A), line 4).... Salaries, other compensation, employee enefits (Part I, column (A), lines 5 1) Professional fundraising fees (Part I, column (A), line 11e). Total fundraising expenses (Part D(, column (D), line 5) ll-113/959 Other expenses (Part I, column (A), lines 11a-11d,11f-4f).... Total expenses Add lines (must equal Part I, column (A), line 5) Revenue less expenses Sutractline18fromline Total assets (Part, line 16). Totalliailities (Part,line 6) Net assets orfund alances Sutract line 1 from line. Signature Block Prior Year Current Year 9,317,61 1,15,575 46,771,338 45,339,135 19,761 83,464 1,515,599 3,99,771 57,714,31 5,54,945 33,31,1 8,94,343 1,656,31,88,36 54,687,3 51,786,75 3,7,8-1,81,76 Beginning of Current Year End of Year,663,6,578,5 14,947,917 13,895,669 7,715,343 6,68,583 Under penalties of perjury, Ideclare that I have examined this return, including accompanying schedules and statements, and to the est of my knowledge and elief, it is true, correct, and complete Declaration of preparer (other than officer) is ased on all information of which preparer has any knowledge, Sig *HH* nature I of officer Date JONATHAN I LAWRENCE PRESIDENT AND CEO, Type or print name and title preparer-s Date Check if Preparerfs identifying numer Srgnature, Mighaelj Grimaldi self- (see instructions) Firmfs name (or yours Lumsden & McCormick LLP if self-employed),, address, and ZIP Main sr suite 43 Buffalo, NY 143 empolyed ll I EIN ll Phone no I- (716) May the IRS discuss this return with the preparer shown aove? (see instructions). I7 Yes I-

2 4d Other program services (Descrie in Schedule O ) (Expenses $ including grants of$ ) (Revenue $ ) 4e Total program service expenseshl-$ 37,3 14,448 Form 99 (9) Form 99 (9) Page Statement of Program Service Accomplishments 1 Briefly descrie the organizationls mission PROVIDE THE COMMUNITY WITH AN ARRAY OF QUALITY HEALTHCARE SERVICES INCLUDING HOSPITAL, EMERGENCY, PRIMARY CARE, LONG TERM, HOME HEALTH, DENTAL, MENTAL HEALTH AND CHEMICAL DEPENDENCY SERVICES Did organization undertake any significant program services during the year which were not listed on thepriorform99or99-ez? I-YesI7 If"Yes," descrie these new services on Schedule O services7... I7YesI- 3 Did the organization cease conducting, or make significant changes in how it conducts, any program If"Yes," descrie these changes on Schedule O 4 Descrie the exempt purpose achievements for each ofthe organizationfs three largest program services y expenses Section 51(c)(3) and 51(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount ofgrants and allocations to others, the total expenses, and revenue, ifany, for each program service reported 4a (Code ) (Expenses $ 37,314,448 including grants of $ ) (Revenue $ 49,13,371 ) THE ORGANIZATION OPERATES A HOSPITAL, SKILLED NURSING FACILITY, EMERGENCY ROOM AND LONG TERM HOME HEALTH CARE SERVICES FOR THE WESTERN NEW YORK COMMUNITY, INCLUDING ACUTE INPATIENT, OUTPATIENT, PSYCHIATRIC CARE, LONG TERM NURSING CARE AND HOME HEALTH CARE ON A DIAGNOSTIC AND PREVENTIIVE TREATMENT BASIS 4 (Code ) (Expenses $ including grants of $ ) (Revenue $ ) 4C (Code ) (Expenses $ including grants of $ ) (Revenue $ )

3 Form 99 (9) page 3 w checklist of Required schedules Yes 1 Yes completescheduleae... IstheorganizationrequiredtocompleteScheduleB,ScheduleofContriutors?E Did the organization engage in direct or indirect political campaign activities on ehalfofor in opposition Is the organization descried in section 51(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," to PartII... candidates for pulic office? If "Yes,"complete Schedule C, Section 51(c)(3) organizations. Did the organization engage in loying activities? If "Yes,"complete Schedule C, Section 51(c)(4), 51(c)(5), and 51(c)(6) organizations. Is the organization suject to the section 6 33(e) notice and reporting requirement and proxy tax? If "Yes,"complete Schedule C, Part III.... Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distriution or investment ofamounts in such funds or accounts? If "Yes," complete ScheduleD,PartIE... Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas or historic structures? If "Yes,"complete Schedule D, Part IIE.. Did the organization maintain collections ofworks ofart, historical treasures, or other similar assets? If completescheduled,partiiie Did the organization report an amount in Part, line 1, serve as a custodian for amounts not listed in P provide credit counseling, det management, credit repair, or det negotiation services? If "Yes," completescheduled,partil/e Did the organization, directly or through a related organization, hold assets in term, permanent,or quasiendowments? If "Yes," complete Schedule D, Part l/e Is the organization"s answer to any ofthe following questions "Yes"? If so,complete Schedule D, Parts VI, VII, VIII, I, oras applicale I Did the organization report an amount for land, uildings, and equipment in Part, line1? If "Yes,"complete Schedule D, Part VI. I Did the organization report an amount for investments-other securities in Part, line 1 that is 5% or its total assets reported in Part, line 16? If "Yes,"complete Schedule D, Part VII. I Did the organization report an amount for investments-program related in Part, line 13 that is 5% or its total assets reported in Part, line 16? If "Yes,"complete Schedule D, Part VIII. I Did the organization report an amount for other assets in Part, line 15 that is 5% or more ofits total reported in Part, line 16? If "Yes," complete Schedule D, Part I. I Did the organization report an amount for other liailities in Part, line 5? If "Yes,"complete Schedule "Yes, 1/ art, or *E more of more of assets D, Part Yes Yes Yes 1 1A 13 14a I Did the organizationls separate or consolidated financial statements forthe tax year include a footnote that addresses the organizationls liaility for uncertain tax positions under FIN 48? If "Yes,"complete Schedule D, Part. Did the organization otain separate, independent audited financial statements for the tax year? If "Yes," scheduie D, Paris I, II, and III *E Was the organization included in consolidated, independent audited financial statements forthe tax year? If "Yes,"completing Schedule D, Parts I, II, and III is optional E a Is the organization a school descried in section 17()(1)(A)(ii)? If "Yes,"complete ScheduleE Did the organization maintain an office, employees, or agents outside ofthe United States?.... Did the organization have aggregate revenues or expenses of more than $1, from grantmaking, fundraising, usiness, and service activities outside the United States? If "Yes, " complete Schedule F, Part I Did the organization report on Part I, column (A), line 3, more than $5, ofgrants or assistance to a organization or entity located outside the U S? If "Yes,"complete ScheduleF, Part II.. Did the organization report on Part I, column (A), line 3, more than $5, ofaggregate grants or assis individuals located outside the U S? If "Yes,"complete ScheduleF, Part III.. Did the organization report a total of more than $15,, ofexpenses for professional fundraising services on Part I, column (A), lines 6 and 11e? If "Yes,"complete Schedule G, Part I Did the organization report more than $15, total offundraising event gross income and contriutions VIII, lines 1c and 8a? If "Yes,"complete Schedule G, Part II Did the organization report more than $15, ofgross income from gaming activities on Part VIII, line "Yes,"completeScheduleG,PartIII Did the organization operate one or more hospitals? If "Yes,"complete ScheduleH. complete DFOQ lam nv tance to on Part 9a? If *E a Yes Form 99 (9)

4 Form 99 (9) page4 M Checklist of Required Schedules (continued) 1 3 4a c d 5a Did the organization report more than $5, ofgrants and other assistance to governments and organizations the United States on Part I, column (A), line 1? If "Yes/"complete Schedule I, Parts I and II.. Did the organization report more than $5, ofgrants and other assistance to individuals in the United States on Part I, column (A), line? If "Yes/"complete Schedule I, Parts I and III..... Did the organization answer "Yes" to Part VII, Section A, questions 3, 4, or 5, aout compensation ofthe organizationls current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes/"complete ScheduleJ E Did the organization have a tax-exempt ond issue with an outstanding principal amount of more than $1, as ofthe last day ofthe year, that was issued after Decemer 31,? If "Yes/"answer quest/ons 4-4d and complete Schedule K. If ","go to l/he Did the organization invest any proceeds oftax-exempt onds eyond a temporary period exception?.. Did the organization maintain an escrow account other than a refunding escrow at any time during the year todefeaseanytax-exemptonds? Did the organization act as an "on ehalfof" issuer for onds outstanding at any time during the year?... Section 51(c)(3) and 51(c)(4) organizations. Did the organization engage in an excess enefit transaction with a disqualified person during the year? If"Yes/"complete Schedule L, Part I E Is the organization aware that it engaged in an excess enefit transaction with a disqualified person in a prior year, and that the transaction has not een reported on any ofthe organizationls prior Forms 99 or 99-EZ? If "Yes/"complete Schedule L, PartI E Was a loan to or y a current orformer officer, director, trustee, key employee, highly compensated employee, or PartII... disqualified person outstanding as ofthe end ofthe organizationls tax year? If "Yes/"complete Schedule L,.E Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, sustantia contriutor, or a grant selection committee memer, or to a person related to such an individual? If "Yes," completeschedulel,partiii E Was the organization a party to a usiness transaction with one ofthe following parties? (see Schedule L, Part IV instructions for applicale filing thresholds, conditions, and exceptions) in 1 3 Yes 4a N 4 4c 4d 5a N o 5 N o 6 7 c A current orformer officer, director, trustee, or key employee? If "Yes/"complete Schedule L, Part E A family memer ofa current orformer officer, director, trustee, or key employee? If "Yes," completeschedulel,partiv e An entity ofwhich a current orformer officer, director, trustee, or key employee ofthe organization (or a family memer) was an officer, director, trustee, or owner? If "Yes/"complete Schedule L, Part IV.. E Did the organization receive more than $5, in non-cash contriutions? If "Yes/"complete ScheduleM Did the organization receive contriutions ofart, historical treasures, or other similar assets, or qualified conservation contriutions? If "Yes/"complete ScheduleM Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes/"complete Schedule N, Did the organization sell, exchange, dispose of, ortransfer more than 5% ofits net assets? If "Yes/"complete ScheduleN,PartII... Did the organization own 1% ofan entity disregarded as separate from the organization under Regulations sections31771-and ?if"yes,"completescheduler,parti E Was the organization related to any tax-exempt or taxale entity? If "Yes/"complete Schedule R, Parts II, III, IV, andv,l/ne1...e Is any related organization a controlled entity within the meaning ofsection 51()(13)? If "Yes/"complete ScheduleR,PartV,l/ne E Section 51(c)(3) organizations. Did the organization make any transfers to an exempt non-charitale related organization? If "Yes/"complete Schedule R, Part V, l/ne E Did the organization conduct more than 5% ofits activities through an entity that is not a related organization and that is treated as a partnership forfederal income tax purposes? If "Yes/"complete Schedule R, Part VI E Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? te.all Form 99 filers are required to complete Schedule O a Yes Zs Yes 8C Yes Yes 35 Yes Yes Form 99 (9)

5 Form 99 (9) M Statements Regarding Other IRS Filings and Tax Compliance 1a a 3a 4a 5a 6a c c a c d e f 9 h a a a 1a Enter the numer reported in Box 3 of Form 196, Annual Summary and Transmittal of U.S. Information Returns. Enter -- if not applicale.... 1a 84 Enter the numer of Forms W-G included in line 1a Enter -- if not applicale 1 Did the organization comply with ackup withholding rules for reportale payments to vendors gaming (gamling)winnings to prize winners? Enter the numer ofemployees reported on Form W-3, Transmittal of Wage and Tax Statements filed forthe calendar year ending with or within the year covered y this reportale and return...3 Ifat least one is reported on line a, did the organization file all required federal employment tax returns? te: Ifthe sum oflines 1a and a is greater than 5, you may e required to e-file this return (see instructions) return?... Did the organization have unrelated usiness gross income of$1, or more during the year If"Yes," has it filed a Form 99-T for this year? If "/"provide an explanation in Schedule O. At any time during the calendar year, did the organization have an interest in, or a signature r other authority over, a financial account in a foreign country (such as a ank account, securities account, or ther financial account)?... If"Yes," enterthe name ofthe foreign country llcovered y this See the instructions for exceptions and filing requirements for Form TD F 9-1, Report of Foreign Bank and Financial Accounts Was the organization a party to a prohiited tax sheltertransaction at any time during the tax year?.. Did any taxale party notify the organization that it was or is a party to a prohiited tax shelter transaction? If"Yes" to line 5a or 5, did the organization file Form 8886-T, Disclosure y Tax-Exempt En ProhiitedTaxShelterTransaction? Does the organization have annual gross receipts that are normally greaterthan $1,, a organization solicit any contriutions that were not tax deductile? werenottaxdeductile? Organizations that may receive deductile contriutions under section 17(c). If"Yes," did the organization include with every solicitation an express statement that such c ontriutions or g ifts servicesprovidedtothepayor? If"Yes," did the organization notify the donor ofthe value ofthe goods or services provided? Did the organization receive a payment in excess of$75 made partly as a contriution and partly for goods and fileform88?... If"Yes," indicate the numer of Forms 88 filed during the year... I 7d I tity Regarding nd did the Did the organization sell, exchange, or otherwise dispose oftangile personal property for whi ch it was required to enefitcontract?... Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal Did the organization, during the year, pay premiums, directly or indirectly, on a personal enefit contract?. For all contriutions ofqualified intellectual property, did the organization file Form 8899 as re For contriutions ofcars, oats, airplanes, and other vehicles, did the organization file a Form 198-C as required?... quired?.. Sponsoring organizations maintaining donor advised funds and section 59(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained y a sponsoring organization, have excess usiness holdings at any time during the year? Sponsoring organizations maintaining donor advised funds. Did the organization make any taxale distriutions under section 4966?.... Did the organization make a distriution to a donor, donor advisor, or related person?. Section 51(c)(7) organizations. Enter Initiation fees and capital contriutions included on Part VIII, line a Gross receipts, included on Form 99, Part VIII, line 1, for pulic use ofclu 1 facilities Section 51(c)(1) organizations. E nter Grossincomefrommemersorshareholders year a Gross income other sources (Do not net amounts or paid to other sources againstamountsdueorreceivedfromthem) fform Section 4947(a)(1) non-exempt charitale trusts. Is the organization filing Form 99 in lieu If"Yes," enterthe amount oftax-exempt interest received or accrued during the 141? 976 1c Yes Yes 3a Yes 3 Yes 4a 5a 5 5c 6a 6 7a 7 7c 7e 7f 79 7h 8 9a 9 1a Page 5 Yes Form 99 (9)

6 Form 99 (9) Page 6 M Governance, Management, and Disclosure For each "Yes" response to lines through 7 elow, and for a "" response to lines 8a, 8, or 1 elow, descrie the circumstances, processes, or changes in Schedule O. See instructions. Section A. Governing Body and Management Yes 16a Did the organization invest in, contriute assets to, or participate in a Joint venture or similar arrangement with a taxaleentityduringtheyear? a Yes If"Yes," has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in Joint venture arrangements under applicale federal tax law, and taken steps to safeguard the organizationfsexemptstatuswithrespecttosucharrangements? Section C. Disclosure 17 List the States with which a copy ofthis Form 99 is required to e filedhl-ny 18 Section 614 requires an organization to make its Form 13 (or 14 ifapplicale), 99, and 99-T (51(c) (3)s only) availale for pulic inspection Indicate how you make these availale Check all that apply I- Own wesite I- Another"s wesite I7 Upon request 19 Descrie in Schedule O whether (and ifso, how), the organization makes its governing documents, conflict of interest policy, and financial statements availale to the pulic See Additional Data Tale State the name, physical address, and telephone numer ofthe person who possesses the ooks and records ofthe organization ll Tony J Pawlowski Controller 845 ROUTES 5 IRVING,NY 1481 (716) Form 99 (9) 1a Enter the numer ofvoting memers ofthe governing ody. Enterthe numer ofvoting memers that are independent.. Did any officer, director, trustee, or key employee have a family relationship or a usiness relationship with any otherofficer,director,trustee,orkeyemployee? Did the organization delegate control over management duties customarily performed y or underthe direct supervision of officers, directors ortrustees, or key employees to a management company or other person?.. 3 Yes 4 Did the organization make any significant changes to its organizational documents since the prior Form 99 filed? 1a WBS 4 5 Did the organization ecome aware during the year ofa material diversion ofthe organizationfs assets? 5 6 Doestheorganizationhavememersorstockholders? Yes 7a Does the organization have memers, stockholders, or other persons who may elect one or more memers ofthe governingody?... 7a Are any decisions ofthe governing ody suject to approval y memers, stockholders, or other persons? Did the organization contemporaneously document the meetings held or written actions undertaken during the year y the following a Thegoverningody? a Yes Eachcommitteewithauthoritytoactonehalfofthegoverningody? Yes 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot e reached at the organizationfs mailing address? If"Yes," provide the names and addresses in Schedule O Section B. Policies (This Section B requests information aout policies not required y the Internal Revenue Code.) Yes 1a Doestheorganizationhavelocalchapters,ranches,oraffiliates? a If"Yes," does the organization have written policies and procedures governing the activities ofsuch chapters, affiliates, and ranches to ensure their operations are consistent with those ofthe organization? Has the organization provided a copy ofthis Form 99 to all memers ofits governing ody efore filing the form? 11A Descrie in Schedule O the process, ifany, used y the organization to review the Form 99 toconflicts? a Does the organization have a written conflict ofinterest policy? If ","gotol/ne a Yes Are officers, directors ortrustees, and key employees required to disclose annually interests that could give rise Yes c Does the organization regularly and consistently monitor and enforce compliance with the policy? If"Yes," descrieinscheduleohowthisisdone c Yes 13 Doestheorganizationhaveawrittenwhistlelowerpolicy? Yes 14 Does the organization have a written document retention and destruction policy? Yes 15 Did the process for determining compensation ofthe following persons include a review and approval y independent persons, comparaility data, and contemporaneous sustantiation ofthe delieration and decision? a The organizationfs CEO, Executive Director, ortop management official a Yes Otherofficersorkeyemployeesoftheorganization Yes If"Yes" to line a or, descrie the process in Schedule O (See instructions)

7 Form 99 (9) Form 99 (9) page7 Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this tale for all persons required to e listed Report compensation forthe calendar year ending with or within the organizationfs tax year Use Schedule J- ifadditional space is needed I List all ofthe organizationfs current officers, directors, trustees (whether individuals or organizations), regardless ofamount ofcompensation, and current key employees Enter -- in columns (D), (E), and (F) if no compensation was paid I List all ofthe organizationfs current key employees See instructions for definition of"key employee " I List the organizationfs five current highest compensated employees (otherthan an officer, director, trustee or key employee) who received reportale compensation (Box 5 of Form W- and/or Box 7 of Form 199-MISC) of more than $1, from the organization and any related organizations I List all ofthe organizationfs former officers, key employees, or highest compensated employees who received more than $1, of reportale compensation from the organization and any related organizations I List all ofthe organizationfs former directors or trusteesthat received, in the capacity as a former director or trustee ofthe organization, more than $1, of reportale compensation from the organization and any related organizations List persons in the following order individual trustees or directors, institutional trustees, officers, key employees, highest compensated employees, and former such persons I- Check this ox ifthe organization did not compensate any current orformer officer, director, trustee or key employee (A) (B) (C) (D) (E) (F) Name and Title Average Position (check all Reportale Reportale Estimated hours that apply) compensation compensation amount ofother per from the from related compensation - - MISC) related ri week : 1 organization (W- organizations from the - /199-MISC) (W- /199- organization and I 3 - organizations 1 E See add"l data

8 Form 99 (9) Page 8 1 Terai PI 1,9,537l 33,769l 64,39I Total numer ofindividuals (including ut not limited to those listed aove) who received more than $1, in reportale compensation from the organizationhl-14 3 Did the organization list any former officer, director ortrustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedulelforsuch individual For any individual listed on line 1a, is the sum of reportale compensation and other compensation from the organization and related organizations greater than $15,? If"Yes,"comp/ete Schedulelforsuch individual Did any person listed on line 1a receive or accrue compensation from any unrelated organization for services rendered to the organization? If "Yes/"complete Schedulelforsuch person (A) (B) Section B. Independent Contractors 1 Complete this tale for your five highest compensated independent contractors that received more than $1, ofcompensation from the organization BONADIO & CO LLP CORPORATE CROSSINGS 171 SULLYS TR PITTSFORD, NY Willcare PO Box 8 Department Buffalo, NY 1467 LAB CORPORATION OF AMERICA PO BO 114 BURLINGTON, NC 716 CHAUTAUQUA OPPORTUNITIES INC 17 WEST COURTNEY STREET DUNKIRK, NY 1448 JAMESTOWN REHAB SERVICES 448 KATHLEEN STREET HAmurg, NY 1475 Name and usiness address Description of services Yes Yes (C) Compensation CONSULTING 649,818 Home healthcare 499,787 LAB SERVICES 363,69 HOMe healthcare 314,699 REHAB SERVICES 69,43 Total numer ofindependent contractors (including ut not limited to those listed aove) who received more than $1, in compensation from the organization ll-16 Form 99 (9)

9 Form 99 (9) Statement of Revenue 1a c d e f 9 h a c d e f Federated campaigns. 1a Memership dues. 1 Fundraising events.. 1c Related organizations... 1d Government grants (contriutions) 1e All other contriutions, gifts, grants, and 1f similar amounts not included aove ncash contriutions included in lines 1a-1f$ TotaI.Add lines 1a-1f. PATIENT SERVICE REVENU 1,57,96 94,615 (A) Total revenue.. F* 1,15,575 Business Code (B) Related or exempt function revenue 9,99 45,56,851 45,56,851 (C) Unrelated usiness revenue OTHER SERVICES 61,5 163, ,337 NURSING SERVICE REVENU 9,99 93,178 93,178 PSYCHIATRIC SERVICE RE 9,99 5,769 5,769 All other program service revenue Page 9 (D) Revenue excluded from tax under sections 51, 513, or a c d 7a c d 8a c 9a c 1a c 11a 1 c d e Investment income (including dividends, interest and other similar amounts)... Income from investment of tax-exempt ond Royalties (i) Real Gross Rents Less rental expenses Rental income or (loss) Net rental income or(loss).. Gross amount from sales of assets other than inventory Less cost or other asis and sales expenses Gain $1 or (loss) (i) Securities Netgainor(loss).... Gross income from fundraising events (not including ofcontriutions reported on line 1c) See Part IV, line F* (ii) Personal...Ft (ii) Other Less directexpenses... Net income or (loss) from fundraising events.. E" Gross income from gaming activities See Part IV, line a Less directexpenses... Net income or (loss) from gaming activities...e Gross sales ofinventory, less returns and allowances. Less cost ofgoods sold.. Net income or (loss) from sales ofinventory.. E" Miscellaneous Revenue Business Code Flood Related 9,99,8,553,8,553 83,464 83,464 MISCELLANEOUS 9,99 955, ,396,198 CA FETERIA SALES 9,99 16,898 16,898 Allother revenue.. TotaI.Addlines11a-11d. Total revenue. See Instructions. TotaI.Add lines a-f ii 45,339,135.. F* proceeds I I ll,ii ll ll 44,76 44,76 3,99,771 5,54,945 49,13, ,535 83,464 Form 99 (9)

10 Form 99 (9) page 1 M Statement of Functional Expenses Section 51(c)(3) and 51(c)(4) organizations must complete all columns. All ot her organizations must complete column (A) ut are not required to complete columns (B), (C), and (D). Do not include amounts reported on lines 6, (A) PrOgra(n?)Sen/Ice 7, 8, 9, and 1 of Part VIII. TOYBI SPSHSSS expenses 1 Grants and other assistance to governments and organizations in the U S See Part IV, line 1 Grants and other assistance to individuals in U S See Part IV, line 3 Grants and other assistance to governments, organizations, and individuals outside the U S See Part IV, lines 15 and 16 4 Benefits paid to or for memers 5 Compensation ofcurrent officers, directors, trustees, and keyemployees Compensation not included aove, to disqualified persons (as defined under section 4958(f)(1)) and persons descried in section 4958(c)(3)(B)... 7 Other salaries and wages 8 Pension plan contriutions (include section 41(k) and section 43()employercontriutions) Otheremployeeenefits.. 1 Payrolltaxes Fees for services (non-employees) a Management Legal.. c Accounting. dloying... e Professionalfundraising SeePartIV,l/ne17. f Investmentmanagementfees. gother... 1 Advertisingand promotion. 13 Officeexpenses Informationtechnology. 15 Royalties.. 16 Occupancy. 17Travel Payments oftravel or entertainment expenses for any federal, state, or local pulic officials Conferences, conventions, and meetings. Interest Paymentstoaffiliates..... Depreciation, depletion, and amortization. 3 Insurance Other expenses Itemize expenses not covered aove (Expenses grouped together and laeled miscellaneous may not exceed 5% of total expenses shown on line 5 elow) a PURCHASED SERVICES the (C) Management and genera I expenses 95,446 95,446 (D) Fundraising expenses,356,411 17,518,6 4,79,834 45, ,91 455,579 13,37 1,185 3,974,481 3,73,7 89,786 7,993 1,688,914 1,36, ,38 3, , ,837 96,69 96,69 48, 48,,381,54 1,37,348 1,144,176 4,43,114 4,3,813 6, , ,11 143,95 755,61 131,177 3, ,9 5,3 6, ,99 439,99 1,31,886 1,5,39 6,577 6,145,84 3,64, 56 3,38,87 43,177 PHARMACY,93,77,93,77 c MISCELLANEOUS 1,79,598 43,811 1,85,199 11,588 d BAD DEBT EPENSE 1,76,64 1,381,83 345,31 e LEASES AND RENTALS 758,49 531,666 6,583 f All other expenses 5 Total functional expenses. A dd lines 1 through 4f 51,786,75 37,314,448 14,358,98 113,959 6 Joint costs. Check here ll- I- iffollowing SO P 98- Complete this line only ifthe organization reported in column (B)Joint costs from a comined educa tional campaign and fundraising solicitation Form 99 (9)

11 Form 99 (9) Page 11 M Balance Sheet r si* a Cash-non-interest-earing.... Savings and temporary cash investments. Pledges and grants receivale, net.. Accounts receivale, net Receivales from current and former officers, directors, trustees, key employees, and highest compensated employees Complete Part II of ScheduleL... Receivales from other disqualified persons (as defined under section 4958(f)(1)) and persons descried in section 4958(c)(3)(B) Complete Part II of ScheduleL tes and loans receivale, net. Inventories for sale or use.... Prepaid expenses and deferred charges Land, uildings, and equipment cost or other asis Complete 35,74,51 Part VI of Schedule D 18 Less accumulateddepreciation.. 1 7,45,7 Investments-pulicly traded securities.... Investments-other securities See Part IV, line 11. Investments-program-related See Part IV, line 11. Intangile assets Other assets See Part IV, line Total assets.add lines 1 through 15 (must equal line 34). Accounts payale and accrued expenses. Grantspayale Deferredrevenue... Tax-exemptondliailities Escrow or custodial account liaility Complete Part IVofSchedu/eD. Payales to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons Complete Part II ofschedu/el Secured mortgages and notes payale to unrelated third parties. Unsecured notes and loans payale to unrelated third parties. Other liailities Complete Part ofschedule D.... Total liailities. Add lines 17 through Organizations that follow SFAS 117, check here ll- I7 and complete lines 7 through 9, and lines 33 and 34. Unrestrictednetassets.. Temporarily restricted net assets. Permanently restricted netassets..... Organizations that do not follow SFAS 117, check here ll- I- and complete lines 3 through 34. Capital stock ortrust principal, or current funds.... Paid-in or capital surplus, or land, uilding or equipment fund.. Retained earnings, endowment, accumulated income, or otherfunds Total net assets orfund alances..... Total liailities and net assets/fund alances. 8 8 (A) (B) Beginning ofyear End ofyear 3, ,44 38,73 98,867 6, ,935 9,6, ,4, , 8 339,651 15, ,456 9,516,7 1c 7,849, ,98, ,73,83,663,6 16,578,5 1,184, ,894, ,983,773 3,484,91 4,779,791 5,515,933 14,947, ,895,669 5,39, ,8,57 8,45,56 9,654, ,715, ,68,583,663,6 34,578,5 Form 99 (9)

12 Form 99 (9) page 1 Financial Statements and Reporting Yes 1 Accounting method used to prepare the Form 99 I- Cash I7Accrual I-Other Ifthe organization changed its method ofaccounting from a prior year or checked "Other," explain in Schedule O a Were the organizationfs financial statements compiled or reviewed y an independent accountant?. a Were the organizationfs financialstatements audited y anindependent accountant? Yes c If"Yes,"to a or, does the organization have a committee that assumes responsiility for oversight ofthe audit, review, or compilation ofits financial statements and selection ofan independent accountant? Ifthe organization changed either its oversight process or selection process during the tax year, explain in Schedule O... C yes d If"Yes" to line a or, check a ox elow to indicate whether the financial statements for the year were issued on a consolidated asis, separate asis, or oth I- Separate asis I7 Consolidated asis I- Both consolidated and separated asis 3a As a result ofa federal award, was the organization required to undergo an audit or audits as set forth in the SingleAuditActandOMBCircularA-133? NO If"Yes," did the organization undergo the required audit or audits? Ifthe organization did not undergo the required 3 audit or audits, explain why in Schedule O and descrie any steps taken to undergo such audits.. Form 99 (9)

13 n (Form efile GRAPHIC rint - DO NOT 99 PROCESS As r99oez) Filed Data - DLN: SCHEDULE A Pulic Charity Status and Pulic Support OMB Complete if the organization is a section 51(c)(3) organization or a section IDeparwInSntoftheSTreasury erna evenue ervice 4947(a)(1) nonexempt charitale trust. open to Pulic P Attach to Form 99 or Form 99-EZ. P See separate instructions. Inspection 1 I- A church,convention ofchurches,or association ofchurches section 17()(1)(A)(i). N ame of the organization Employer identification numer TLC HEALTH NETWORK m Reason for Pulic Charity Status (All organizations must complete this part.) See instructions The organization is not a private foundation ecause it is (For lines 1 through 11, check only one ox) A school descried in section 17()(1)(A)(ii). (Attach Schedule E ) 3 A hospital or a cooperative hospital service organization descried in section 17()(1)(A)(iii). 4 A medical research organization operated in conjunction with a hospital descried in section 17()(1)(A)(iii). Enterthe hospital"s name, city, and state 5 I- An organization operated for the enefit ofa college or university owned or operated y a governmental unit descried in section 17()(1)(A)(iv). (Complete Part II) 6 I- A federal, state, or local government or governmental unit descried in section 17()(1)(A)(v). 7 I- An organization that normally receives a sustantial part ofits support from a governmental unit or from the general pulic descried in section 17()(1)(A)(vi) (Complete Part II ) 8 I- A community trust descried in section 17()(1)(A)(vi) (Complete Part II) 9 I- An organization that normally receives (1) more than 331/3% ofits support from contriutions, memership fees, and gross receipts from activities related to its exempt functions-suject to certain exceptions, and () no more than 331/3% of its support from gross investment income and unrelated usiness taxale income (less section 511 tax) from usinesses acquired y the organization after June 3,1975 See section 59(a)(). (Complete Part III) 1 I- An organization organized and operated exclusively to test for pulic safety Seesection 59(a)(4). 11 I- An organization organized and operated exclusively for the enefit of, to perform the functions of, orto carry out the purposes of one or more pulicly supported organizations descried in section 59(a)(1) or section 59(a)() See section 59(a)(3). Check the ox that descries the type ofsupporting organization and complete lines 11e through 11h a I-TypeI I-TypeII c I-TypeIII this - Functionallyintegrated ox d I-TypeIII - Other I e I- By checking this ox, I certify that the organization is not controlled directly or indirectly y one or more disqualified persons otherthan foundation managers and otherthan one or more pulicly supported organizations descried in section 59(a)(1) or section 59(a)() f Ifthe organization received a written determination from the IRS that it a Type I, Type II or Type III supporting organization, g Since August 17, 6, has the organization accepted any gift or contriution from any ofthe following persons? (i) a person who directly or indirectly controls, either alone ortogether with persons descried in (ii) Yes and (iii) elow, the governing ody ofthe the supported organization? (ii) family memer ofa person descried in (i) aove? (iii) a 35% controlled entity ofa person descried in (i) or (ii) aove? h Provide the following information aout the supported organization(s) (iii) Type of I,-f":,fe (vi (vi) (i) Orgamzatlon organization In Did you notify the Is the (vii) Name of (ii) (descned on Col (I) listed In organization in organization in organization orirc section document-, SUPPOV In 9 (see in5tructin5)) Yes N Yes N Yes N Amount of supported EIN lines 1-9 aove yourgovemmg CCI (I) fty?uv CCI (LEIOVSJBSUI-Pzed Support? Total For Paperwork Reduction Actlice, see lhelnstruclions for Form 99 Cat 1 185F ScheduleA(Form 99or 99-EZ)9

14 Schedule A (Form 99 or 99-EZ) 9 ScheduleA (Form 99 or99-ez)9 Page i support schedule for organizations Descried in IRC 17o()(1)(A)(iv) and 17o()(1)(A)(vi) (Complete only if you checked the ox on line 5, 7, or 8 of Part I.) Section A. Pulic Support In) (a) ( ) (C) ( ) (e) ( ) Ola Calendaryear (orfiscalyear eginning d 8 9 f T I 1 Gifts, grants, contriutions, and memership fees received (Do not include any "unusual grants ") Tax revenues levied forthe organization"s enefit and either paid to or expended on its ehalf 3 The value ofservices orfacilities furnished y a governmental unit to the organization without charge 4 TotaI.Add lines 1 through 3 5 The portion oftotal contriutions y each person (otherthan a governmental unit or pulicly supported organization) included on line 1 that exceeds % ofthe amount shown on line 11, column (f) 6 Pulic Support. Sutract line 5 from line 4 Section B. Total Support Calendar year (or fiscal year eginning In) (a)oo5 ()oo6 (e)oo7 (d)oos (e)oo9 (f)toiei 7 Amounts from line 4 8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources 9 Net income from unrelated usiness activities, whether or not the usiness is regularly carried on 1 Other income (Explain in Part IV )Do not include gain or loss from the sale ofcapital assets 11 Total support (Add lines 7 through 1) 1 Gross receipts from related activities, etc (See instructions) i 1 I 13 First Five Years Ifthe Form 99 is for the organization"s first, second, third, fourth, orfifth tax year as a 51(c)(3) organization, check this ox and stop here PI Section C. Computation of Pulic Support Percentage 14 Pulic Support Percentage for 9 (line 6 column (f) divided y line 11 column (f)) Pulic Support Percentage for 8 Schedule A, Part II, line a 33 1/3/o support test-9. Ifthe did not check the ox on line 13, and line 14 is 33 1/3% or more, check this ox and stop here.the organization qualifies as a pulicly supported organization FI 33 organization 1/3/o support test-8. Ifthe did not check the ox on line 13 16a, and line 15 is 33 FI 1/o-facts-and-circumstances test-8. Ifthe organization did not check a ox on line 13, 16a, 16, or 17a and 1/3% or more, check this ox and stop here.the qualifies as a pulicly supported organization PI 17a 1/o-facts-and-circumstances test-9. Ifthe did not check a ox on line 13, 16a, or 16 and line 14 is 1% more, and Ifthe meets the "facts and circumstances" test, check this ox and stop here. Explain in Part IV how the meets the "facts and circumstances" test The qualifies as a pulicly supported line supported instructions organization FI PI 15 is 1% more, and Ifthe organization meets the "facts and circumstances" test, check this ox and stop here. Explain Part IV how the organization meets the "facts and circumstances" test The qualifies as a pulicly 18 Private Foundation Ifthe organization did not check a ox line 13,16a,16,17a or 17, check this ox and see

15 Schedule A (Form 99 or 99-EZ) 9 ScheduleA (Form 99 or99-ez)9 Page3 1E support schedule for organizations Descried in IRC 5o9(a)() (Complete only if you checked the ox on line 9 of Part I.) Section A. Pulic Support Calendar year (or fiscal year eginning a C 8 In) (a)oo5 ()oo6 (e)oo7 (d)oos (e)oo9 (f)toiei Gifts, grants, contriutions, and memership fees received (Do not include any "unusual grants ") Gross receipts from admissions, merchandise sold or services performed, orfacilities furnished in any activity that is related to the organization"s tax-exempt purpose Gross receipts from activities that are not an unrelated trade or usiness under section 513 Tax revenues levied forthe organization"s enefit and either paid to or expended on its ehalf The value ofservices orfacilities furnished y a governmental unit to the organization without charge TotaI.Add lines 1 through 5 Amounts included on lines 1,, and 3 received from disqualified persons Amounts included on lines and 3 received from otherthan disqualified persons that exceed the greater of$5, or 1% ofthe amount on line 13 forthe year Add lines 7a and 7 Pulic Support (Sutract line 7c from line 6) Section B. Total Support Calendar year (or fiscal year eginning 9 1a c In) (a)oo5 ()oo6 (e)oo7 (d)oos (e)oo9 (f)toiei Amounts from line 6 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources Unrelated usiness taxale income (less section 511 taxes) from usinesses acquired after June 3,1975 Add lines 1a and 1 Net income from unrelated usiness activities not included in line 1, whether or not the usiness is regularly carried on Other income Do not include gain or loss from the sale of capital assets (Explain in Part IV ) Total support (Add lines 9,1c, 11 and 1) First Five Years Ifthe Form 99 is for the organization"s first, second, third, fourth, orfifth tax year as a 51(c)(3) organization, check this ox and stop here FI Section C. Computation of Pulic Support Percentage Pulic Support Percentage for 9 (line 8 column (f) divided y line 13 column (f)) 15 Pulic support percentage from 8 Schedule A, Part III, line Section D. Computation of Investment Income Percentage 19a Investment income percentage for 9 (line 1c column (f) divided y line 13 column (f)) 17 Investment income percentage from 8 Schedule A, Part III, line /3/o support tests-9. Ifthe organization did not check the ox on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this ox and stop here.the organization qualifies as a pulicly supported organization PI 33 1/3/o support tests-8. Ifthe organization did not check a ox on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this ox and stop here.the organization qualifies as a pulicly supported organization FI Private Foundation Ifthe organization did not check a ox on line 14,19a or 19, check this ox and see instructions FI

16 Schedule A (Form 99 or 99-EZ) 9 Page 4 Supplemental Information. Supplemental Information. Complete this part to provide the explanation required y Part II, line 15 Part II, line 17a or 17g or Part III, line 1. Provide any other additional information. See instructions Schedule A (Form 99 or 99-EZ) 9

17 Additional Data Software ID: Softwa re Version: EIN: Name: TLC HEALTH NETWORK (A) (B) (C) (D) Name and Title Average Position (check all Reportale Form 99, Part VII - Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors hours that apply) compensation per week n3 E from the organization (W /199-MISC) (E) Reportale compensation from related organizations (W- /199 MISC) (F) Estimated amount of other compensation from the organization and related organizations CRAIG BROWN CHAIRMAN CHRISTOPHER LANSKI CHAIRMAN ELECT LOUIS DIPALMA TREASURER BRIAN FENZL SECRETARY EUGENE BAILEN MEMBER WALTER GOTOWKA MEMBER RICHARD MILAZZO MD MEMBER DENNIS HEFNER MEMBER TIMOTHY COOPER MEMBER THOMASM POSTLE MEMBER THOMAS SVROCZYNSKI MEMBER JAMES WILD MD MEMBER VIRGINIA COOPER MEMBER GJAY BISHOP MD MEMBER DR SUSAN MCNAMARA MEMBER KEVIN OUWEELEEN MD MEMBER LOUIS DIRIENZO CIO KENDRICKBENTHAM VICE PRESIDENT ELLEN FRANZ VICE PRESIDENT CHARLES KOMUREK VICE PRESIDENT JONATHAN I LAWRENCE PRESIDENT AND CEO Ahsan Mahmood PSYCHIATRIST John Mcalevey PSYCHIATRIST Dean Mast PHYSICIAN ROBERT PIOTROWSKI PHYSICIAN ASSISTANT ,643 69,46 73,31 8,47 16,44 194, , ,581 33,769 5,433 5,37 5,893 5,394 5, ,94 4,891 3,985

18 A) (B) (C) (D) hours per week Form 99, Part VII - Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Name and Title Average Position (check all Reportale thatapply) compensation 3 E organization (W /199-MISC) (E) Reportale compensation from related organizations (W- /199 MISC) amount of other compensation organization an organizations JOEL YOVIENE PHYSICIAN LOUIS FRANSCELLA FORMER CEO 4 O O 15, ,1

19 Form 99, Part I - Statement of Functional Expenses - 4a - 4e Other Expenses Do not include amounts reported online (A) (B) (C) (D) 6, 8, 9, and 1 of Part VIII. Total expenses Program service Management and Fundraising expenses general expenses expenses PURCHASED SERVICES 6,145,84 3,64, 56 3,38,87 43,177 PHARMACY,93,77,93,77 MISCELLANEOUS 1,79,598 43,811 1,85,199 11,588 BAD DEBT EPENSE 1,76,64 1,381,83 345,31 LEASES AND RENTALS 758,49 531,666 6,583

20 D OMB efile GRAPHIC rint - DO NOT PROCESS AS Filed Data - DLN: """ 99) Supplemental Financial Statements ll- Complete if the organization answered "Yes," to Form 99, Deparlmenloflhe Treasury part IV, line 5, 7, 3, gl 1, 11, or 1- Open t PUiiC lnlemal Revenue SSH/ICS ll- Attach to Form 99. ll- See separate instructions. Il15PeCtil1 Name of the organization Employer identification numer TLC HEALTH NETWORK M Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 99 Part IV, line 6. (a) Donor advised funds () Funds and other accounts Total numer at end ofyear Aggregate contriutions to (during year) Aggregate grants from (during year) Aggregate value at end ofyear Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization"s property, suject to the organization"s exclusive legal control? I- Yes I- N Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may e used only for charitale purposes and not forthe enefit ofthe donor or donor advisor, orfor any other purpose conferring impermissile private enefit I- Yes I- N m Conservation Easements. Complete if the organization answered "Yes" to Form 99, Part IV, line Purpose(s) ofconservation easements held y the organization (check all that apply) I- Preservation ofland for pulic use (e g,recreation or pleasure) I- Preservation ofan historically importantly land area I- Protection of natural haitat I- Preservation ofa certified historic structure I- Preservation ofopen space Complete lines a-d ifthe organization held a qualified conservation contriution in the form ofa conservation easement on the last day ofthe tax year Held at the End of the Year Total numer ofconservation easements a Total acreage restricted y conservation easements Numer ofconservation easements on a certified historic structure included in (a) C Numer ofconservation easements included in (c) acquired after 8/17/6 d Numer ofconservation easements modified, transferred, released, extinguished, orterminated y the organization during the taxale year ll Numer ofstates where property suject to conservation easement is located ll Does the organization have a written policy regarding the periodic monitoring, inspection, handling ofviolations, and enforcement ofthe conservation easements it holds? I- Yes I- N Staffand volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year ll Amount ofexpenses incurred in monitoring, inspecting, and enforcing conservation easements during the year ll-$ Does each conservation easement reported on line (d) aove satisfy the requirements ofsection 17o(h)(4)(B)(i).-.ind 17o(ii)(4)(B)(ii)v I-Yes I- In Part IV, descrie how the organization reports conservation easements in its revenue and expense statement, and alance sheet, and include, ifapplicale, the text ofthe footnote to the organizationfs financial statements that descries the organizationfs accounting for conservation easements Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. 1a Complete if the organization answered "Yes" to Form 99, Part IV, line 8. Ifthe organization elected, as permitted under SFAS 116, not to report in its revenue statement and alance sheet works of art, historical treasures, or other similar assets held for pulic exhiition, education or research in furtherance ofpulic service, provide, in Part IV, the text ofthe footnote to its financial statements that descries these items Ifthe organization elected, as permitted under SFAS 116, to report in its revenue statement and alance sheet works ofart, historical treasures, or other similar assets held for pulic exhiition, education, or research in furtherance ofpulic service, provide the following amounts relating to these items (I) Revenues included in Form 99, Part VIII, line 1 ll-$ (ii)assets included in Form 99,Part ll-$ Ifthe organization received or held works ofart, historical treasures, or other similar assets forfinancial gain, provide the following amounts required to e reported under SFAS 116 relating to these items Revenues includedin Form 99,PartVIII,line 1 ll-$ Assets included in Form 99,Part ll-$ For Privacy Act and Paperwork Reduction Act tice, see the Int ruct ions for Form 99 C at N o D Schedule D (Form 99) 9