Short Form Return of Organization Exempt From Income Tax

Transcription

1 Form Deprtment of the Tresury Internl Revenue Servie A B G For the 0 lenr yer, or tx yer eginning Chek if pplile: C Nme of orgniztion Aress hnge Nme hnge Initil return Finl return/ terminte Amene return n ening OMB No. -0 Open to Puli Inspetion D Employer ientifition numer F Group Exemption Applition pening Numer Aounting Metho: Csh Arul Other (speify) H Chek if the orgniztion is I Wesite: not require to tth Sheule B J Tx-exempt sttus (hek only one) 0()() 0() ( ) (insert no.) ()() or (Form 0, 0-EZ, or 0-PF). K Form of orgniztion: Corportion Trust Assoition Other L Revenue Expenses Net Assets 0 Totl revenue. A lines,,,,,,, n Oupny, rent, utilities, n mintenne ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Printing, pulitions, postge, n shipping ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other expenses (esrie in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl expenses. A lines 0 through 0 Uner setion 0(),, or ()() of the Internl Revenue Coe (exept privte fountions) Do not enter soil seurity numers on this form s it my e me puli. Go to for instrutions n the ltest informtion. Numer n street (or P.O. ox, if mil is not elivere to street ress) City or town, stte or provine, ountry, n ZIP or foreign postl oe A lines,, n to line to etermine gross reeipts. If gross reeipts re $00,000 or more, or if totl ssets (Prt II, For Pperwork Reution At Notie, see the seprte instrutions. Room/suite E Telephone numer olumn (B) elow) re $00,000 or more, file Form 0 inste of Form 0-EZ $ Prt I Revenue, Expenses, n Chnges in Net Assets or Fun Blnes (see the instrutions for Prt I) LHA 0-EZ Chek if the orgniztion use Sheule O to respon to ny question in this Prt I Contriutions, gifts, grnts, n similr mounts reeive Progrm servie revenue inluing government fees n ontrts ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~ Memership ues n ssessments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Investment inome Gross mount from sle of ssets other thn inventory ~~~~~~~~~~~~~ Less: ost or other sis n sles expenses ~~~~~~~~~~~~~~~~~ Gin or (loss) from sle of ssets other thn inventory (Sutrt line from line ) ~~~~~~~~~~~~~~~ Gming n funrising events Gross inome from gming (tth Sheule G if greter thn $,000) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gross inome from funrising events (not inluing $ from funrising events reporte on line ) (tth Sheule G if the sum of suh gross inome n ontriutions exees $,000) Less: iret expenses from gming n funrising events ~~~~~~~~~~~~~~ ~~~~~~~~~~ of ontriutions Net inome or (loss) from gming n funrising events ( lines n n sutrt line ) Gross sles of inventory, less returns n llownes ~~~~~~~~~~~~~ Less: ost of goos sol ~~~~~~~~~~~~~~~~~~~~~~~~~~ Gross profit or (loss) from sles of inventory (Sutrt line from line ) Other revenue (esrie in Sheule O) Short Form Return of Orgniztion Exempt From Inome Tx ALCOR CARE TRUST SUPPORTING ORGANIZATION EAST ACOMA DR STE 0 SCOTTSDALE, AZ 0 ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Grnts n similr mounts pi (list in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Benefits pi to or for memers~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Slries, other ompenstion, n employee enefits ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Professionl fees n other pyments to inepenent ontrtors ~~~~~~~~~~~~~~~~~~~~~~~~ Exess or (efiit) for the yer (Sutrt line from line ) Net ssets or fun lnes t eginning of yer (from line, olumn (A)) (must gree with en-of-yer figure reporte on prior yer's return) Other hnges in net ssets or fun lnes (explin in Sheule O) ETENDED TO NOVEMBER, 0 ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ Net ssets or fun lnes t en of yer. Comine lines through Form 0-EZ (0) ALCOR CARE TRUST SUPPORTI _

2 Form 0-EZ (0) Prt II Blne Sheets (see the instrutions for Prt II) Chek if the orgniztion use Sheule O to respon to ny question in this Prt II (A) Beginning of yer Totl ssets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl liilities (esrie in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~ Net ssets or fun lnes (line of olumn (B) must gree with line ) Prt III Sttement of Progrm Servie Aomplishments (see the instrutions for Prt III) Chek if the orgniztion use Sheule O to respon to ny question in this Prt III Desrie the orgniztion's progrm servie omplishments for eh of its three lrgest progrm servies, s mesure y expenses. In ler n onise mnner, esrie the servies provie, the numer of persons enefite, n other relevnt informtion for eh progrm title. Csh, svings, n investments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ln n uilings ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other ssets (esrie in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~ Wht is the orgniztion's primry exempt purpose? SEE SCHEDULE O ALCOR CARE TRUST SUPPORTING ORGANIZATION SEE SCHEDULE O - (B) En of yer Pge Expenses (Require for setion 0()() n 0()() orgniztions; optionl for others.) (Grnts $ ) If this mount inlues foreign grnts, hek here 0 (Grnts $ ) If this mount inlues foreign grnts, hek here (Grnts $ ) If this mount inlues foreign grnts, hek here Other progrm servies (esrie in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ (Grnts $ ) If this mount inlues foreign grnts, hek here Totl progrm servie expenses ( lines through ) Prt IV List of Offiers, Diretors, Trustees, n Key Employees (list eh one even if not ompenste - see the instrutions for Prt IV) Chek if the orgniztion use Sheule O to respon to ny question in this Prt IV () Averge hours () Reportle () Helth enefits, (e) Estimte ompenstion (Forms ontriutions to () Nme n title per week evote to W-/0-MISC) employee enefit mount of other position (if not pi, enter -0-) plns, n eferre ompenstion ompenstion BRIAN WOWK TRUSTEE MICHAEL RISKIN TRUSTEE STEPHEN W BRIDGE TRUSTEE.00 MICHAEL KORNS TRUSTEE.00 ANDREW AYMELOGLU TRUSTEE Form 0-EZ (0) ALCOR CARE TRUST SUPPORTI _

3 Form 0-EZ (0) Pge Prt V Other Informtion (Note the Sheule A n personl enefit ontrt sttement requirements in the instrutions for Prt V.) Chek if the orgniztion use Sh. O to respon to ny question in this Prt V Yes No Di the orgniztion file Form 0-POL for this yer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0 e Di the orgniztion engge in ny signifint tivity not previously reporte to the IRS? If "Yes," provie etile esription of eh tivity in Sheule O ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Were ny signifint hnges me to the orgnizing or governing ouments? If "Yes," tth onforme opy of the mene ouments if they reflet hnge to the orgniztion's nme. Otherwise, explin the hnge on Sheule O (see instrutions) ~~~~~~ Di the orgniztion hve unrelte usiness gross inome of $,000 or more uring the yer from usiness tivities (suh s those reporte on lines,, n, mong others)? If "Yes" to line, hs the orgniztion file Form 0-T for the yer? If "No," provie n explntion in Sheule O ~~~~~~~~~~~ Ws the orgniztion setion 0()(), 0()(), or 0()() orgniztion sujet to setion 0(e) notie, reporting, n proxy tx requirements uring the yer? If "Yes," omplete Sheule C, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion unergo liquition, issolution, termintion, or signifint isposition of net ssets uring the yer? If "Yes," omplete pplile prts of Sheule N Enter mount of politil expenitures, iret or iniret, s esrie in the instrutions Di the orgniztion orrow from, or mke ny lons to, ny offier, iretor, trustee, or key employee or were ny suh lons me in prior yer n still outstning t the en of the tx yer overe y this return? ~~~~~ If "Yes," omplete Sheule L, Prt II n enter the totl mount involve ~~~~~~~~~~~~~~ Setion 0()() orgniztions. Enter: Initition fees n pitl ontriutions inlue on line ~~~~~~~~~~~~~~~~~~~~~ Gross reeipts, inlue on line, for puli use of lu filities ~~~~~~~~~~~~~~~~~~ Setion 0()() orgniztions. Enter mount of tx impose on the orgniztion uring the yer uner: Setion ()() nonexempt hritle trusts filing Form 0-EZ in lieu of Form 0 - Chek here setion ; setion ; setion Setion 0()(), 0()(), n 0()() orgniztions. Di the orgniztion engge in ny setion exess enefit trnstion uring the yer, or i it engge in n exess enefit trnstion in prior yer tht hs not een reporte on ny of its prior Forms 0 or 0-EZ? If "Yes," omplete Sheule L, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Setion 0()(), 0()(), n 0()() orgniztions. Enter mount of tx impose on orgniztion mngers or isqulifie persons uring the yer uner setions,, n ~~~~~ Setion 0()(), 0()(), n 0()() orgniztions. Enter mount of tx on line 0 reimurse y the orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ All orgniztions. At ny time uring the tx yer, ws the orgniztion prty to prohiite tx shelter trnstion? If "Yes," omplete Form -T ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ List the sttes with whih opy of this return is file The orgniztion's ooks re in re of ALCOR CARE TRUST SUPPORTING ORGANIZATION Lote t ZIP + 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 "Yes," enter the nme of the foreign ountry: See the instrutions for exeptions n filing requirements for FinCEN Form, Report of Foreign Bnk n Finnil Aounts (FBAR). At ny time uring the lenr yer, i the orgniztion mintin n offie outsie the Unite Sttes? ~~~~~~~~~~~~~~~~~ If "Yes," enter the nme of the foreign ountry: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ AZ BONNIE MAGEE Telephone no E ACOMA DR STE 0, SCOTTSDALE, AZ 0- n enter the mount of tx-exempt interest reeive or rue uring the tx yer ~~~~~~~~~~~~~~~~~ N/A N/A N/A - 0 0e N/A N/A Yes No Di the orgniztion mintin ny onor vise funs uring the yer? If "Yes," Form 0 must e omplete inste of Form 0-EZ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion operte one or more hospitl filities uring the yer? If "Yes," Form 0 must e omplete inste of Form 0-EZ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion reeive ny pyments for inoor tnning servies uring the yer? If "Yes" to line, hs the orgniztion file Form 0 to report these pyments? If "No," provie n explntion in Sheule O ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion hve ontrolle entity within the mening of setion ()()? -- ~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion reeive ny pyment from or engge in ny trnstion with ontrolle entity within the mening of setion ()()? If "Yes," Form 0 n Sheule R my nee to e omplete inste of Form 0-EZ (see instrutions) Yes No Form 0-EZ (0) ALCOR CARE TRUST SUPPORTI _

4 Form 0-EZ (0) 0 ALCOR CARE TRUST SUPPORTING ORGANIZATION - Di the orgniztion engge, iretly or iniretly, in politil mpign tivities on ehlf of or in opposition to nites for puli offie? If "Yes," omplete Sheule C, Prt I Prt VI Setion 0()() orgniztions only All setion 0()() orgniztions must nswer questions - n, n omplete the tles for lines 0 n. Chek if the orgniztion use Sheule O to respon to ny question in this Prt VI Di the orgniztion engge in loying tivities or hve setion 0(h) eletion in effet uring the tx yer? If "Yes," omplete Sh. C, Prt II Is the orgniztion shool s esrie in setion 0()()(A)(ii)? If "Yes," omplete Sheule E ~~~~~~~~~~~~~~~~~~~ Di the orgniztion mke ny trnsfers to n exempt non-hritle relte orgniztion? ~~~~~~~~~~~~~~~~~~~~~~ If "Yes," ws the relte orgniztion setion orgniztion? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Pge Yes No Complete this tle for the orgniztion's five highest ompenste employees (other thn offiers, iretors, trustees, n key employees) who eh reeive more thn $00,000 of ompenstion from the orgniztion. If there is none, enter "None." () Nme n title of eh employee () Averge hours () Reportle () Helth enefits, (e) Estimte ompenstion (Forms ontriutions to per week evote to W-/0-MISC) employee enefit mount of other position plns, n eferre ompenstion ompenstion NONE Yes No f Totl numer of other employees pi over $00,000 ~~~~~~~~~~~~~~~~ Complete this tle for the orgniztion's five highest ompenste inepenent ontrtors who eh reeive more thn $00,000 of ompenstion from the orgniztion. If there is none, enter "None." NONE () Nme n usiness ress of eh inepenent ontrtor () Type of servie () Compenstion Totl numer of other inepenent ontrtors eh reeiving over $00,000 ~~~~~~~~~~~~~~ Di the orgniztion omplete Sheule A? Note: All setion 0()() orgniztions must tth omplete Sheule A 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 true, orret, n omplete. Delrtion of preprer (other thn offier) is se on ll informtion of whih preprer hs ny knowlege. Sign Here Pi Preprer Use Only = = Signture of offier ANDREW AYMELOGLU, TRUSTOR Type or print nme n title Print/Type preprer's nme Preprer's signture Dte Chek Dte self- employe KRISTEN BASS // P0 Firm's nme CBIZ MHM, LLC Firm's EIN - Firm's ress N TH ST, STE 00 Phone no. 0-- PHOENI, AZ 0 My the IRS isuss this return with the preprer shown ove? See instrutions if PTIN Yes Yes No No Form 0-EZ (0) ALCOR CARE TRUST SUPPORTI _

5 SCHEDULE A (Form 0 or 0-EZ) Deprtment of the Tresury Internl Revenue Servie 0 e f Complete if the orgniztion is setion 0()() orgniztion or setion ()() nonexempt hritle trust. Atth to Form 0 or Form 0-EZ. Go to for instrutions n the ltest informtion. The orgniztion is not privte fountion euse it is: (For lines through, hek only one ox.) A hurh, onvention of hurhes, or ssoition of hurhes esrie in setion 0()()(A)(i). A shool esrie in setion 0()()(A)(ii). (Atth Sheule E (Form 0 or 0-EZ).) OMB No. -00 Open to Puli Inspetion Nme of the orgniztion Employer ientifition numer ALCOR CARE TRUST SUPPORTING ORGANIZATION - Prt I Reson for Puli Chrity Sttus (All orgniztions must omplete this prt.) See instrutions. A hospitl or oopertive hospitl servie orgniztion esrie in setion 0()()(A)(iii). A meil reserh orgniztion operte in onjuntion with hospitl esrie in setion 0()()(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 0()()(A)(iv). (Complete Prt II.) A feerl, stte, or lol government or governmentl unit esrie in setion 0()()(A)(v). An orgniztion tht normlly reeives sustntil prt of its support from governmentl unit or from the generl puli esrie in setion 0()()(A)(vi). (Complete Prt II.) A ommunity trust esrie in setion 0()()(A)(vi). (Complete Prt II.) An griulturl reserh orgniztion esrie in setion 0()()(A)(ix) operte in onjuntion with ln-grnt ollege or university or non-ln-grnt ollege of griulture (see instrutions). Enter the nme, ity, n stte of the ollege or university: 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,. 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 in lines through tht esries the type of supporting orgniztion n omplete lines e, f, n g. Type I. A supporting orgniztion operte, supervise, or ontrolle y its supporte orgniztion(s), typilly y giving the supporte orgniztion(s) the power to regulrly ppoint or elet mjority of the iretors or trustees of the supporting orgniztion. You must omplete Prt IV, Setions A n B. Type II. A supporting orgniztion supervise or ontrolle in onnetion with its supporte orgniztion(s), y hving ontrol or mngement of the supporting orgniztion veste in the sme persons tht ontrol or mnge the supporte orgniztion(s). You must omplete Prt IV, Setions A n C. Type III funtionlly integrte. A supporting orgniztion operte in onnetion with, n funtionlly integrte with, its supporte orgniztion(s) (see instrutions). Puli Chrity Sttus n Puli Support You must omplete Prt IV, Setions A, D, n E. Type III non-funtionlly integrte. A supporting orgniztion operte in onnetion with its supporte orgniztion(s) tht is not funtionlly integrte. The orgniztion generlly must stisfy istriution requirement n n ttentiveness requirement (see instrutions). You must omplete Prt IV, Setions A n D, n Prt V. Chek this ox if the orgniztion reeive written etermintion from the IRS tht it is Type I, Type II, Type III funtionlly integrte, or Type III non-funtionlly integrte supporting orgniztion. Enter the numer of supporte orgniztions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0 g Provie the following informtion out the supporte orgniztion(s). (i) Nme of supporte (ii) EIN (iii) Type of orgniztion (iv) Is the orgniztion liste (v) Amount of monetry (vi) Amount of other in your governing oument? orgniztion (esrie on lines -0 support (see instrutions) support (see instrutions) ove (see instrutions)) Yes No ALCOR LIFE ETENSION FOUNDATION -0 Totl LHA For Pperwork Reution At Notie, see the Instrutions for Form 0 or 0-EZ Sheule A (Form 0 or 0-EZ) ALCOR CARE TRUST SUPPORTI _

6 Sheule A (Form 0 or 0-EZ) 0 Prt II Support Sheule for Orgniztions Desrie in Setions 0()()(A)(iv) n 0()()(A)(vi) Clenr yer (or fisl yer eginning in) Totl. A lines through ~~~ Puli support. Sutrt line from line. Clenr yer (or fisl yer eginning in) 0 Totl support. A lines through 0 () 0 () 0 () 0 () 0 (e) 0 (f) Totl () 0 () 0 () 0 () 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 (Complete only if you heke the ox on line,, 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 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 ssets (Explin in Prt VI.) ~~~~ Gross reeipts from relte tivities, et. (see instrutions) ~~~~~~~~~~~~~~~~~~~~~~~ Puli support perentge for 0 (line, olumn (f) ivie y line, olumn (f)) ~~~~~~~~~~~~ Puli support perentge from 0 Sheule A, Prt II, line ALCOR CARE TRUST SUPPORTING ORGANIZATION - ~~~~~~~~~~~~~~~~~~~~~ /% 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 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ /% 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 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0% -fts-n-irumstnes test - 0. If the orgniztion i not hek ox on line,, or, 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 VI 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, 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 VI 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,,,, or, hek this ox n see instrutions Pge Sheule A (Form 0 or 0-EZ) 0 % % ALCOR CARE TRUST SUPPORTI _

7 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 ~~~ 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 n ~~~~~~~ Puli support. (Sutrt line 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 ~ () 0 () 0 () 0 () 0 (e) 0 (f) Totl () 0 () 0 () 0 () 0 (e) 0 (f) Totl 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 0 (Complete only if you heke the ox on line 0 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 Unrelte usiness txle inome (less setion txes) from usinesses quire fter June 0, ~~~~ 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 VI.) ~~~~ Totl support. (A lines, 0,, n.) First five yers. If the Form 0 is for the orgniztion's first, seon, thir, fourth, or fifth tx yer s setion 0()() orgniztion, Pge Puli support perentge for 0 (line, olumn (f) ivie y line, olumn (f)) ~~~~~~~~~~~~ % Investment inome perentge for 0 (line 0, olumn (f) ivie y line, olumn (f)) Investment inome perentge from 0 Sheule A, Prt III, line ALCOR CARE TRUST SUPPORTING ORGANIZATION - ~~~~~~~~~~~~~~~~~~ ~~~~~~~~ % /% support tests - 0. If the orgniztion i not hek the ox on 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 ~~~~~~~~~~ /% 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) ALCOR CARE TRUST SUPPORTI _ % %

8 Sheule A (Form 0 or 0-EZ) 0 Prt IV Supporting Orgniztions ouments? If "No," esrie in Prt VI how the supporte orgniztions re esignte. If esignte y lss or purpose, esrie the esigntion. If histori n ontinuing reltionship, explin. uner setion 0()() or ()? If "Yes," explin in Prt VI how the orgniztion etermine tht the supporte orgniztion ws esrie in setion 0()() or (). Di the orgniztion hve supporte orgniztion esrie in setion 0()(), (), or ()? () n () elow. purposes? If "Yes," explin in Prt VI wht ontrols the orgniztion put in ple to ensure suh use. supporte orgniztion? If "Yes," esrie in Prt VI how the orgniztion h suh ontrol n isretion espite eing ontrolle or supervise y or in onnetion with its supporte orgniztions. uner setions 0()() n 0()() or ()? If "Yes," explin in Prt VI wht ontrols the orgniztion use to ensure tht ll support to the foreign supporte orgniztion ws use exlusively for setion 0()()(B) Type I or Type II only. Ws ny e or sustitute supporte orgniztion prt of lss lrey Sustitutions only. Ws the sustitution the result of n event eyon the orgniztion's ontrol? Prt VI. in setion 0()() or ())? If "Yes," provie etil in Prt VI. the supporting orgniztion h n interest? If "Yes," provie etil in Prt VI. If "Yes," nswer Ws ny supporte orgniztion not orgnize in the Unite Sttes ("foreign supporte orgniztion")? "Yes," n if you heke or in Prt I, nswer () n () elow. purposes. (Complete only if you heke ox in line on Prt I. If you heke of Prt I, omplete Setions A n B. If you heke of Prt I, omplete Setions A n C. If you heke of Prt I, omplete Setions A, D, n E. If you heke of Prt I, omplete Setions A n D, n omplete Prt V.) Setion A. All Supporting Orgniztions Are ll of the orgniztion's supporte orgniztions liste y nme in the orgniztion's governing Di the orgniztion hve ny supporte orgniztion tht oes not hve n IRS etermintion of sttus Di the orgniztion onfirm tht eh supporte orgniztion qulifie uner setion 0()(), (), or () n stisfie the puli support tests uner setion 0()()? If "Yes," esrie in Prt VI when n how the orgniztion me the etermintion. Di the orgniztion ensure tht ll support to suh orgniztions ws use exlusively for setion 0()()(B) Di the orgniztion hve ultimte ontrol n isretion in eiing whether to mke grnts to the foreign Di the orgniztion support ny foreign supporte orgniztion tht oes not hve n IRS etermintion Di the orgniztion, sustitute, or remove ny supporte orgniztions uring the tx yer? If "Yes," nswer () n () elow (if pplile). Also, provie etil in Prt VI, inluing (i) the nmes n EIN numers of the supporte orgniztions e, sustitute, or remove; (ii) the resons for eh suh tion; (iii) the uthority uner the orgniztion's orgnizing oument uthorizing suh tion; n (iv) how the tion ws omplishe (suh s y menment to the orgnizing oument). esignte in the orgniztion's orgnizing oument? Sheule A (Form 0 or 0-EZ) ALCOR CARE TRUST SUPPORTI _ If If "Yes," provie etil in regr to sustntil ontriutor? If "Yes," omplete Prt I of Sheule L (Form 0 or 0-EZ). If "Yes," omplete Prt I of Sheule L (Form 0 or 0-EZ). supporting orgniztions)? If "Yes," nswer 0 elow. etermine whether the orgniztion h exess usiness holings.) ALCOR CARE TRUST SUPPORTING ORGANIZATION - Di the orgniztion provie support (whether in the form of grnts or the provision of servies or filities) to nyone other thn (i) its supporte orgniztions, (ii) iniviuls tht re prt of the hritle lss enefite y one or more of its supporte orgniztions, or (iii) other supporting orgniztions tht lso support or enefit one or more of the filing orgniztion's supporte orgniztions? Di the orgniztion provie grnt, lon, ompenstion, or other similr pyment to sustntil ontriutor (efine in setion ()()(C)), fmily memer of sustntil ontriutor, or % ontrolle entity with Di the orgniztion mke lon to isqulifie person (s efine in setion ) not esrie in line? Ws the orgniztion ontrolle iretly or iniretly t ny time uring the tx yer y one or more isqulifie persons s efine in setion (other thn fountion mngers n orgniztions esrie Di one or more isqulifie persons (s efine in line ) hol ontrolling interest in ny entity in whih Di isqulifie person (s efine in line ) hve n ownership interest in, or erive ny personl enefit from, ssets in whih the supporting orgniztion lso h n interest? If "Yes," provie etil in Prt VI. 0 Ws the orgniztion sujet to the exess usiness holings rules of setion euse of setion (f) (regring ertin Type II supporting orgniztions, n ll Type III non-funtionlly integrte Di the orgniztion hve ny exess usiness holings in the tx yer? (Use Sheule C, Form 0, to 0 0 Yes Pge No

9 Sheule A (Form 0 or 0-EZ) 0 Prt IV Supporting Orgniztions (ontinue) A % ontrolle entity of person esrie in () or () ove? Setion B. Type I Supporting Orgniztions If "Yes" to,, or, provie etil in Prt VI. tx yer? If "No," esrie in Prt VI how the supporte orgniztion(s) effetively operte, supervise, or ontrolle the orgniztion's tivities. If the orgniztion h more thn one supporte orgniztion, Prt VI how proviing suh enefit rrie out the purposes of the supporte orgniztion(s) tht operte, supervise, or ontrolle the supporting orgniztion. Setion C. Type II Supporting Orgniztions or trustees of eh of the orgniztion's supporte orgniztion(s)? If "No," esrie in Prt VI how ontrol or mngement of the supporting orgniztion ws veste in the sme persons tht ontrolle or mnge orgniztion(s) or (ii) serving on the governing oy of supporte orgniztion? If "No," explin in Prt VI how the orgniztion mintine lose n ontinuous working reltionship with the supporte orgniztion(s). inome or ssets t ll times uring the tx yer? If "Yes," esrie in Prt VI the role the orgniztion's supporte orgniztions plye in this regr. Setion E. Type III Funtionlly Integrte Supporting Orgniztions Chek the ox next to the metho tht the orgniztion use to stisfy the Integrl Prt Test uring the yer (see instrutions). The orgniztion stisfie the Ativities Test. Complete line elow. The orgniztion is the prent of eh of its supporte orgniztions. Complete line elow. The orgniztion supporte governmentl entity. Desrie in Prt VI how you supporte government entity (see instrutions). Hs the orgniztion epte gift or ontriution from ny of the following persons? A person who iretly or iniretly ontrols, either lone or together with persons esrie in () n () elow, the governing oy of supporte orgniztion? A fmily memer of person esrie in () ove? Di the iretors, trustees, or memership of one or more supporte orgniztions hve the power to regulrly ppoint or elet t lest mjority of the orgniztion's iretors or trustees t ll times uring the esrie how the powers to ppoint n/or remove iretors or trustees were llote mong the supporte orgniztions n wht onitions or restritions, if ny, pplie to suh powers uring the tx yer. Di the orgniztion operte for the enefit of ny supporte orgniztion other thn the supporte orgniztion(s) tht operte, supervise, or ontrolle the supporting orgniztion? the supporte orgniztion(s). Setion D. All Type III Supporting Orgniztions Yes Yes Yes Yes Pge Ativities Test. Answer () n () elow. Yes No the supporte orgniztion(s) to whih the orgniztion ws responsive? If "Yes," then in Prt VI ientify those supporte orgniztions n explin how these tivities iretly furthere their exempt purposes, how the orgniztion ws responsive to those supporte orgniztions, n how the orgniztion etermine tht these tivities onstitute sustntilly ll of its tivities. of the orgniztion's supporte orgniztion(s) woul hve een engge in? If "Yes," explin in Prt VI the resons for the orgniztion's position tht its supporte orgniztion(s) woul hve engge in these tivities ut for the orgniztion's involvement. Prent of Supporte Orgniztions. Answer () n () elow. ALCOR CARE TRUST SUPPORTING ORGANIZATION - trustees of eh of the supporte orgniztions? Provie etils in Prt VI. If "Yes," explin in Were mjority of the orgniztion's iretors or trustees uring the tx yer lso mjority of the iretors Di the orgniztion provie to eh of its supporte orgniztions, y the lst y of the fifth month of the orgniztion's tx yer, (i) written notie esriing the type n mount of support provie uring the prior tx yer, (ii) opy of the Form 0 tht ws most reently file s of the te of notifition, n (iii) opies of the orgniztion's governing ouments in effet on the te of notifition, to the extent not previously provie? Were ny of the orgniztion's offiers, iretors, or trustees either (i) ppointe or elete y the supporte By reson of the reltionship esrie in (), i the orgniztion's supporte orgniztions hve signifint voie in the orgniztion's investment poliies n in ireting the use of the orgniztion's Di sustntilly ll of the orgniztion's tivities uring the tx yer iretly further the exempt purposes of Di the tivities esrie in () onstitute tivities tht, ut for the orgniztion's involvement, one or more Di the orgniztion hve the power to regulrly ppoint or elet mjority of the offiers, iretors, or Di the orgniztion exerise sustntil egree of iretion over the poliies, progrms, n tivities of eh of its supporte orgniztions? If "Yes," esrie in Prt VI the role plye y the orgniztion in this regr Sheule A (Form 0 or 0-EZ) ALCOR CARE TRUST SUPPORTI _ No No No No

10 Sheule A (Form 0 or 0-EZ) 0 Prt V Type III Non-Funtionlly Integrte 0()() Supporting Orgniztions Pge Chek here if the orgniztion stisfie the Integrl Prt Test s qulifying trust on Nov. 0, 0 (explin in Prt VI.) See instrutions. All Setion A - Ajuste Net Inome Ajuste Net Inome (sutrt lines,, n from line ) Setion B - Minimum Asset Amount e other Type III non-funtionlly integrte supporting orgniztions must omplete Setions A through E. Net short-term pitl gin Reoveries of prior-yer istriutions Other gross inome (see instrutions) A lines through Depreition n epletion Portion of operting expenses pi or inurre for proution or olletion of gross inome or for mngement, onservtion, or mintenne of property hel for proution of inome (see instrutions) Other expenses (see instrutions) Aggregte fir mrket vlue of ll non-exempt-use ssets (see instrutions for short tx yer or ssets hel for prt of yer): Averge monthly vlue of seurities Averge monthly sh lnes Fir mrket vlue of other non-exempt-use ssets Totl ( lines,, n ) Disount lime for lokge or other ftors (explin in etil in Prt VI): Aquisition ineteness pplile to non-exempt-use ssets Sutrt line from line Csh eeme hel for exempt use. Enter -/% of line (for greter mount, see instrutions) Net vlue of non-exempt-use ssets (sutrt line from line ) Multiply line y.0 Reoveries of prior-yer istriutions Minimum Asset Amount ( line to line ) ALCOR CARE TRUST SUPPORTING ORGANIZATION - (A) Prior Yer (A) Prior Yer (B) Current Yer (optionl) (B) Current Yer (optionl) Setion C - Distriutle Amount Current Yer Ajuste net inome for prior yer (from Setion A, line, Column A) Enter % of line Minimum sset mount for prior yer (from Setion B, line, Column A) Enter greter of line or line Inome tx impose in prior yer Distriutle Amount. Sutrt line from line, unless sujet to emergeny temporry reution (see instrutions) Chek here if the urrent yer is the orgniztion's first s non-funtionlly integrte Type III supporting orgniztion (see instrutions). Sheule A (Form 0 or 0-EZ) ALCOR CARE TRUST SUPPORTI _

11 Sheule A (Form 0 or 0-EZ) 0 Prt V Type III Non-Funtionlly Integrte 0()() Supporting Orgniztions Setion D - Distriutions 0 Amounts pi to supporte orgniztions to omplish exempt purposes Amounts pi to perform tivity tht iretly furthers exempt purposes of supporte orgniztions, in exess of inome from tivity Aministrtive expenses pi to omplish exempt purposes of supporte orgniztions Amounts pi to quire exempt-use ssets Qulifie set-sie mounts (prior IRS pprovl require) Other istriutions (esrie in Prt VI). See instrutions. Totl nnul istriutions. A lines through. Distriutions to ttentive supporte orgniztions to whih the orgniztion is responsive (provie etils in Prt VI). See instrutions. Distriutle mount for 0 from Setion C, line Line mount ivie y line mount Setion E - Distriution Allotions (see instrutions) ALCOR CARE TRUST SUPPORTING ORGANIZATION - (i) Exess Distriutions (ontinue) (ii) Uneristriutions Pre-0 Current Yer (iii) Distriutle Amount for 0 Pge e f g h i j e Distriutle mount for 0 from Setion C, line Uneristriutions, if ny, for yers prior to 0 (resonle use require- explin in Prt VI). See instrutions. Exess istriutions rryover, if ny, to 0 From 0 From 0 From 0 From 0 Totl of lines through e Applie to uneristriutions of prior yers Applie to 0 istriutle mount Crryover from 0 not pplie (see instrutions) Reminer. Sutrt lines g, h, n i from f. Distriutions for 0 from Setion D, line : $ Applie to uneristriutions of prior yers Applie to 0 istriutle mount Reminer. Sutrt lines n from. Remining uneristriutions for yers prior to 0, if ny. Sutrt lines g n from line. For result greter thn zero, explin in Prt VI. See instrutions. Remining uneristriutions for 0. Sutrt lines h n from line. For result greter thn zero, explin in Prt VI. See instrutions. Exess istriutions rryover to 0. A lines j n. Brekown of line : Exess from 0 Exess from 0 Exess from 0 Exess from 0 Exess from 0 Sheule A (Form 0 or 0-EZ) ALCOR CARE TRUST SUPPORTI _

12 ALCOR CARE TRUST SUPPORTING ORGANIZATION - Sheule A (Form 0 or 0-EZ) 0 Pge Prt VI Supplementl Informtion. Provie the explntions require y Prt II, line 0; Prt II, line or ; Prt III, line ; Prt IV, Setion A, lines,,,,,,,,,,,,, n ; Prt IV, Setion B, lines n ; Prt IV, Setion C, line ; Prt IV, Setion D, lines n ; Prt IV, Setion E, lines,,,, n ; Prt V, line ; Prt V, Setion B, line e; Prt V, Setion D, lines,, n ; n Prt V, Setion E, lines,, n. Also omplete this prt for ny itionl informtion. (See instrutions.) Sheule A (Form 0 or 0-EZ) ALCOR CARE TRUST SUPPORTI _

13 SCHEDULE O (Form 0 or 0-EZ) Deprtment of the Tresury Internl Revenue Servie Nme of the orgniztion Supplementl Informtion to Form 0 or 0-EZ Complete to provie informtion for responses to speifi questions on Form 0 or 0-EZ or to provie ny itionl informtion. Atth to Form 0 or 0-EZ. Go to for the ltest informtion. OMB No Open to Puli Inspetion Employer ientifition numer ALCOR CARE TRUST SUPPORTING ORGANIZATION - FORM 0-EZ, PART III, PRIMARY EEMPT PURPOSE - SUPPORT ALCOR LIFE ETENSION FOUNDATION. FORM 0-EZ, PART III, LINE, PROGRAM SERVICE ACCOMPLISHMENTS: RETAIN AND DIRECT PROFESSIONAL INVESTMENT MANAGERS TO IMPLEMENT INVESTMENT STRATEGIES ESTABLISHED BY THE SUPPORTING ORGANIZATION. SOLICIT THE SUPPORTED ORGANIZATION'S MEMBERS AND OTHERS FOR CONTRIBUTIONS TO THE ALCOR CARE TRUST AND PERFORMING OTHER FUNDRAISING FUNCTIONS. DISBURSE ALCOR CARE TRUST FUND ASSETS TO THE SUPPORTED ORGANIZATION. LHA For Pperwork Reution At Notie, see the Instrutions for Form 0 or 0-EZ. Sheule O (Form 0 or 0-EZ) (0) ALCOR CARE TRUST SUPPORTI _

14 Form Applition for Automti Extension of Time To File n Exempt Orgniztion Return (Rev. Jnury 0) Deprtment of the Tresury Internl Revenue Servie File seprte pplition for eh return. Informtion out Form n its instrutions is t OMB No. -0 Eletroni filing (e-file). Type or print File y the ue te for filing your return. See instrutions. Applition Is For You n eletronilly file Form to request -month utomti extension of time to file ny of the forms liste elow with the exeption of Form 0, Informtion Return for Trnsfers Assoite With Certin Personl Benefit Contrts, for whih n extension request must e sent to the IRS in pper formt (see instrutions). For more etils on the eletroni filing of this form, visit lik on Chrities & Non-Profits, n lik on e-file for Chrities n Non-Profits. Automti -Month Extension of Time. Only sumit originl (no opies neee). All orportions require to file n inome tx return other thn Form 0-T (inluing 0-C filers), prtnerships, REMICs, n trusts must use Form 00 to request n extension of time to file inome tx returns. Nme of exempt orgniztion or other filer, see instrutions. Numer, street, n room or suite no. If P.O. ox, see instrutions. City, town or post offie, stte, n ZIP oe. For foreign ress, see instrutions. Enter the Return Coe for the return tht this pplition is for (file seprte pplition for eh return) Form 0 or Form 0-EZ Form 0-BL Form 0 (iniviul) Form 0-PF Form 0-T (se. 0() or 0() trust) Form 0-T (trust other thn ove) The ooks re in the re of Return Coe Applition Is For Blne ue. Sutrt line from line. Inlue your pyment with this form, if require, Enter filer's ientifying numer Employer ientifition numer (EIN) or Soil seurity numer (SSN) Cution: If you re going to mke n eletroni funs withrwl (iret eit) with this Form, see Form -EO n Form -EO for pyment instrutions. LHA For Privy At n Pperwork Reution At Notie, see instrutions. Form (Rev. -0) $ $ $ Return Coe Form 0-T (orportion) 0 Form 0-A Form 0 (other thn iniviul) Form Form 0 Form 0 Telephone No. Fx No. If the orgniztion oes not hve n offie or ple of usiness in the Unite Sttes, hek this ox ~~~~~~~~~~~~~~~~~ If this is for Group Return, enter the orgniztion's four igit Group Exemption Numer (GEN). If this is for the whole group, hek this ox. If it is for prt of the group, hek this ox n tth list with the nmes n EINs of ll memers the extension is for. I request n utomti -month extension of time until for the orgniztion nme ove. The extension is for the orgniztion's return for: ALCOR CARE TRUST SUPPORTING ORGANIZATION EAST ACOMA DR STE 0 SCOTTSDALE, AZ 0 lenr yer BONNIE MAGEE E ACOMA DR STE 0 - SCOTTSDALE, AZ or, to file the exempt orgniztion return tx yer eginning, n ening. If the tx yer entere in line is for less thn months, hek reson: Initil return Finl return Chnge in ounting perio If this pplition is for Forms 0-BL, 0-PF, 0-T, 0, or 0, enter the tenttive tx, less ny nonrefunle reits. See instrutions. NOVEMBER, 0 If this pplition is for Forms 0-PF, 0-T, 0, or 0, enter ny refunle reits n estimte tx pyments me. Inlue ny prior yer overpyment llowe s reit. y using EFTPS (Eletroni Feerl Tx Pyment System). See instrutions MAIL TO: DEPARTMENT OF THE TREASURY INTERNAL REVENUE SERVICE CENTER OGDEN, UT ALCOR CARE TRUST SUPPORTI _