I The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection

Transcription

1 Form 99 Return of Orgniztion Exempt From ncome Tx Under section 51(c), 527, or 4947()(1) of the nternl Revenue Code (except lck lung enefit trust or privte foundtion) OMB No À¾µ Open to Pulic Deprtment of the Tresury nternl Revenue Service The orgniztion my hve to use copy of this return to stisfy stte reporting requirements. nspection A For the 212 clendr yer, or tx yer eginning B Check if pplicle: Activities & Governnce Revenue Expenses Net Assets or Fund Blnces Address chnge Nme chnge nitil return C Nme of orgniztion Doing Business As Numer nd street (or P.O. ox if mil is not delivered to street ddress) 7/1, 212, nd ending 6/, 2 1 D Employer identifiction numer Room/suite E Telephone numer Terminted City, town or post office, stte, nd ZP code Amended return BUFFALO, NY G Gross receipts $ 19,668. Appliction F Nme nd ddress of principl officer: H() s this group return for Yes No pending EDWARD P. SCHNEDER ffilites? BO 9 BUFFALO, NY H() Are ll ffilites included? Yes No Tx-exempt sttus: 51(c)() 51(c) ( ) (insert no.) 4947()(1) or 527 f "No," ttch list. (see instructions) J Wesite: H(c) Group exemption numer Prt Check this ox UB FOUNDATON SERVCES, NC BO 9 (716) J K Form of orgniztion: Corportion Trust Assocition Other L Yer of formtion: 1988 M Stte of legl domicile: NY Prt Summry 1 Briefly descrie the orgniztion's mission or most significnt ctivities: TO CARRY OUT THE PURPOSES OF THE UNV AT BUFFALO FOUNDATON AND THE UNV AT BUFFALO BY ADMNSTERNG RESEARCH GRANTS, PROVDNG FNANCAL SERVCES, AND ACQURNG REAL ESTATE CRTCAL TO UB NTATVES. Numer of voting memers of the governing ody (Prt V, line 1) Numer of independent voting memers of the governing ody (Prt V, line 1) Totl numer of individuls employed in clendr yer 212 (Prt V, line 2) Totl numer of volunteers (estimte if necessry) Totl unrelted usiness revenue from Prt V, column (C), line 12 Net unrelted usiness txle income from Form 99-T, line 4 m m m m m m m m m m m m m m m m m m m m m m m m m Prior Yer m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m if the orgniztion discontinued its opertions or disposed of more thn 25% of its net ssets. 8 Contriutions nd grnts (Prt V, line 1h) 9 Progrm service revenue (Prt V, line 2g) 1 nvestment income (Prt V, column (A), lines, 4, nd 7d) m m m m m 11 Other revenue (Prt V, column (A), lines 5, 6d, 8c, 9c, 1c, nd 11e) m m m m m 12 Totl revenue - dd lines 8 through 11 (must equl Prt V, column (A), line 12) 1 Grnts nd similr mounts pid (Prt, column (A), lines 1-) 14 Benefits pid to or for memers (Prt, column (A), line 4) m m m m m m m m m m 15 Slries, other compenstion, employee enefits (Prt, column (A), lines 5-1) 16 Professionl fundrising fees (Prt, column (A), line 11e) m m m m m m m m m m m m m m m m m Totl fundrising expenses (Prt, column (D), line 25) 17 Other expenses (Prt, column (A), lines 11-11d, 11f-24e) m m m m m m 18 Totl expenses. Add lines 1-17 (must equl Prt, column (A), line 25) m m m m m m m m m m 19 Revenue less expenses. Sutrct line 18 from line 12 Totl ssets (Prt, line 16) Totl liilities (Prt, line 26) Net ssets or fund lnces. Sutrct line 21 from line 2 Signture Block m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Beginning of Current Yer Current Yer End of Yer Under penlties of perjury, declre tht hve exmined this return, including ccompnying schedules nd sttements, nd to the est of my knowledge nd elief, it is true, correct, nd complete. Declrtion of preprer (other thn officer) is sed on ll informtion of which preprer hs ny knowledge , , , , , ,668. 7, , ,87. 21, , ,89. 7,879,1. 8,127,55. 7,7,826. 7,617, , ,8. Sign Here Pid M Signture of officer Dte M EDWARD P. SCHNEDER Type or print nme nd title Print/Type preprer's nme Preprer's signture Dte Check if PTN self-employed EECUTVE DRECTOR Firm's EN Phone no. m m m m m m m m m m m m m m m m m m m m m m m m m P Preprer Firm's nme KPMG LLP Use Only Firm's ddress 6 SOUTH STREET BOSTON, MA My the RS discuss this return with the preprer shown ove? (see instructions) Yes No For Pperwork Reduction Act Notice, see the seprte instructions. Form 99 (212) 2E GG PAGE 2

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3 Form 99 (212) Pge 2 Prt UB FOUNDATON SERVCES, NC Sttement of Progrm Service Accomplishments Check if Schedule O contins response to ny question in this Prt m m m m m m m m m m m m m m m m m m m m m m m m 1 Briefly descrie the orgniztion's mission: THE ORGANZATON'S MSSON S TO CARRY OUT THE PURPOSES OF THE UNV. AT BUFFALO FOUNDATON, NC. AND THE UNV. AT BUFFALO BY ADMNSTERNG RESEARCH GRANTS; PROVDNG FNANCAL AND ADMNSTRATVE SERVCES; AND AQURNG REAL ESTATE FOR CRTCAL UNVERSTY NTATVES. m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m f "Yes," descrie these new services on Schedule O. 2 Did the orgniztion undertke ny significnt progrm services during the yer which were not listed on the prior Form 99 or 99-EZ? Yes No m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m f "Yes," descrie these chnges on Schedule O. Did the orgniztion cese conducting, or mke significnt chnges in how it conducts, ny progrm services? Yes No 4 Descrie the orgniztion's progrm service ccomplishments for ech of its three lrgest progrm services, s mesured y expenses. Section 51(c)() nd 51(c)(4) orgniztions re required to report the mount of grnts nd lloctions to others, the totl expenses, nd revenue, if ny, for ech progrm service reported. 4 (Code: ) (Expenses $ 189,859. including grnts of $ 7,472. ) (Revenue $ 192,627. ) ADMNSTERNG RESEARCH GRANTS AND PROVDNG FNANCAL, ACCOUNTNG, AND ADMNSTRATVE SERVCES FOR VAROUS UNVERSTY AT BUFFALO PROGRAMS. 4 (Code: ) (Expenses $ including grnts of $ ) (Revenue $ ) 4c (Code: ) (Expenses $ including grnts of $ ) (Revenue $ ) 4d Other progrm services (Descrie in Schedule O.) (Expenses $ including grnts of $ ) (Revenue $ ) 4e Totl progrm service expenses 189,859. 2E12 2. Form 99 (212) 14GG PAGE

4 UB FOUNDATON SERVCES, NC Form 99 (212) Pge Prt V Checklist of Required Schedules m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m s the orgniztion required to complete Schedule B, Schedule of Contriutors (see instructions)? m m m m m m m m m Did the orgniztion engge in direct or indirect politicl cmpign ctivities on ehlf of or in opposition to cndidtes for pulic office? f "Yes," complete Schedule C, Prt m m m m m m m m m m m m m m m m m m m m m m m m m m m Section 51(c)() orgniztions. Did the orgniztion engge in loying ctivities, or hve section 51(h) election in effect during the tx yer? f "Yes," complete Schedule C, Prt m m m m m m m m m m m m m m m m m m m m m m s the orgniztion descried in section 51(c)() or 4947()(1) (other thn privte foundtion)? f "Yes," complete Schedule A 1 2 s the orgniztion section 51(c)(4), 51(c)(5), or 51(c)(6) orgniztion tht receives memership dues, ssessments, or similr mounts s defined in Revenue Procedure 98-19? f "Yes," complete Schedule C, Prt m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion mintin ny donor dvised funds or ny similr funds or ccounts for which donors hve the right to provide dvice on the distriution or investment of mounts in such funds or ccounts? f "Yes," complete Schedule D, Prt m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion receive or hold conservtion esement, including esements to preserve open spce, the environment, historic lnd res, or historic structures? f "Yes," complete Schedule D, Prt m m m m m m m m m m Did the orgniztion mintin collections of works of rt, historicl tresures, or other similr ssets? f "Yes," complete Schedule D, Prt m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion report n mount in Prt, line 21, for escrow or custodil ccount liility; serve s custodin for mounts not listed in Prt ; or provide credit counseling, det mngement, credit repir, or det negotition services? f "Yes," complete Schedule D, Prt V m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion, directly or through relted orgniztion, hold ssets in temporrily restricted endowments, permnent endowments, or qusi-endowments? f "Yes," complete Schedule D, Prt V m m m m m m m 11 f the orgniztion s nswer to ny of the following questions is "Yes," then complete Schedule D, Prts V, V, V,, or s pplicle. Did the orgniztion report n mount for lnd, uildings, nd equipment in Prt, line 1? f "Yes," c d e f 2E complete Schedule D, Prt V m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion report n mount for investments-other securities in Prt, line 12 tht is 5% or more of its totl ssets reported in Prt, line 16? f "Yes," complete Schedule D, Prt V m m m m m m m m m m m m m m m m m Did the orgniztion report n mount for investments-progrm relted in Prt, line 1 tht is 5% or more of its totl ssets reported in Prt, line 16? f "Yes," complete Schedule D, Prt V m m m m m m m m m m m m m m m m m Did the orgniztion report n mount for other ssets in Prt, line 15 tht is 5% or more of its totl ssets reported in Prt, line 16? f "Yes," complete Schedule D, Prt m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion report n mount for other liilities in Prt, line 25? f "Yes," complete Schedule D, Prt Did the orgniztion s seprte or consolidted finncil sttements for the tx yer include footnote tht ddresses the orgniztion's liility for uncertin tx positions under FN 48 (ASC 74)? f "Yes," complete Schedule D, Prt m m m m m m Did the orgniztion otin seprte, independent udited finncil sttements for the tx yer? f "Yes," complete Schedule D, Prts nd m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Ws the orgniztion included in consolidted, independent udited finncil sttements for the tx yer? f "Yes," nd if the orgniztion nswered "No" to line 12, then completing Schedule D, Prts nd is optionl m m m m s the orgniztion school descried in section 17()(1)(A)(ii)? f "Yes," complete Schedule E Did the orgniztion mintin n office, employees, or gents outside of the United Sttes?m m m m m m m m m m m m m Did the orgniztion hve ggregte revenues or expenses of more thn $1, from grntmking, fundrising, usiness, investment, nd progrm service ctivities outside the United Sttes, or ggregte foreign investments vlued t $1, or more? f "Yes," complete Schedule F, Prts nd V m m m m m m m m m m m Did the orgniztion report on Prt, column (A), line, more thn $5, of grnts or ssistnce to ny orgniztion or entity locted outside the United Sttes? f "Yes," complete Schedule F, Prts nd V m m m m m m m Did the orgniztion report on Prt, column (A), line, more thn $5, of ggregte grnts or ssistnce to individuls locted outside the United Sttes? f "Yes," complete Schedule F, Prts nd V m m m m m m m m m m m Did the orgniztion report totl of more thn $15, of expenses for professionl fundrising services on Prt, column (A), lines 6 nd 11e? f "Yes," complete Schedule G, Prt (see instructions) m m m m m m m m m m m Did the orgniztion report more thn $15, totl of fundrising event gross income nd contriutions on Prt V, lines 1c nd 8? f "Yes," complete Schedule G, Prt m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion report more thn $15, of gross income from gming ctivities on Prt V, line 9? f "Yes," complete Schedule G, Prt m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion operte one or more hospitl fcilities? f "Yes," complete Schedule H m m m m m m m f "Yes" to line 2, did the orgniztion ttch copy of its udited finncil sttements to this return? m m m m m m c 11d 11e 11f Yes No Form 99 (212) 14GG PAGE 4

5 UB FOUNDATON SERVCES, NC Form 99 (212) Pge 4 Prt V Checklist of Required Schedules (continued) c d c m m m m m m m m m m m m on Prt, column (A), line 2? f "Yes," complete Schedule, Prts nd m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion report more thn $5, of grnts nd other ssistnce to ny government or orgniztion in the United Sttes on Prt, column (A), line 1? f "Yes," complete Schedule, Prts nd 21 Did the orgniztion report more thn $5, of grnts nd other ssistnce to individuls in the United Sttes 22 Did the orgniztion nswer "Yes" to Prt V, Section A, line, 4, or 5 out compenstion of the orgniztion's current nd former officers, directors, trustees, key employees, nd highest compensted employees? f "Yes," complete Schedule J m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion hve tx-exempt ond issue with n outstnding principl mount of more thn $1, s of the lst dy of the yer, tht ws issued fter Decemer 1, 22? f "Yes," nswer lines 24 through 24d nd complete Schedule K. f No, go to line 25 m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion invest ny proceeds of tx-exempt onds eyond temporry period exception? m m m m m m m Did the orgniztion mintin n escrow ccount other thn refunding escrow t ny time during the yer to defese ny tx-exempt onds? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion ct s n "on ehlf of" issuer for onds outstnding t ny time during the yer? m m m m m m m Section 51(c)() nd 51(c)(4) orgniztions. Did the orgniztion engge in n excess enefit trnsction with disqulified person during the yer? f "Yes," complete Schedule L, Prt m m m m m m m m m m m m m m m m m m m s the orgniztion wre tht it engged in n excess enefit trnsction with disqulified person in prior yer, nd tht the trnsction hs not een reported on ny of the orgniztion's prior Forms 99 or 99-EZ? f "Yes," complete Schedule L, Prt m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Ws lon to or y current or former officer, director, trustee, key employee, highly compensted employee, or disqulified person outstnding s of the end of the orgniztion's tx yer? f "Yes," complete Schedule L, Prt m Did the orgniztion provide grnt or other ssistnce to n officer, director, trustee, key employee, sustntil contriutor or employee thereof, grnt selection committee memer, or to 5% controlled entity or fmily memer of ny of these persons? f "Yes," complete Schedule L, Prt m m m m m m m m m m m m m m m Ws the orgniztion prty to usiness trnsction with one of the following prties (see Schedule L, Prt V instructions for pplicle filing thresholds, conditions, nd exceptions): A current or former officer, director, trustee, or key employee? f "Yes," complete Schedule L, Prt V m m m m m m m m A fmily memer of current or former officer, director, trustee, or key employee? f "Yes," complete Schedule L, Prt V m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m An entity of which current or former officer, director, trustee, or key employee (or fmily memer thereof) ws n officer, director, trustee, or direct or indirect owner? f "Yes," complete Schedule L, Prt V m m m m m m m m m Did the orgniztion receive more thn $25, in non-csh contriutions? f "Yes," complete Schedule M Did the orgniztion receive contriutions of rt, historicl tresures, or other similr ssets, or qulified conservtion contriutions? f "Yes," complete Schedule M m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion liquidte, terminte, or dissolve nd cese opertions? f "Yes," complete Schedule N, Prt m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion sell, exchnge, dispose of, or trnsfer more thn 25% of its net ssets? f "Yes," complete Schedule N, Prt m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion own 1% of n entity disregrded s seprte from the orgniztion under Regultions sections nd ? f "Yes," complete Schedule R, Prt m m m m m m m m m m m m m m m m m m m m m Ws the orgniztion relted to ny tx-exempt or txle entity? f "Yes," complete Schedule R, Prt,, or V, nd Prt V, line 1 m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion hve controlled entity within the mening of section 512()(1)? m m m m m m m m m m m m m m f "Yes" to line 5, did the orgniztion receive ny pyment from or engge in ny trnsction with controlled entity within the mening of section 512()(1)? f "Yes," complete Schedule R, Prt V, line 2 m m m m m m Section 51(c)() orgniztions. Did the orgniztion mke ny trnsfers to n exempt non-chritle relted orgniztion? f "Yes," complete Schedule R, Prt V, line 2 m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion conduct more thn 5% of its ctivities through n entity tht is not relted orgniztion nd tht is treted s prtnership for federl income tx purposes? f "Yes," complete Schedule R, Prt V m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion complete Schedule O nd provide explntions in Schedule O for Prt V, lines 11 nd 19? Note. All Form 99 filers re required to complete Schedule O m m m m m m m m m m m m m m m m m m m m m m m m m c 24d c Yes No Form 99 (212) 2E GG PAGE 5

6 Form 99 (212) Pge 5 Prt V Sttements Regrding Other RS Filings nd Tx Complince Check if Schedule O contins response to ny question in this Prt V m m m m m m m m m m m m m m m m m m m m m m m Yes c Did the orgniztion comply with ckup withholding rules for reportle pyments to vendors nd reportle gming (gmling) winnings to prize winners? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 1c 2 Enter the numer of employees reported on Form W-, Trnsmittl of Wge nd Tx Sttements, filed for the clendr yer ending with or within the yer covered y this return m 2 f t lest one is reported on line 2, did the orgniztion file ll required federl employment tx returns? 2 4 f Yes, enter the nme of the foreign country: See instructions for filing requirements for Form TD F , Report of Foreign Bnk nd Finncil Accounts. 5 Ws the orgniztion prty to prohiited tx shelter trnsction t ny time during the tx yer? m m m m m m m m Did ny txle prty notify the orgniztion tht it ws or is prty to prohiited tx shelter trnsction? c f "Yes" to line 5 or 5, did the orgniztion file Form 8886-T? m m m m m m m m m m m m m m m m m m m m m m m m m m m m 6 Does the orgniztion hve nnul gross receipts tht re normlly greter thn $1,, nd did the c d e f g h c 14 Enter the numer reported in Box of Form 196. Enter -- if not pplicle m Enter the numer of Forms W-2G included in line 1. Enter -- if not pplicle m m m m m m m m m Note. f the sum of lines 1 nd 2 is greter thn 25, you my e required to e-file (see instructions) Did the orgniztion hve unrelted usiness gross income of $1, or more during the yer? f "Yes," hs it filed Form 99-T for this yer? f "No," provide n explntion in Schedule O m m m m m m m m m m m m m At ny time during the clendr yer, did the orgniztion hve n interest in, or signture or other uthority over, finncil ccount in foreign country (such s nk ccount, securities ccount, or other finncil ccount)? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m orgniztion solicit ny contriutions tht were not tx deductile s chritle contriutions? m m m m m m m m m m m f "Yes," did the orgniztion include with every solicittion n express sttement tht such contriutions or gifts were not tx deductile? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Orgniztions tht my receive deductile contriutions under section 17(c). Did the orgniztion receive pyment in excess of $75 mde prtly s contriution nd prtly for goods nd services provided to the pyor? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m f "Yes," did the orgniztion notify the donor of the vlue of the goods or services provided? m m m m m m m m m m m m Did the orgniztion sell, exchnge, or otherwise dispose of tngile personl property for which it ws required to file Form 8282? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m f "Yes," indicte the numer of Forms 8282 filed during the yer m m m m m m m m m m m m m m m m 7d Did the orgniztion receive ny funds, directly or indirectly, to py premiums on personl enefit contrct? m m m Did the orgniztion, during the yer, py premiums, directly or indirectly, on personl enefit contrct? f the orgniztion received contriution of qulified intellectul property, did the orgniztion file Form 8899 s required? m m m f the orgniztion received contriution of crs, ots, irplnes, or other vehicles, did the orgniztion file Form 198-C? Sponsoring orgniztions mintining donor dvised funds nd section 59()() supporting orgniztions. Did the supporting orgniztion, or donor dvised fund mintined y sponsoring orgniztion, hve excess usiness holdings t ny time during the yer? m m m m m m m m m m m m m m m m m m m m m m m Sponsoring orgniztions mintining donor dvised funds. Did the orgniztion mke ny txle distriutions under section 4966? m m m m m m m Did the orgniztion mke distriution to donor, donor dvisor, or relted person? m m m m m m m m m m m m m m m m Section 51(c)(7) orgniztions. Enter: nitition fees nd cpitl contriutions included on Prt V, line 12 m m m m m m m m m m 1 Gross receipts, included on Form 99, Prt V, line 12, for pulic use of clu fcilities m m m m 1 Section 51(c)(12) orgniztions. Enter: Gross income from memers or shreholders m m m m m m m m m m m m m m m m m m m m m m m m m m 11 Gross income from other sources (Do not net mounts due or pid to other sources ginst mounts due or received from them.) m m m m m m m m m m m m m m m m m m m m m m m m m m m 11 Section 4947()(1) non-exempt chritle trusts. s the orgniztion filing Form 99 in lieu of Form 141? f "Yes," enter the mount of tx-exempt interest received or ccrued during the yer m m m m m 12 Section 51(c)(29) qulified nonprofit helth insurnce issuers. s the orgniztion licensed to issue qulified helth plns in more thn one stte? m m m m m m m m m m m m m m m m m m 1 Note. See the instructions for dditionl informtion the orgniztion must report on Schedule O. Enter the mount of reserves the orgniztion is required to mintin y the sttes in which 2E14 1. UB FOUNDATON SERVCES, NC the orgniztion is licensed to issue qulified helth plns 1 Enter the mount of reserves on hnd m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 1c Did the orgniztion receive ny pyments for indoor tnning services during the tx yer? m m m m m m m f "Yes," hs it filed Form 72 to report these pyments? f "No," provide n explntion in Schedule O m m m m m m c c 7e 7f 7g 7h No Form 99 (212) 14GG PAGE 6

7 Form 99 (212) Pge 6 Prt V Governnce, Mngement, nd Disclosure For ech "Yes" response to lines 2 through 7 elow, nd for "No" response to line 8, 8, or 1 elow, descrie the circumstnces, processes, or chnges in Schedule O. See instructions. Check if Schedule O contins response to ny question in this Prt V Section A. Governing Body nd Mngement Enter the numer of voting memers of the governing ody t the end of the tx yer. m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m f there re mteril differences in voting rights mong memers of the governing ody, or if the governing ody delegted rod uthority to n executive committee or similr committee, explin in Schedule O. Enter the numer of voting memers included in line 1, ove, who re independent m m m m m m 1 Did ny officer, director, trustee, or key employee hve fmily reltionship or usiness reltionship with ny other officer, director, trustee, or key employee? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion delegte control over mngement duties customrily performed y or under the direct supervision of officers, directors, or trustees, or key employees to mngement compny or other person? Did the orgniztion mke ny significnt chnges to its governing documents since the prior Form 99 ws filed? m m Did the orgniztion ecome wre during the yer of significnt diversion of the orgniztion's ssets? Did the orgniztion hve memers or stockholders? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion hve memers, stockholders, or other persons who hd the power to elect or ppoint one or more memers of the governing ody? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Are ny governnce decisions of the orgniztion reserved to (or suject to pprovl y) memers, stockholders, or persons other thn the governing ody? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 8 Did the orgniztion contemporneously document the meetings held or written ctions undertken during the yer y the following: The governing ody? m m m m m m m m m m m m m m m m m m m m m m m m m m m m 8 Ech committee with uthority to ct on ehlf of the governing ody? m m m m m m m m m m m m m m m m m m m m m m m 8 9 s there ny officer, director, trustee, or key employee listed in Prt V, Section A, who cnnot e reched t the orgniztion's miling ddress? f "Yes," provide the nmes nd ddresses in Schedule O m m m m m m m m m m m m 9 Section B. Policies (This Section B requests informtion out policies not required y the nternl Revenue Code.) c 16 Did the orgniztion hve locl chpters, rnches, or ffilites? m m m m m m m m m m m m m m m m m m m m m m m m m m m f "Yes," did the orgniztion hve written policies nd procedures governing the ctivities of such chpters, ffilites, nd rnches to ensure their opertions re consistent with the orgniztion's exempt purposes? m m Hs the orgniztion provided complete copy of this Form 99 to ll memers of its governing ody efore filing the form? m m 11 Descrie in Schedule O the process, if ny, used y the orgniztion to review this Form Were officers, directors, or trustees, nd key employees required to disclose nnully interests tht could give Did the orgniztion hve written conflict of interest policy? f "No," go to line 1 m m m m m m m m m m m m m m m m m rise to conflicts? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the orgniztion regulrly nd consistently monitor nd enforce complince with the policy? f "Yes," descrie in Schedule O how this ws done m m m m m m m m Did the orgniztion hve written whistlelower policy? m m m m m m m m m m m m Did the orgniztion hve written document retention nd destruction policy? m m m m m m m m m m m m m m m m m m m Did the process for determining compenstion of the following persons include review nd pprovl y independent persons, comprility dt, nd contemporneous sustntition of the deliertion nd decision? The orgniztion's CEO, Executive Director, or top mngement officil m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Other officers or key employees of the orgniztion f "Yes" to line 15 or 15, descrie the process in Schedule O (see instructions). Did the orgniztion invest in, contriute ssets to, or prticipte in joint venture or similr rrngement with txle entity during the yer? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m f "Yes," did the orgniztion follow written policy or procedure requiring the orgniztion to evlute its prticiption in joint venture rrngements under pplicle federl tx lw, nd tke steps to sfegurd the orgniztion's exempt sttus with respect to such rrngements? m m m m m m m m m m m m m m m m m m m m m m m m m m List the sttes with which copy of this Form 99 is required to e filed NY, Section C. Disclosure Section 614 requires n orgniztion to mke its Forms 12 (or 124 if pplicle), 99, nd 99-T (Section 51(c)()s only) ville for pulic inspection. ndicte how you mde these ville. Check ll tht pply. Own wesite Another's wesite Upon request Other (explin in Schedule O) Descrie in Schedule O whether (nd if so, how), the orgniztion mde its governing documents, conflict of interest policy, nd finncil sttements ville to the pulic during the tx yer. Stte the nme, physicl ddress, nd telephone numer of the person who possesses the ooks nd records of the orgniztion: EDWARD P. SCHNEDER BO 9 BUFFALO, NY Form 99 (212) 2E UB FOUNDATON SERVCES, NC GG PAGE c Yes Yes No No

8 UB FOUNDATON SERVCES, NC Compenstion of Officers, Directors, Trustees, Key Employees, Highest Compensted Employees, nd ndependent Contrctors Form 99 (212) Pge 7 Prt V Section A. Check if Schedule O contins response to ny question in this Prt V m m m m m m m m m m m m m m m m m m m m Officers, Directors, Trustees, Key Employees, nd Highest Compensted Employees 1 Complete this tle for ll persons required to e listed. Report compenstion for the clendr yer ending with or within the orgniztion's tx yer. % % % % List ll of the orgniztion's current officers, directors, trustees (whether individuls or orgniztions), regrdless of mount of compenstion. Enter -- in columns (D), (E), nd (F) if no compenstion ws pid. List ll of the orgniztion's current key employees, if ny. See instructions for definition of "key employee." List the orgniztion's five current highest compensted employees (other thn n officer, director, trustee, or key employee) who received reportle compenstion (Box 5 of Form W-2 nd/or Box 7 of Form 199-MSC) of more thn $1, from the orgniztion nd ny relted orgniztions. List ll of the orgniztion's former officers, key employees, nd highest compensted employees who received more thn $1, of reportle compenstion from the orgniztion nd ny relted orgniztions. List ll of the orgniztion's former directors or trustees tht received, in the cpcity s former director or trustee of the orgniztion, more thn $1, of reportle compenstion from the orgniztion nd ny relted orgniztions. List persons in the following order: individul trustees or directors; institutionl trustees; officers; key employees; highest compensted employees; nd former such persons. Check this ox if neither the orgniztion nor ny relted orgniztion compensted ny current officer, director, or trustee. (C) (A) (B) Position (D) (E) (F) Nme nd Title Averge hours per week (list ny (do not check more thn one ox, unless person is oth n officer nd director/trustee) hours for relted orgniztions elow dotted line) ndividul trustee or director nstitutionl trustee Officer Key employee Highest compensted employee Former Reportle compenstion from the orgniztion (W-2/199-MSC) Reportle compenstion from relted orgniztions (W-2/199-MSC) Estimted mount of other compenstion from the orgniztion nd relted orgniztions (1) DANNE BENNETT DRECTOR (2) RANDALL CLARK DRECTOR () ROBERT DENNNG CHAR (4) JEREMY JACOBS DRECTOR (5) ROSS KENZE DRECTOR (6) GERALD MAZURKEWCZ DRECTOR (7) WLLAM SCHAPRO DRECTOR (8) ELEEN SLVERS DRECTOR (9) LAWRENCE ZELNSK DRECTOR ,528. 5,461. (1) EDWARD SCHNEDER 2. EECUTVE DRECTOR , ,21. (11) (12) (1) (14) Form 99 (212) 2E GG PAGE 8

9 UB FOUNDATON SERVCES, NC Form 99 (212) Pge 8 Prt V Section A. Officers, Directors, Trustees, Key Employees, nd Highest Compensted Employees (continued) (A) (B) (C) (D) (E) (F) Nme nd title Averge hours per week (list ny hours for relted orgniztions elow dotted line) Position (do not check more thn one ox, unless person is oth n officer nd director/trustee) ndividul trustee or director nstitutionl trustee Officer Key employee Highest compensted employee Former Reportle compenstion from the orgniztion (W-2/199-MSC) Reportle compenstion from relted orgniztions (W-2/199-MSC) Estimted mount of other compenstion from the orgniztion nd relted orgniztions 1 Su-totl m m m m m m m m m m m m m m m m m m m m m m m m m c Totl from continution sheets to Prt V, Section A m m m m m m m m m m m m m m m m m m m m m m m m m m m m d Totl (dd lines 1 nd 1c) 2 Totl numer of individuls (including ut not limited to those listed ove) who received more thn $1, of reportle compenstion from the orgniztion Did the orgniztion list ny former officer, director, or trustee, key employee, or highest compensted employee on line 1? f "Yes," complete Schedule J for such individul m m m m m m m m m m m m m m m m m m m m m m m m m m 4 For ny individul listed on line 1, is the sum of reportle compenstion nd other compenstion from the orgniztion nd relted orgniztions greter thn $15,? f Yes, complete Schedule J for such individul m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 4 5 Did ny person listed on line 1 receive or ccrue compenstion from ny unrelted orgniztion or individul for services rendered to the orgniztion? f Yes, complete Schedule J for such person m m m m m m m m m m m m m m m m 5 Section B. ndependent Contrctors 19,969. 5, ,969. 5, Complete this tle for your five highest compensted independent contrctors tht received more thn $1, of compenstion from the orgniztion. Report compenstion for the clendr yer ending with or within the orgniztion's tx yer. Yes No (A) Nme nd usiness ddress (B) Description of services (C) Compenstion 2 Totl numer of independent contrctors (including ut not limited to those listed ove) who received more thn $1, in compenstion from the orgniztion 2E155. Form 99 (212) 14GG PAGE 9

10 UB FOUNDATON SERVCES, NC Sttement of Revenue Check if Schedule O contins response to ny question in this Prt V Form 99 (212) Pge 9 Prt V Contriutions, Gifts, Grnts nd Other Similr Amounts Progrm Service Revenue Other Revenue 1 c d e 2 c d c Federted cmpigns Memership dues Fundrising events Relted orgniztions m m m m m m m m m m Government grnts (contriutions) f All other contriutions, gifts, grnts, nd similr mounts not included ove 1f g Noncsh contriutions included in lines 1-1f: $ h Totl. Add lines 1-1f m m m m m m m m m m m m m m m m m m m Business Code e f All other progrm service revenue g Totl. Add lines 2-2f m m m m m m m m m m m m m m m m m m m nvestment income (including dividends, interest, nd other similr mounts) m m m m m m m m m m m m m m m m ncome from investment of tx-exempt ond proceeds Roylties m m m m m m m m m m m m m m m m m m m m m m m m m Rel (ii) Personl Gross rents m m m m m Less: rentl expenses m c Rentl income or (loss) m d Net rentl income or (loss) m m m m m m m m m m m m m m m m m Gross mount from sles of ssets other thn inventory Less: cost or other sis nd sles expenses c Gin or (loss) m m d Net gin or (loss) m m m m m m m m m m m m m m m m m m m m m Gross income from fundrising events (not including $ of contriutions reported on line 1c). See Prt V, line 18 m Less: direct expenses m m m m m m m m m m c Net income or (loss) from fundrising events m m m m m m m m Gross income from gming ctivities. See Prt V, line 19 m Less: direct expenses m m m m m m m m m m c Net income or (loss) from gming ctivities m m m m m m m m m Gross sles of inventory, less returns nd llownces Less: cost of goods sold m m m m m m m m m c Net income or (loss) from sles of inventorym m m m m m m m m d All other revenue e Totl. Add lines 11-11d 12 Totl revenue. See instructions m m m m m m m m m m m m m m 2E Miscellneous Revenue 1 1 1c 1d 1e Securities (ii) Other Business Code m m m m m m m m m m m m m m m m m m m m m (A) Totl revenue m m m m m m m m m m m m m m m m m m m m m m m m m (B) Relted or exempt function revenue SPONSORED PROGRAMS , , ,627. (C) Unrelted usiness revenue (D) Revenue excluded from tx under sections 512, 51, or 514 1,41. 1,41. 19, ,627. 1,41. Form 99 (212) 14GG PAGE 1

11 UB FOUNDATON SERVCES, NC Prt Sttement of Functionl Expenses Section 51(c)() nd 51(c)(4) orgniztions must complete ll columns. All other orgniztions must complete column (A). Form 99 (212) Pge 1 Check if Schedule O contins response to ny question in this Prt m m m m m m m m m m m m m m m m m m m m m m m m m m Do not include mounts reported on lines 6, 7, 8, 9, nd 1 of Prt V. 1 2 m m m m m m m Grnts nd other ssistnce to governments nd orgniztions in the United Sttes. See Prt V, line 21 Grnts nd other ssistnce to individuls in the United Sttes. See Prt V, line 22 Grnts nd other ssistnce to governments, orgniztions, nd individuls outside the United Sttes. See Prt V, lines 15 nd 16m 4 Benefits pid to or for memers m m m m m m m m m 5 Compenstion of current officers, directors, trustees, nd key employees m m m m m m m m m m 6 Compenstion not included ove, to disqulified persons (s defined under section 4958(f)(1)) nd persons descried in section 4958(c)()(B) 7 Other slries nd wges m m m m m m m m m m m m 8 Pension pln ccruls nd contriutions (include section 41(k) nd 4() employer contriutions) 9 Other employee enefits Pyroll txes m m m m m m m m m m m m m m m m m m Fees for services (non-employees): Mngement Legl m m m m m m m m m m m m m m m m m m m m m c Accounting d Loying m m m m m m m m m m m m m m m m m m m e Professionl fundrising services. See Prt V, line 17 f nvestment mngement fees m m m m m m m m m g Other. (f line 11g mount exceeds 1% of line 25, column (A) mount, list line 11g expenses on Schedule O.) Advertising nd promotion Office expenses m m m nformtion technology Roylties m m m m m m m m m m m m m m m m m m m m Occupncy Trvel m m m m m m m m m m m m m m m m m m m m m c d e Pyments of trvel or entertinment expenses for ny federl, stte, or locl pulic officils Conferences, conventions, nd meetings nterest Pyments to ffilites Deprecition, depletion, nd mortiztion nsurnce m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Other expenses. temize expenses not covered ove (List miscellneous expenses in line 24e. f line 24e mount exceeds 1% of line 25, column (A) mount, list line 24e expenses on Schedule O.) All other expenses 25 Totl functionl expenses. Add lines 1 through 24e 26 Joint costs. Complete this line only if the orgniztion reported in column (B) joint costs from comined eductionl cmpign nd fundrising solicittion. Check here if following SOP 98-2 (ASC ) m m m m m m m (A) (B) (C) (D) Totl expenses Progrm service Mngement nd Fundrising expenses generl expenses expenses 7,472. 7,472. Form 99 (212) 2E ,985. 1,985. SALARY EPENSES NON-EMPLOYEE 15,42. 15, , , GG PAGE 11

12 Form 99 (212) Pge 11 Prt Blnce Sheet Check if Schedule O contins response to ny question in this Prt m m m m m m m m m m m m m m m m m m m m m (A) (B) Beginning of yer End of yer Assets Liilities Net Assets or Fund Blnces m m m m m m m m m m m m m m m m m m m m m m m m m m m Csh - non-interest-ering Svings nd temporry csh investments Pledges nd grnts receivle, net Accounts receivle, net m m m m m m m m m m m m m m m m m m m m m m m m m m m m Lons nd other receivles from current nd former officers, directors, trustees, key employees, nd highest compensted employees. Complete Prt of Schedule L m m m m m m m m m m m m m m m m m m m m m m m m m Lons nd other receivles from other disqulified persons (s defined under section 4958(f)(1)), persons descried in section 4958(c)()(B), nd contriuting employers nd sponsoring orgniztions of section 51(c)(9) voluntry employees' eneficiry orgniztions (see instructions). Complete Prt of Schedule L Notes nd lons receivle, net nventories for sle or use m m m m m m m m m m m m m m m m m m m m m m m m m m m m Prepid expenses nd deferred chrges Lnd, uildings, nd equipment: cost or UB FOUNDATON SERVCES, NC m m m m m m m m m m m m m m m m m m m m other sis. Complete Prt V of Schedule D 1 1,264,78. Less: ccumulted deprecition m m m m m 1 nvestments - pulicly trded securities m m m m m nvestments - other securities. See Prt V, line 11 m nvestments - progrm-relted. See Prt V, line 11 ntngile ssets m m m m m m m m m Other ssets. See Prt V, line 11 m m m m m m m m m m m m m m Totl ssets. Add lines 1 through 15 (must equl line 4) Accounts pyle nd ccrued expenses Grnts pyle m m Deferred revenue m m m m m Tx-exempt ond liilities m m m m m m m m m m m m m m m m m m m m m m m Escrow or custodil ccount liility. Complete Prt V of Schedule D m m m m Lons nd other pyles to current nd former officers, directors, trustees, key employees, highest compensted employees, nd disqulified persons. Complete Prt of Schedule L m m m m m m m m m m m m m m m m Secured mortgges nd notes pyle to unrelted third prties Unsecured notes nd lons pyle to unrelted third prties Other liilities (including federl income tx, pyles to relted third prties, nd other liilities not included on lines 17-24). Complete Prt of Schedule D m m m m m m m m m m m m m m Totl liilities. Add lines 17 through 25 m m m m m m m m m m m m m m m m m m m m Orgniztions tht follow SFAS 117 (ASC 958), check here nd complete lines 27 through 29, nd lines nd 4. Unrestricted net ssets m m m m m Temporrily restricted net ssets Permnently restricted net ssets m m m m m m m m m m m m m m m m m m m m m m m m Orgniztions tht do not follow SFAS 117 (ASC 958), check here nd complete lines through 4. Cpitl stock or trust principl, or current funds m m m m m m m m Pid-in or cpitl surplus, or lnd, uilding, or equipment fund m m m m Retined ernings, endowment, ccumulted income, or other funds Totl net ssets or fund lnces m m m m m m Totl liilities nd net ssets/fund lnces m m m m m m m m m m m m m m m m m m 1,94,954. 9, ,767. 9, c 1,264,78. 6,445,7. 7,879, ,852,152. 8,127, , ,7, ,945,496. 7,7, ,617, , , ,274. 7,879, ,8. 8,127,55. Form 99 (212) 2E GG PAGE 12

13 Form 99 (212) Pge 12 Prt Prt Reconcilition of Net Assets Check if Schedule O contins response to ny question in this Prt m m m m m m m m m m m Totl revenue (must equl Prt V, column (A), line 12) 1 Totl expenses (must equl Prt, column (A), line 25) 2 Revenue less expenses. Sutrct line 2 from line 1 m m m m m m m m m m m m m m m m m m m m m Net ssets or fund lnces t eginning of yer (must equl Prt, line, column (A)) 4 Net unrelized gins (losses) on investments 5 Donted services nd use of fcilities 6 nvestment expenses m m 7 Prior period djustments m m m m m m m m m m m m m m m m m m m m m m m m 8 Other chnges in net ssets or fund lnces (explin in Schedule O) m m m m m m m m m m m m m m m m 9 Net ssets or fund lnces t end of yer. Comine lines through 9 (must equl Prt, line, column (B)) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 1 Finncil Sttements nd Reporting Check if Schedule O contins response to ny question in this Prt m m m m m m m m m m m m m m m m m 1 Accounting method used to prepre the Form 99: Csh Accrul Other f the orgniztion chnged its method of ccounting from prior yer or checked "Other," explin in Schedule O. 2 Were the orgniztion's finncil sttements compiled or reviewed y n independent ccountnt? m m m m m m 2 f "Yes," check ox elow to indicte whether the finncil sttements for the yer were compiled or reviewed on seprte sis, consolidted sis, or oth: Seprte sis Consolidted sis Both consolidted nd seprte sis Were the orgniztion's finncil sttements udited y n independent ccountnt? m m m m m m m m m m m m m m 2 f "Yes," check ox elow to indicte whether the finncil sttements for the yer were udited on seprte sis, consolidted sis, or oth: Seprte sis Consolidted sis Both consolidted nd seprte sis c As result of federl wrd, ws the orgniztion required to undergo n udit or udits s set forth in UB FOUNDATON SERVCES, NC f "Yes" to line 2 or 2, does the orgniztion hve committee tht ssumes responsiility for oversight of the udit, review, or compiltion of its finncil sttements nd selection of n independent ccountnt? f the orgniztion chnged either its oversight process or selection process during the tx yer, explin in Schedule O. the Single Audit Act nd OMB Circulr A-1? m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m f "Yes," did the orgniztion undergo the required udit or udits? f the orgniztion did not undergo the required udit or udits, explin why in Schedule O nd descrie ny steps tken to undergo such udits 2c 19, ,859.,89. 55, ,8. Yes No Form 99 (212) 2E GG PAGE 1

14 SCHEDULE A (Form 99 or 99-EZ) Deprtment of the Tresury nternl Revenue Service Pulic Chrity Sttus nd Pulic Support Complete if the orgniztion is section 51(c)() orgniztion or section 4947()(1) nonexempt chritle trust. Attch to Form 99 or Form 99-EZ. See seprte instructions. OMB No À¾µ Open to Pulic nspection Nme of the orgniztion Employer identifiction numer UB FOUNDATON SERVCES, NC Prt Reson for Pulic Chrity Sttus (All orgniztions must complete this prt.) See instructions. The orgniztion is not privte foundtion ecuse it is: (For lines 1 through 11, check only one ox.) A church, convention of churches, or ssocition of churches descried in section 17()(1)(A). A school descried in section 17()(1)(A)(ii). (Attch Schedule E.) A hospitl or coopertive hospitl service orgniztion descried in section 17()(1)(A)(iii). A medicl reserch orgniztion operted in conjunction with hospitl descried in section 17()(1)(A)(iii). Enter the hospitl's nme, city, nd stte: 5 An orgniztion operted for the enefit of college or university owned or operted y governmentl unit descried in section 17()(1)(A)(iv). (Complete Prt.) 6 7 A federl, stte, or locl government or governmentl unit descried in section 17()(1)(A)(v). An orgniztion tht normlly receives sustntil prt of its support from governmentl unit or from the generl pulic descried in section 17()(1)(A)(vi). (Complete Prt.) 8 9 A community trust descried in section 17()(1)(A)(vi). (Complete Prt.) An orgniztion tht normlly receives: (1) more thn 1/ % of its support from contriutions, memership fees, nd gross receipts from ctivities relted to its exempt functions - suject to certin exceptions, nd (2) no more thn 1/% of its support from gross investment income nd unrelted usiness txle income (less section 511 tx) from usinesses cquired y the orgniztion fter June, See section 59()(2). (Complete Prt.) 1 11 An orgniztion orgnized nd operted exclusively to test for pulic sfety. See section 59()(4). An orgniztion orgnized nd operted exclusively for the enefit of, to perform the functions of, or to crry out the purposes of one or more pulicly supported orgniztions descried in section 59()(1) or section 59()(2). See section 59()(). Check the ox tht descries the type of supporting orgniztion nd complete lines 11e through 11h. Type Type c Type -Functionlly integrted d Type -Non-functionlly integrted e f g h By checking this ox, certify tht the orgniztion is not controlled directly or indirectly y one or more disqulified persons other thn foundtion mngers nd other thn one or more pulicly supported orgniztions descried in section 59()(1) or section 59()(2). f the orgniztion received written determintion from the RS tht it is Type, Type, or Type supporting orgniztion, check this ox m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Since August 17, 26, hs the orgniztion ccepted ny gift or contriution from ny of the following persons? A person who directly or indirectly controls, either lone or together with persons descried in (ii) nd (iii) elow, the governing ody of the supported orgniztion? (ii) A fmily memer of person descried in ove? m m m m m m m (iii) A 5% controlled entity of person descried in or (ii) ove? m m m m m m m m m m m m m m m m m m m m m m Provide the following informtion out the supported orgniztion(s). Nme of supported orgniztion (A) ATTACHMENT 1 (B) (ii) EN (iii) Type of orgniztion (descried on lines 1-9 ove or RC section (see instructions)) (iv) s the (v) Did you notify (vi) s the orgniztion in the orgniztion orgniztion in col. listed in in col. of col. orgnized your governing document? your support? in the U.S.? Yes No Yes No Yes No 11g 11g(ii) 11g(iii) Yes No (vii) Amount of monetry support (C) (D) (E) Totl For Pperwork Reduction Act Notice, see the nstructions for Form 99 or 99-EZ. 189,859. Schedule A (Form 99 or 99-EZ) 212 2E GG PAGE 14

15 Schedule A (Form 99 or 99-EZ) 212 Pge 2 Prt Support Schedule for Orgniztions Descried in Sections 17()(1)(A)(iv) nd 17()(1)(A)(vi) (Complete only if you checked the ox on line 5, 7, or 8 of Prt or if the orgniztion filed to qulify under Prt. f the orgniztion fils to qulify under the tests listed elow, plese complete Prt.) Section A. Pulic Support Clendr yer (or fiscl yer eginning in) 1 Gifts, grnts, contriutions, nd memership fees received. (Do not include ny "unusul grnts.") m m m m m m 2 Tx revenues levied for the orgniztion's enefit nd either pid to or expended on its ehlf m m m m m m m The vlue of services or fcilities furnished y governmentl unit to the orgniztion without chrge 4 Totl. Add lines 1 through m m m m m m m 5 The portion of totl contriutions y ech person (other thn governmentl unit or pulicly supported orgniztion) included on line 1 tht exceeds 2% of the mount shown on line 11, column (f) m m m m m m m 6 Pulic support. Sutrct line 5 from line 4. Section B. Totl Support Clendr yer (or fiscl yer eginning in) 7 Amounts from line 4 m m m m m m m m m m 8 Gross income from interest, dividends, pyments received on securities lons, rents, roylties nd income from similr sources m m m m m m m m m m m m m m m m m 9 Net income from unrelted usiness ctivities, whether or not the usiness is regulrly crried on m m m m m m m m m m 1 Other income. Do not include gin or loss from the sle of cpitl ssets () 28 () 29 (c) 21 (d) 211 (e) 212 (f) Totl () 28 () 29 (c) 21 (d) 211 (e) 212 (f) Totl (Explin in Prt V.) m m m m m m m m m 11 Totl support. Add lines 7 through 1 m m 12 Gross receipts from relted ctivities, etc. (see instructions) m m m m m m m m m m m m m m m m m m m m m m m m m m 12 orgniztion, check this ox nd stop here m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Section C. Computtion of Pulic Support Percentge 15 m m m m m m m m m m m m m m m m m m m 1 First five yers. f the Form 99 is for the orgniztion's first, second, third, fourth, or fifth tx yer s section 51(c)() 14 Pulic support percentge for 212 (line 6, column (f) divided y line 11, column (f)) Pulic support percentge from 211 Schedule A, Prt, line / % support test f the orgniztion did not check the ox on line 1, nd line 14 is 1/ % or more, check 17 UB FOUNDATON SERVCES, NC this ox nd stop here. The orgniztion qulifies s pulicly supported orgniztion m m m m m m m m m m m m m m m m m m m m check this ox nd stop here. The orgniztion qulifies s pulicly supported orgniztion m m m m m m m m m m m m m m m m m 1/ % support test f the orgniztion did not check ox on line 1 or 16, nd line 15 is 1/ % or more, 1%-fcts-nd-circumstnces test f the orgniztion did not check ox on line 1, 16, or 16, nd line 14 is 1% or more, nd if the orgniztion meets the "fcts-nd-circumstnces" test, check this ox nd stop here. Explin in Prt V how the orgniztion meets the "fcts-nd-circumstnces test. The orgniztion qulifies s pulicly supported orgniztion m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 1%-fcts-nd-circumstnces test f the orgniztion did not check ox on line 1, 16, 16, or 17, nd line 15 is 1% or more, nd if the orgniztion meets the "fcts-nd-circumstnces" test, check this ox nd stop here. Explin in Prt V how the orgniztion meets the "fcts-nd-circumstnces" test. The orgniztion qulifies s pulicly supported orgniztion m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 18 Privte foundtion. f the orgniztion did not check ox on line 1, 16, 16, 17, or 17, check this ox nd see instructions m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m % % Schedule A (Form 99 or 99-EZ) 212 2E GG PAGE 15