Breast Cancer Survivors Foundation

8/3/2019 Breast Cancer Survivors Foundation

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New Jersey Office of the Attorney General

Division of Consumer AffairsOffice of Consumer Protection

Charities RegistrationSection124 Halsey Street, 7v" Floor, P.O. Box 45021

Newark, NJ 07101(973) 504-6215

Form CRI-300RLong-Form Renewal Registration/Verification Statement

(Revised April 2008)

All questio ns must be answered.

12011 JUL 19CHART T I ES'RF

TR

Pursuant to the New Jersey Charitable Registration and Investigation Act (also known as "the C.R.I. Act" ( N.J.S.A . 45:17A-18 rtit .).

and prior to operating or commencing solicitation activity in the State, a charitable organization unless exempted from registration

requirements (or qualified to file a Short-Form Registration Statement, CRI-200) shall file a Long-Form Initial Registration Statement,

CR1-150-I. Charities submitting their annual long-form renewal registration must use Form CRI-300R. Please see the checklist at the

end of this form for a discussion of fees, financial statements, documents to be attached, and other requirements for registration.

1. This statement contains the facts and financial information for the fiscal year ending: 12 / 31 1 2010,noom d.y Ur

2. Federal ID Number (EIN) 2a. N.J. Charities Registration Number: CH- 33145

3. Full legal name of the registering organization: Breast Cancer Survivors Foundation, Inc.In care of: (if necessary, otherwise leave this lint blank)

4. Mailing Address : 443 E Westfield Ave Ste 1 Roselle Park, NJ 07204 Change of AddresssrmiAdo=% cay State wco

NOTE: If "in care of," a postal, private or rural delivery mail box number is used, the street address of the charity must be given below.

5. The principal street address of the registering organization 443 E Westfield Ave Ste 1 , Roselle Park , NJ 07204 Same as Mailing Address ArveIAdhen c.y Stwe zrPCnde

6. Does the organization have any offices in New Jersey in addition to the one listed above?If "Yes," attach a list giving the street address and telephone number of each office in New Jersey.

Yes X No

6a. If the street address listed above is not where the organization's official records are kept, or if the organization does not maintain an

office in New Jersey. indicate the name, full address. phone and fax numbcrof the person having custody of the of the organization's

records, and to whom correspondence should be addressed.

Refer to attachment "Responsible for Custody of Financial Records"Gntxt m on S,rcc , bd " eu Cby Rube ZIP G+Ie

Tetep1gw nw bn (,ndmk mea -kj Faa -V . , t,ndn,k area eak)

7. Organization's contact information:

908-241-2288 908-241-0222ldrpim wnhr (tnd.& rca cadeI fig tnrmh" (m. Ind: n,o-&)

[email protected] www.breastcancersurvivor.orgL m ,1 aNra- W,+.-

8. Type of organization (check one):

IN Nonprofit corporation Foundation Individual Association Society

Partnership Trust Other (Specify)

Form CRI -300R Page 1 of 7


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9. Where and when was the organization legally established? Date: 611/2010 State: Delaware

As required by the C.R.I. Act ( N.J.S.A . 45:1?A-24c(l)), attach to this registration a copy of the organization's bylaws and

instrument of organization (that is. the organization's charter, articles of incorporation or organization, agreement of association.

instrument of trust, or constitution) only if the document has been issued or amended during the fiscal year being reported.

10. Does the organization solicit funds under any name or names other than as indicated on line 3 of this form? []Yes O No

If "Yes." indicate all of the other names used:

11. Does the organization intend to solicit contributions from the general public ? 0 Yes C No

12. Is the organization authorized by any other state or jurisdiction to solicit contributions? K1 Yes 0 No

If "Yes." please provide a list of those states or jurisdictions, below or on a separate sheet of paper.

Refer to attachment "List of States, Counties and Cities where Registered"

13. Does the organization have affiliates which share the contributions or other revenue it raised in New Jersey? O Yes 0 No

If "Yes." provide a separate listing of those affiliates indicating the name, street address and telephone number for each one.

14. What is the charitable purpose or purposes for which the organization was formed? If necessary, attach a separate statement to this

registration.

Refer to attachment "Statementof Charitable Purpose and Program Service Accomplishments"

14a. What are the specific programs and charitable purposes for which contributions arc used? For each program. state whether it

already exists or is planned. Only major program categories need be listed. If necessary. attach a separate statement to this

registration.

Refer to attachment"Statement of Charitable Purpose and Program Service Accomplishments"

15. Does the organization use an independent paid fund-raiser or fund-raising counsel'? KI Yes 0 Noif"Yes. " please attach to this registration a list of paid fund-raiser(s) or fund-raising counsel(s), including their full address, telephone

number, fax number. registration number in New Jersey, and a contact person's name.

15a. Does the independent paid fund -raiser or fund-raising counsel have custody, control or access to the organization's funds?

O Yes IN NoIf "Yes," please describe thesituation.

16. Has the organization permitted a charitable sales promotion to be conducted on its behalf by a commercial co-venturer during the

fiscal year -end being reported? 0 Yes No

If "Yes," please explain:

17. Has the Internal Revenue Service (I.R.S.) detennined that the organization is tax exempt under code 501(c)(3)? 1)51 Yes0 No

a. If"No," has an application been filed which is still pending? If so, please attach a copy of theI.R.S. 1023 form filed. O Yes O No

b. Has a tax exemption been granted under another I.R.S. code? O Yes No

If "Yes," advise which one: 3

c. Has an I.R.S. tax exemption been refused, changed or revoked? O Yes No

If an exemption has been refused, changed or revoked, attach to this registration a copy of the I.R.S. determination letter of

notification and provide a detailed explanation of the circumstances on a separate sheet of paper.

Form CRI- 300R Page 2 of 7


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18. Has the organizationever had its authority to conduct charitable activities denied,suspended, or revoked in any jurisdiction or has the

organization ever enteredinto any voluntaryagreementof discontinuance with anygovernmentalentity? Yes M NoIf "Yes," attach to this registration a copy of the denial, suspension , revocation or voluntary agreement of discontinuance. If the

document does not explain the reasons for the denial, suspension or revocation, attach to this registration an explanation on a

separate sheet of paper.

19. Has the organization voluntarily entered into an assurance of voluntary compliance or similar order or agreement (including, but

not limited to, a settlement of an administrative investigation or proceeding, with or without an admission of liability) with any

jurisdiction, stateor federal agency or officer? Yes IN NoIf "Yes," please attach to this registration the relevant document.

20. Has the organizationor any of its present officers, directors, executive personnel or trustees ever been found to have engaged in

unlawful practices in the solicitation of contributions or administration of charitable assets or been enjoined from soliciting

contributions, or are such proceedings pending in this or any other jurisdiction? Yes KI NoIf"Yes," attach to this registration photocopies of any and all written documentation(such as a court order, administrative order.

judgment, fonnal notice, written assurance or other document) which show the final disposition of the matter.

21. Has the organizationor any of its presentofficers, directors, trustees or principal salaried executive staff employees ever been

convicted of any criminal offense committed in connection with the performance of activities regulated under this act or any

criminal or civil offense involving untruthfulness or dishonesty or any criminal offense relating adversely to the registrant's

fitness to perform activities regulatedby this Act? A plea of guilty, non vult, nolo contendere or any similar dispositionof alleged criminalactivity shall be deemed a conviction. Yes K1 No

22. Has the organization or any of its officers , directors , trustees or principal salaried executive staf f employees been adjudged liable

in any administrative or civil action involving theft , fraud, or deceptive business practices ? For purposes of this question a judgment

of liability in an administrative or civil action shall include , but is not limited to, any finding or admission that the individual engaged

in an unlawful practice in relation to the solicitation of contributions or the administration of charitable assets . Yes Xi No

If "Yes," identify the individual (s) below and attach to this registration a copy of any order,judgment or other documents indicating

the final disposition of the matter.

23. Provide the following information for each of ficer, director, trustee and the five most-highly compensated executive staffemployees:

Name Business address Telephone number Title Salary

(includearea code)

N/A. Officers and Directors are not compensated.

Refer to attachment "List of Officers and Directors " for contact Information.

Form CRI - 30OR Page 3 of 7


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CRI-300R Long-Form Registration Renewal Financial Statement

Note: If the financial value of a line hens = 0, place a zero in the space provided.

Please report all figures as GROSS, not NET

Full legal name and street address of the organization

Full legal name:Breast Cancer Survivors Foundation, Inc.

Fiscal year-end being reported: 12 / 31 1 2010 Federal [D Number (E1N, _wonU, dov cm

Mailing address:443 E Westfield Ave Ste 1, Roselle Park, NJ 07204

Mali, , Ad'd,u P 0 tto' Nnmber er Sn C q Scut 7IP coat

Street address of the registering organization: 443 E Westfield Ave Ste 1 , Roselle Park , NJ 07204S M4 Addn s Gov sue ZIP Cods

New Jersey Charities Registration number: CH 33145 -00 Telephone number: 908-241-2288(lr,clydra'r C drl

Attach to this registration the most recent Internal Revenue Service Form 990 and ScheduleA (990). if the organization has filed those

forms. Attach a copy if the organization's annual financial repor t included an audited financial statement, or if the organization

received gross revenue in excess of $250,000. Note: l i t h e organization received gross revenue of less than $250.000.

the financial reports must be certified by the organization's president or other authorized officer of the organization's board.

( i In lieu ofcompleting the CRI-300R Financial Statement pages. attached please find a copy of die LR.S. 990 filing for the fiscal year-end

indicated above.

A. ReceiptsLine A la. Direct Public Support received from the following sources:

(I) Directmail ................................................. IRS 990 Is attached(2) Telephone solicitation .....................................(3) Commercial co-venture ...................................

(4) Gross receipts from fund-raising events ...............(5) Canisters, counter cards, door to door etc .............

(6) Corporations and other businesses ......................

(7) Foundations and tnists ....................................

(8) Donated land, buildings, property, equipment and

materials ............... __ ........ ....... ......

(9) Legacies and bequests ....................................

(10) Membership dues solely resulting from

solicitations ..................................................

(I 1) Other support (specify) ..... . ... . . . ........................

Line A l b. Total Direct Publ ic Support (add lines Ala ( ]) through A l a(I 1) ......

Line A l e. Indirect Public Support received from the followingsources:

(1) Federated fund -raising organization ....................(2) From an affiliated organization ... .......................

(3) From another fundraising organization ..... . ..........

Line A I d. Total Indirect Public Support (add lines Alc(i) thru A I c(3))...........

Line Ale Total Gross Contributions (add lines A i b and A Id) ..................

Form CRI- 300R Page 4 of 7


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Line A2. Government grants includingpurchase of service contracts (specify agency)

a . .........................................................................b. .........................................................................

c.d . .........................................................................

Line Ale. Total Government Grants (add lines 2a thru2d) ............................

Line A3. Other Support

a. Bonafide membership ..............................................b. Program service revenue ............................................c. Professional services rendered by volunteers ..................

d. Miscellaneous income (specify) ..................................

Line.43e.Total Other Support(add the totalof lines A3a thru A3d) ................

Line A4. Total Gross Revenue(add lines Ale, Ate and A3e) .....................

B. Expenses

Line BI. Program expenses ..........................................................

Line B2. Management and general expenses ......................................

Line B3. Fund-raising expenses .....................................................

Line B4. Payments to state/national affiliates (if applicable) ....................

Line B5. Total Expenses (add the totals of line B I thru B4) ...... ......

C. Excess or Deficit

For the fiscal year-end (subtract line B5 from line A4) ........ .......................

D. Fund Balance

Line DI. Net assets or fund balances at beginningof year ...................

Line D2. Other changes in net assets or fund balances(attach explanation).....Line D3. Net assets or fund balances at endof year (Combine lineC, DI and D2) ...

Please Note: The amount of Gross Contributions ( line Ale on this form) determines the registration fee which must be paid and the

form which should be used. July 2006 revisions to the Charities Registration Act now require all charities to pay a registration fee,

including charities whose Gross Contributions are less than $10,000. Further information for charity registrants may be found on our

Web site: Unp//www niconsumeraf fairs gov/ocp/charities htm

Form CRI-300R Page 5 of 7


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Long-Form Renewal Registration StatementForm CRI-300RC

Confidential Information

Organization 's Name: Breast Cancer Survivors Fo undation, Inc.

N.J. Charities RegistrationNumber: CH - 33145 -00 Federal ID Number (EIN,

Fiscal Year-End being reported: 12 / _31 i 2010m th da,

24. Are any of the organization's of ficers. directors, trustees or the five most-highly compensated employees related by blood,

marriage or adoption to:

a. each other? Yes 9 No

b. any officers, agents or employees of any fund-raising counsel or independent paid fund-raiser under contract to theorganization? Yes IN No

c. any chief executive, employee, any other employee of the organization with a direct financial interest in the transaction,

or any partner, proprietor, director, officer,trustee, or to any shareholder of the organization with more than two (2)

percent interest in any supplier or vendor providing goods or services to the organization? Ycs ig Nod. If you answered "Yes." to questions 24a, b. or c, please provide a statement explaining these relationships.

25. Do any of the organization's officers, directors. trustees or the five most-highly compensated employees have a financial

interest in any activities engaged in by a fund-raising counsel or independent paid fiind-raiserunder contract to the organization,

or any supplier or vendor providing goods or services to the organization? Yes 29 Noif "Yes." please detail these relationships below or on a separate sheet of paper, and provide the name, business address and

telephone num ber of all interested parties.

We understand that this registration is being issued at the discretion of the Division of Consumer Affairs and agree that employees

of the Division may inspect the records in the possession of this organization in order to ascertain compliance with the statute and all

pertinent regulations. We also understand that we may be required to provide additional information if requested.

We hereby certify that the above information and the attached financial schedule(s) and statement(s) are true. We are awarethat if any

of the above statements are wlfully false we are subleal to punishmentil, .Signature e Yulius Poplyansky Title Pres Date Zhp

Signature .Qolr k2, ,'--` ame Marjorie Velasco Title Sec/of fic esare 6-2- /l

This form must be signed by two (2) authorised of ficers of the orguni:cuion . including rho: ciueffrnancial of cei:

Note : Form CRI-300RC must be filed MJi1i Form CRI-3008.

Form CRI-300R Page 6 of 7


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Breast Cancer Survivors Foundation, Inc.

Attachment referenced in question 6a

Responsible for Custody of FinancialRecords

Yulius Poplyansky MD, President, Board Member443 E Westfield Ave Ste 1Roselle Park, NJ 07204

908-241-2288

FEIN:


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Breast Cancer Survivors Foundation, Inc. FEIN:

Attachment referenced in question 12

List of States , Counties and Cities where Registered

Alaska: Alaska Department Of Law, 1031 W. 4th Ave., Suite 200, Anchorage, AK 99501Alabama: Consumer Affairs Section, 500 Dexter Avenue, Montgomery, AL 36130Arkansas: Consumer Protection Division, 323 Center Street, 200 Tower Bldg, Little Rock, AR 72201

Arizona: Secretary of State-Charities Division, 1700 W. Washington St., 7th Floor, Phoenix, AZ 85007

California: Registry Of Charitable Trusts, 1300 1 Street, Suite 101, Sacramento, CA 95814Colorado: Office Of The Secretary Of State, 1700 Broadway, Suite 300, Denver, CO 80290Connecticut: Public Charities Unit, 165 Capitol Avenue, Hartford, CT 06106

Florida: Division Of Consumer Services, 2005 Apalachee Parkway. Tallahassee, FL 32399Georgia: Office Of The Secretary Of State, 237 Coliseum Drive,Macon, GA 31217Hawaii: Department of the Attorney General, 425 Queen Street, Honolulu, HI 96813Illinois: Charitable Trust Bureau, 100 W. Randolph St., 11th Fl., Chicago, IL 60601

Kansas : Secretary Of State's Office, 120 S.W. 10th Ave., 1st Fl, Topeka, KS 66612Kentucky: Consumer Protection Division, 1024 Capital Center Drive, Frankfort, KY 40601Louisiana: Consumer Protection Section, 1885 N. 3rd Street, Baton Rouge, LA 70802Massachusetts: Public Charities Division, 1 Ashburton Place, Boston, MA 02108

Maryland: Charitable Organization Division, 16 Francis Street, Annapolis, MD 21401Maine: Office of Licensing and Regulation, 122 Northern Ave, Gardiner, ME 04345Michigan: Charitable Trust Section , 690 Law Bldg , 525 W . Ottawa Street , Lansing , MI 48913Minnesota: Office of the Attorney General/Charities, 445 Minnesota Street, Suite 1200, St Paul, MN 55101Mississippi: Off ice Of The Secretary Of State, 700 North Street, Jackson, MS 39202-3024

North Carolina: Secretary Of State, 2 South Salisbury Street, Raleigh, NC 27601North Dakota: Secretary Of State, 600 East Boulevard , Bismarck, ND 58505New Hampshire: Charitable Trusts Unit, 33 Capitol Street, Concord, NH 03301New Jersey: Office of Consumer Protection, 124 Halsey Street, 7th Floor, Newark, NJ 07101New Mexico: Office of the Attorney General, 111 Lomas Blvd., NW, Suite 300, Albuquerque, NM 87102New York: Charities Bureau, 120 Broadway, New York, NY 10271Ohio: Charitable Foundation Section, 150 E. Gay Steet, 23rd Floor, Columbus, OH 43215Oklahoma: Oklahoma Secretary Of State, 2300 N. Lincoln Blvd., Room 101, Oklahoma City, OK 73105

Oregon: Department Of Justice, 1515 SW 5th Avenue, Suite 410, Portland, OR 97201Pennsylvania: Bureau Of Charitable Organizations, 207 North Off ice Building, Harrisburg, PA 17120Rhode Island: Charitable Organization Section, 1511 Pontiac Ave, Bldg 69-1, Cranston, RI 02920South Carolina: Office Of The Attorney General, 1205 Pendleton Street, Ste 525, Columbia, SC 29201Tennessee: Division Of Charitable Solicitations, 312 Rosa L. Parks Avenue, 8th Floor, Nashville, TN 37243Utah: Division Of Consumer Protection, 160 East 300 South, Salt Lake City, UT 45804Virginia: Office of Consumer Affairs, 102 Governor Street, Lower Level, Richmond, VA 23219Washington: Charitable Solicitation Division, 801 Capitol Way South, Olympia, WA 98504

Wisconsin: Dept Of Regulation & Licensing, 1400 E. Washington Avenue, Madison, WI 53702West Virginia: Office Of The Secretary Of State, 1900 Kanawha Blvd., East, Charleston, WV 25305


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Breast Cancer Survivors Foundation, Inc. FEIN:

Attachment referenced in question 15 & 16

List of Agreements with Professional Fundraisers , Professional Fundralsing Counsel , and/or CommericalCo-Venturers

Outreach Calling200 S. Virginia Street, 8th Floor,Reno, NV 89501Term: 09-15-2010 to 09-14-2015


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Breast Cancer Survivors Foundation, Inc.

Attachment referenced in question 14 & 14a

Statement of Charitable Purpose and Program Service Accomplishments

FEIN:

The purposes for which the Corporation is formed are to operate as a charitable and educational organization, toeducate the public about breast cancer and the importance of early detection and self-examination; to provide a

forum for breast cancer survivors to convene and discuss issues related to breast cancer.


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COPILEVITZ & CANTER, LLCATTORNEYS AT LAW

310 W. 20TH STREETSUITE 300

KANSAS CITY, MISSOURI 64108

(816) 472-9000 FAX (8J6) 472-5000

July 15, 2011

Division of Consumer Affairs

Charitable Registration & Investigation

124 Halsey Street, 7th Floor

P.O. Box 45021

Newark, NJ 07101

Re: Breast Cancer Survivors Foundation, Inc. Registration Number: CH3314500

Dear Sir/Madam:

Enclosed please find the above organization's completed Long Form Renewal Registration

Statement CRI-300R and $ 150 filing fee. Accompanying this registration is the organization's

IRS 990 and audit for fiscal year ended December 31, 2010. Please be advised that Breast

Cancer Survivors Foundation received an infusion of capital through donations and related

fundraising in late 2010, soon after its formation and prior to implementation of its charitableprograms before the end of its initial fiscal year. Program service accomplishments

commenced in 2011.

Thank you in advance for your assistance. Should you have any questions or commentsconcerning this matter, feel free to contact me.

Kind Regards,

Stephanie Wetschensky

Legal AssistantFor the Firm

Enclosures

WashingtonD.C. OKcr: 1900 L STREET. SUITE 215. WASHINGTON. D.C. 20036 (202) 861-0740 FAX (202) 331-9841 E-MAIL co,[email protected]


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26W1 116PMForrna

Department of the TreasuryInternal Revenue Service

A For the 20'10 calendar

B ova a apdroehie.:_I Adeasaclings

Nance maniaf-i7 hmalydum

` Tearwiat

_.j an**Ad return

RetL1 -...of Organization Exempt From It? " - Tne TaxUnder soctton_1(c), 527, or 4947(a)(1) of the Internal Revenue Cow (except black lung

benefit trust or private foundation) The organization may have to use a copy of this return to satisfy state reporting (equirements.

Year begInningyear, or tax

C Name of organization

Doing Buslaess As

andendin

BREAST CANCER SURVIVORS FOUNDATION,

INC.

Nunriar and street forP.O. box It mail is not dekveiedto sheet address)

443 EAST WES 'TFIELD AVENUE

City ortown, stateor country, and ZIP 4

ROSELLE PARK NJ 07204

Roomisuiae

F Name and address of principal offuer:YULIUS POPLYANSKY, MD

443 EAST WESTFIELD AVENUE

ROSELLE PARK NJ 07204

I Tax-exempt status 501 c 3J .1 1 50lic) ( ) 4_f,nsen no. I _-t e9e7(a 1) w - ) 527

J webalte:) ' N

H(a) Is Ussap

H(b) Are all t

If -N

D Employer Identllcetlon number

{ H(c) Group exemption number

K Fern d loo A t CapaareI I _ I Trust i.... (A7a0tlaUan i I Vllld srnr a gmaluon " . v a v 1 rn ar c w w w ww.+a

Summary1 Briefly describe the organization 's mission or most significant activities

SEE 3CH8DUL8 O FOR THE ORGANIZATION ' S PURPOSE................ ....... .. ....... ........ ..... ... .

cE

} if the organization discontinued its operations or disposed of more t2 Chock this box 1 J han 25% of its net assets.C7 _

3 Number of voting members of the governing body (Pan Vt, line is) ..... .. . , .. . . ........ ......... . 3 2

4 Number of independent voting members of the governing body (Part VI, line 1b) 4 2

5 Total number of individuals employed in calendar year 2010 (Part V. line 2a) 5 0

6 Total number of volunteers (estimate If necessary) 6 0

7a Total unrelated business revenue from Part VIII. column(C), line 12.. ... .... . . . .

7a

b Net unrelated business taxable income from Fonn 990-T , li ne 34 ...7b 0

Prior Year Currant Year

8 Contributions and grants(Part V ill, line 1h) 531 ,041m ....... . . . . . . . . .. , . , ,C 9 Program service revenue (Pan VIII, lute 2g)

10 Investment income (Part Vill. column (A). lines 3 . 4, and 7d)

column (A). lines 5 . 6d. Se . 9c. lOc, and 1 le)11 Other revenue (Part Vill.

12 Total revenue - add lines 8 through 11 must uaf Part Villcolumn A fine 12 ) 531,041

13 Grants and similar amounts paid (Part IX. column (A), lines 1 - 3)14 Benefits paid to or for members (Part IX , column (A), line 4)

other compensation, employee benefits(Part IX, column(A), lines 5-10)15 Salariesro ,16* Professional fundraising tees (Part IX, column (A), line 11e ) 47 8 918

b Total fundralrring expenses (Part IX , column (D), line 25) 47 8 , 918 cl og` ' ;T >e ... z 'ss 41,E


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I

2 0601 05MM92011 422 PU

Form 990 2010 BREAST CANCER S'L _,VIVORS FOUNDATION ,

.. Statement of Program Service Accomplishments

Check if Schedule 0 contains a response to any question in this Part III

1 Briery desafbe the orgentzation's mission:SEE SCHEDULE 0 FOR THE ORGANIZATION'S PURPOSE.

2 Did the organization undertake any significant program services during the year which were not fisted on the

page 2

11

prior Form 990 or 990-EZ? ( . Yes [XI No

If "Yes,' describe these new services on Schedule 0.

3 Did the organization cease conducting , or make significant changes in how it conducts , any programservices? [ "' I Yes [Xf No

..... .If 'Yes ," describe these changes on Schedule 0.

4 Describe the exempt purpose achievements for each of the organization's three largest program services by expenses . Section

501(c )(3) and 501(c)(4 ) organizations and section 4947(a )(1) trusts are required to report the amount of grants and allocations to

others , the total expenses , and revenue, i1 any, for each program service reported.

4a (Code:. , . )( Expanses $ including grants of $ ) (Revenue $ 5 31 0 41TO EDUCATE THE PUBLIC ABOUT BREAST CANCER AND THE IMPORTANCE OF EARLY

.DETECTION AND SELF -EXAMINATION; TO PROVIDE A FORUM FOR BREAST CANCER

SURVIVORS TO CONVENE ANT? DISCUSS ISSUES RELATED TO.BREAST CANCER.

4b (Code: ) (Expenses $ , including grants of S ) (Revenue $

4c (Code: , ) (Expenses $ including grants of S

4d Other program services (Describe in Schedule 0.)

(Expenses S including grants of S )_(Revenue S

4e Total program service expanses 111-

DM

(Revenue $ . . )

Form 990(2010)


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21601 05109,201 1 412 PM

Form 990 2010 BREAST CANCER S. _ VIVORS FOUNDATION

4T-_.( .(Q Chec klist of Required Schedules

1 is the organization described in section 501 (c)(3) or4947 (a)(1) (other than a private foundation)? If'Yes,

complete Schedule A.. ..... ...... ...................... ...... .................... ....2 Is the organization required to complete Schedule B. Schedule of Contributors ? (see instructions)

3 Did the organization engage In direct or indirect political campaign activities on behalf of or in opposition tocandidates for public office? If "Yes," complete Schedule C, PartI

.. ..... ........................4 ' Section 501 (cX3) organizations. Did the organization engage in lobbying activities , or have a section 501(h)

election in effect during the tax year? If "Yes,' complete Schedule C, Part 11. . .. ...... .........5 is the organization a section 501 (cX4), 501 (c)(5), or 501 (c)(8) organization that receives membership dues .

assessments , or similar amounts as defined in Revenue Procedure 90.19? If 'Yes ," complete Schedule C,

Pert III

6 Did the organization maintain any donor advised funds or any similar funds or accounts where donors have

the right to provide adv ice on the distribution or investment of amounts In such funds or accounts ? If'Yes;

complete Schedule D, Part I

.................................... .. ... ............................... ......... ... ....7 Did the organization receive or hold a conservation easement , including easements to preserve open space.

the environment. historic [and areas , or historic structures? ii'Yes; complete Schedule D. Pan II

8 Did the organization maintain collections of worsts of art, historical treasures , or other similar assets ? If 'Yes,'

complete Schedule O, Part ill

............ .................................. ...... ... ......9 Did the organization report an amount in Part X . fine 21 : serve as a custodian for amounts not listed in PartX: or provide creditcounseling , debt management , credit repair, or debt negotiation services? If 'Yes,'

complete Schedule D , Part IV

...............10 Did the organization , directly or through a related organization , fold assets in term, permanent , or quasi.endowments ? If -Yes,' complete Schedule D, Pan V

......................... .....................................11 if the organization 's answer to any of the following ques tions is'Yea; then complete Schedule D , Parts VI,ViU, VI1l. IX, or X as applicable.

a Did the organization report an amount for land, buildings, and equipment in Part X. line 107 if 'Yes,"

complete Schedule 0, Part VI

b Did the organization report an amount for investments - other securities in Pan X , fine 12 that is 5% or more

of its total assets reportedin Part X, line 16? It "Yes.' complete Schedule D. Part VII

c Did the organization report an amount for Investments- program related in Part X. line 13 that is 5% or more

of its total assets reported In Part X, line 16? If 'Yes.' complete Schedule"D, Part VIII

d Did the organizationreport an amount for otherassetsin Pan X. fine 15 that is 5% or more of its total assets

e Did the organization report an amount for other liabilities inPart X. fine 257 it'Yes,' complete Schedule D. Part X

. .. .. . .. .. .. .. .f Did the organization's separate or consolidated financial statements for the lax year include a footnote that addressesthe organization 's liability for uncertain tax positions under FIN 48 (ASC 740 )? If -Yes." complete Schedule 0, Part X

12a Old the organization obtain separate , independent audited financ ial statements for the tax year? if' Yes' complete

Schedule D, Parts X1 , XI1, and XIII .. _ . _ .. , , -

b Was the organization included In consolidated. independent audited financial statements for the tax year? If 'Yes.' and if

the organization answered "No " to line 12a , then completing Schedule D . Parts XI, XII, and X1ll is optional

13 Is the organization a school described in section 170(b)(1)(AXIi)7 tt 'Yes.' complete Schedule E

........... .... ......... .14a Did the organization maintain an office, employees , or agents outside of the United States?

b Did the organization have aggregate revenues or expenses of more than $10 ,000 from grantmatcing, fundraising,

business , and program service activities outside the United States ? It 'Yes,' complete Schedule F. Parts I and IV...............15 Did the organizationreport on Part IX, column (A), line 3, more than$5,000 of grants or assistance to any

organization or entity located outside the United States ? if 'Yes," complete Schedule F , Parts II and IV

16 Did the organization report on Part IX. column (A), line 3 . more than $5,000 of aggregate grants of assistance

to individuals located outside the United States? If 'Yes,' complete ScheduleF. Parts III and IV

. ... .......... ........ .......17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on

Part IX, column (A), lines 6 and Ile? if 'Yes ,' complete Schedule G. Part t (see instructions)

18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on

Part VIII, lines 1c and 8e? if 'Yes,' complete Schedule G, Part 11. .......... .. .. . .... . .............. ...... ..........19 Did the organization report more than $15 ,000 of gross income from gaming activities on Pan V i ll, line 9a?

If 'Yes,' complete Schedule G. Part III

20a Did the organization operate one or more hospitals? II "Yes," complete Schedule H

b If "Yes" to line 20a, did the organization attach its audited financial statements to this return? Note. Some

Form 990 Clers that operate one or more hospitals must attach audited financial statements(see instructionsZ .

reported in Part X , tine 18? If"Yes," complete Schedule D, Part IX

I

2

4

6

7

a

Page 3

Yes

X

No

X

X

X

X

X

X

X

x

10

F.

11a

11b

tic

lid

lie

12a

12b

13

14a

14b

15

16

17

18

19

20a

2Db

X

X

X

X

xX

X

X

LX

X

X

X

X

X

X

X

XX

Form990 (zoio)


17/48

2t36Q 1 QS/Qgr2Q 1 f 4:22 PM

Form 990 2010 BREAST CANCER SL -.+IIVORS FOUNDATION

aatn Checklist of Required Schedules (continued)

21 Did the organization reportmore than $5 ,000 of grants and other assistance to governments and organizations

in the United States on Part IX , column (A), line 1? If "Yes." complete Schedule I, Parts I and II. ........................ .... .22 Did the organization report more than $5,000 of grants and other assistance to individuals in the United States

on Part IX, column(A), line 2? If'Yes,' complete Schedule 1, Parts I and III23 Did the organization answer'Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the

organization 's current and former officers. directors, trustees , key employees . and highest compensated

employees? It 'Yes," complete Schedule .1............................................................ ....................

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than

$100.000 as of the lass day of the year, that was issued after December 31, 2002? If 'Yes,' answer lines 24b

through 24d and complete Schedule K. If "No ; go to One 25... ....... . ................... ...................b Did (he organization invest any proceeds of tax-exempt bonds beyond a temporary period exceptton2

C Did the organization maintain an escrow account other than a refunding escrow at any time during the year

to defease any tax-exempt bonds?

d Did the organization act as ani on behalf or Issuer for bonds outstanding at any time during the year?......... .. ..........

25a Section 501(cX3) and 501 (c}(4) organizations . Did the organization engage in an excess benefit transaction

with a disqualified person during the year? I('Yes, complete Schedule L, Pan 1... .. ............................... . ......

b Is the organization are that if engaged In an excess benefit transaction with a disqualified person in a prior

year. and that the transaction has not been reported on any of the organization 's prior Forms 990 or 990-EZ?

It "Yes; complete Schedule L, Part I. .. .. .. .. .. .. .. . . .. .. .. .. .. .. .. .. .. .. ..

26 Was a loan to or by a current or former officer , director, trustee, key employee , highly compensated employee, or

disqualified person outstanding as of the and of the organization 's tax year? It 'Yes." complete Schedule L . Pail if

27 Did the organization provide a grant or other assistance to art officer , director, trustee , key employee,

substantial contributor . or a grant selection committee member , or to a person related to such an Individual?

If 'Yes,` complete Schedule L, Part III. .. .28 Was the organization a par ty to a business transaction with one of the following parflas (see Schedule L.

Part IV instructions for applicable filing thresholds, conditions, and exceptions).

a A current or former officer , director, trustee , or key employee') It "Yes," complete Schedule L. Parl IV.. .. ......................b A family member of a current or former officer, direc tor, trustee, or key employee? If "Yes," complete

Schedule L. Pan IV

C An entity of which a current or former officer , director , trustee , or key employee for a family member thereof)

was an officer, director, trustee, or direct or indirect owner? If 'Yes,' complete Schedule L, Part IV

29 Did the organization receive more than $25 .000 in non-cash contributlons9 Ii'Yes; complete Schedule M....... ............ .30 Did the organization receive contributions of an , historical treasures , or other similar assets . or qualified

conservation contributions ? If 'Yes," complete Schedule M. .. .......... ....31 Did the organization liquidate , terminate , or dissolve and cease operations ? If "Yes," complete Schedule N,

Part I............ ........

32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets') If'Yes "

complete Schedule N, Part II

33 Did the organization own 100% of an entity disregardedas separatefrom the organization under Regulations

sections 301.7701-2 and 301.7701.3? If 'Yes,' complete Schedule R, Part I......... ... .......... ......... ... ............

34 Was the organization related to any tax-exempt or taxable entity ? If "Yes; complete Schedule R , Parts it. Ill.

IV, and V, line 1.... . ...

35 Is any related organization a controlled entity within the meaning of section 512 (b)(13)?

a Did the organization receive any payment from or engage in any transaction with a

controlled entity within the meaning of section 512(b )(13)? If "Yes ,- complete Schedule R,Pan V, fine 2 I Yes N.

.36 Section 501 (c)(3) organizations . Did the organization make any transfers to an exempt non-charitable

related organization ? If 'Yes,' complete Schedule R , Part V, line 2

37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization

and that is t reated as a partnership for federal income lax purposes? If'Yes' complete Schedule R,

Part VI

38 Did the organization complete Schedule D and provide explanations in Schedule O for Pan VI, lines 11 and

197 Note. All Form 990 filers are required to completeSchedule l? .

Page 4


18/48

21801 0510912011 4:48 PM

rForm990 2010 BREAST CANCER SL_.'VI 'VORS FOUNDATION

r` pt Statements Regarding Other IRS Filings and Tax ComplianceCheck if Schedule 0 contains a response to any question in this Part V ..............

la Enter the number reported in Box 3of Form 1098. Enter -0- if not applicable . , . , I 1

.1b Enter the number of Forms W -213 Included in line la. Enter -0- if not applicable L .

c Did the organization comply with backup withholding rules for reportablepayments to vendors andreportable gaming (gambling ) winnings to prize winners?

2a Enter the number of employees reported on Form W -3, Transmittal of Wage and TaxStatements, filed for the calendar yearending with or within the year coveredby this return 2a 0

b If at least one is reported on fine 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines to and 2a is greater than250, you may be required to a-rite. (see instructions)

3a Did the organization have unrelated business gross income of $1,000 or more during the year?

b It Yes ,' has it filed a Form 990 -T for this year? If 'No ,' provide an explanation In Schedule 0............... .............

4a At any time during the calendar year , did the organization have an Interest in, or a signature or other authority

over, a financial account in a foreign country (such as a bank account , securities account, or other financial

account)?......... .. .... .... . ... ..... ................. .............. ........... .. . .... .

b II"Yes: enter the name of the foreign country: ...... .......... .........

See instructions for filing requirements for Form TO F 90 . 22.1, Report of Foreign Bank and Financial Accounts.

5a Was the organization a party to a prohibited tax shelter Iransection at any lime during the tax year? _ _, , ,

b Did any taxable party notify the organization that it was or is a party to a prohibted tax shelter transaction? ..

c If -Yes' to line 5a or 5b, did the organization file Form 8886-T?

$a Does the organization have annual grossreceipts that are normally greater than $100 .000, and did the

organization solicit any contributions that were not tax deductible?.... ........ ........

b If Yes,' did the organization include with every solicitation an express statement that such contributions or

gifts were not tax deductible? .. .. ......... . ............ . , . ..... ....

7 Organizations that may receive deductible contributions under section 170(c).

a Did the organization receive a payment In excess of S75 made partly as a contribution and partly for goods

and services provided to the payor?.......... .

to If 'Yes,' did the organization notify the donor of the value of the goods or services provided?

c Did the organization sell, exchange , or otherwise dispose of tangible personal property for which if was

required to file Form 8282?.... !d If 'Yes,' indicate the number of Forms 8282 filed during the year + 7d L

...... .........a Did the-organization receive any funds , directly or Indirectly, to pay premiums on a personal benefit contract? ...

.................I Did the organization , during the year. pay premiums , directly or indirectly , on a personal benerd contract?

g if the organization received a contribution of qualified intellectual property , did the organization file Form 8899 as required?

In if the organization received a contribution of cars . boats , airplanes , or other vehicles, did the organization file a Form 1098-C?

8 Sponsoring organizations maintaining donor advised funds and section 509 (aM3i supporting

organizations . Did the supporting organization , or a donor advised fund maintained by a sponsoring

organization . have excess business holdings at anytime during the year?

9 Sponsoring organizations maintaining donor advised funds.

a Did the organization make any taxable distributions under section 4966?

b Did the organization make a distribution to a donor, donor advisor, or related person

10 Section 501(cX7) organizations. Enter.

a Initiation fees and capitalcontributions included on Part VIII, line 12

b Gross receipts, included on Form 990, Part VIII. line 12. for public use of club facilities , ,

11 Section 501 f c)(12) organizations. Enter:

a Gross income from members or shareholders...... . ...

b Gross income from other sources (Do not net amounts due or paidto other sources

againstamounts due or received from them.) 11 b

12a Section 4947 (a)(1) nonexempt charitable trusts . Is the organization filing Form 990 in lieu of Form 1041?......... ......b If'Yes ; enter the amount of lax-exempt interest received or accrued during the year . . . . . , .. , . , , ( 12b

13 Section 501(c}(29) qualifiod nonprofit health Insurance Issuers.

a Is the organizationlicensed to Issue qualified healthplansin more than one state?

Note . See the instructions for additional information the organization must report on Schedule O.

b Enter the amount of reserves the organization is required to maintain by the statesin which

Page 5

3b

4a

5b

Sc

its

6b

7a

7e

13a

the organization is licensed to issue qualifiedhealth plans .. . , , _ , 13bc Enter the amount of reserves on hand 13c ;ci+':


19/48

4

2860105/0917011 4:22 PM _

Form 990 2014BREAST CANCER Si .. VIVORS FOUNDATION Page6

Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a"No" response to line 8a , 8b, or I Ob below , describe the circumstances, processes , or changes in Schedule0. See instructions.Check if Schedule0 contains a response to any questionin this Part VI

Section A. Governing Bodyand Management

I a Enter the number of voting members of the governing body al the end of the tax year

iXL

b Enter the number of voting members included in line la. atmve, who are independent 1 tb 1 2

2 Old any officer , director, trustee, orkeyemployee have a family relationship or a business relationshipwith t :sr r, s

any other officer, director, trustee, or key employee? 2 {

......3 Did the organization delegate control over management duties customarily performed by or under the direct

supervision of officers , directors or trustees, or key employees to a managementcompany or otherperson?

4 Did the organization make any significant changes to its gover ning documents since the prior Form 990 was filed?

5 Did the organization become aware during the year of a significant diversion of the organizations assets?

...... ... ...... ......6 Does the organization have members or stockholders?... .......... .. .....7a Does the organization have members , stockholders , or other persons who may elect one or more members

of the governing body?

b Are any decisions of the governing body subject to approval by members , stockholders , or other persons

8 Did the organization contemporaneously document the meetings held or written actions undertaken during

the year by the following;

a The governing body?b Each committee with authority to act on behalf of the governing body?

.....9 Is there anyofficer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at

the organization's mailing address? If 'Yes,' provide the names and addresses in Schedule 0

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code .)

10a Does the organization have local chapters , branches , or affiliates?

b If 'Yes,' does the organization have written policies and procedures governing the activities of such

chapters , affiliates, and branches to ensure their operations are consistent with those of the organization ? . . . . . . _ . . . . . . .

11e Has the organization provided a copy of this Form 990 to all members of its gover ning body before filing the

form?

b Descnbe in Schedule 0 the ..process , If any, used by the organization to review this Farm 990.

12a Does the organization have a written conflict of interest policy? It *No,' go to line 13

b Are of ficers, directors or trustees, and key employees required to disclose annually Interests that could give

rise to conflicts?

c Does the organization regularly and consistently monitor and enforce compliance with the policy ? 11 'Yes,'

describe in Schedule 0 how this is done.. ........... ...................... ..13 Does the organization have a written whistleblower policy?

14 Does the organization have a written document retention and destruction policy?

15 Did (he process for determining compensation of the following persons include a review and approval by

Independent persons , comparability data, and contemporaneous substantiation of the deliberation and decision?

a The organization's CEO, Executive Director, or lop management official

.............. ........................... ..... ....b Other officers or key employees of the organization

If'Yes' to line 15a or 15b, describe the process in Schedule O. (See instructions.)

16a Did the organization invest in, contribute assets to , or participate in a joint venture or simi lar arrangement

with a taxable entity during the year?

b If 'Yes ,' has the organization adopted a written policy or procedure requiring the organization to evaluate its

participation in joint venture arrangements under applicable federal tax law , and taken steps to safeguard the

oroauization's exempt status with respect to such arrangements?

Section C. Disclosure

Yes

17 list tho states with which a copy of this Form 090 is required to be filed AK, AL , AR, AZ , CA, CO , CT, DE , DC, FL , GA, HI , IA

18 Section 6104 requires an organization to make its Forms 1023 (or 1024 it applicable ). 990- and 990 .7 (501 (c )(3)s only ) available

for public inspection . Indicate how you make these available . Check all that apply.I j Own websrte J Another's website U Upon request

19 Describe in Schedule 0 whether (and if so , how), the organization makes its governing documents , conflict of Interest policy.

and financial statements available to the public.

20 State the name , physical address , and telephone number of the person who possesses the books and records of the

organization : i' PRESIDENT 443 EAST WESTFIELD AVENUE

ROSELLE PARK NJ 07204 816-472-9000

DAA Form 990 (2010)


20/48

f

28601 O509r1011 4'22 PM

Form 990 2010 BREAST CANCER SI -IVORS FOUNDATION

V : 4t Compensation of Of ficers, Directors , Trustees , Key Employees , Highest Compensated Employees,

and Independent ContractorsCheck if Schedule 0 contains a response to any question in this Part VII .. . .

Section A. Officers Directors, Trustees. Kep F.mptoyees and Highest Compensated Emoyeas1a Complete this table for all persona required to be listed . Report compensation for the calendar yearending with or within the

organization's tax year. .

List all of the organlrallon's current officers , directors, trustees (whether individuals or organizations ), regardless of amount of

compensation. Enter-0- in columns (0), (E), and(F) if no compensation was paid.

List all of the organization 's current key employees , it any. See instrvcirons for definition of "key employee,'

List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)

who received reportable compensation (Box5 of Form W-2 and /or Box 7 ofForm 1099-MISC) of more than $100,000 from the

organization and any related organizations.

List all of the organization's former officers . key employees , and highest compensated employees who received more than

$100,000 of reportable compensation from the organization and any related organizations.

Lis[ all of the organization's former directors or trustees that received , in the capacity as a former director or trustee of the

organization , more than $10,000 of reportable compensation from the organization and any related organizations,

List persons In the following order : Individual trustees or directors : institutional trustees ; officers : key employees ; highest

compensated employees : and former such persons.

Pape 7

;_L

o k.neCK lrlrs pox II neruler me Or zason nor an releleo or aruzallorls rpm nsateo an current unlc er, wrecior or ellalee.

(A) (81 (C) (D) (E) IF)

Name and Tide Averags Position (check at that apply ) Reponaote RepoftJbletd

Erumatedt fhours per

o o = T compeneabon on ramcornpensa amoun ohweek 2 tram related erot

(dccaibehours for

a cItts

orpanrzalionorgan zahona

(W2)1099 -MISC)compencahon

Isom the

related R-8 '

(W21109&MISC) arganizahpnanlzadomrtx

gx g and relatedg

in Schedule organizations

Oy $

(1)YULIUS POPLYANS Y, MD

PRESIDENT 5.00 X 0 0 0

(2)MARJORIE VELASC

ElO iin MEMBE>7 ... 5.00 X 0 0 0

tor)

(a)

lfil

(a)

(a)

la)

ItO)

(1t)

112)

(13)

114)

(15)

(te)

Form 990 (2010)

t

1


21/48

28601 05J09i20114:22 PM{ Form 990 a1o BREAST CANCER ST"' VIVORS FOUNDATION,

P Section A. Officers , Directors , T., .ees , Key Employees , and Highest Compensated -t_.,ployees (continued)

(A) (a) (C) (0 ) (E) (F)Name and Titb Average

hPosition(firedk at that apply) Rbponabte Reportable Estimated

ours perweek R'

'nR

compensationtram

compensation fr om

r l t d

amount of

deecnbo o3

3R

otherthe

e a eorgsrwzailons compensation

hours fore

orgerwcation (W-2J1o99 . k11sc) from therelated

o (W211099 -MISC) organization

orpenrZdtionb and relatedat Schedule organization.O)

_

qG

(17)

(16}

(18)

(24)

(21)

(22)

(23) 1 T

124)

(26)

(26)

(27)

(2e)

1b Sub-total ... ......... .... . ........ ...... ......... .......

c Total from continuation sheets to Part VII , Section A . . . - -

d Total add lines ib and 1c) ..

2 Total number of individuals (including but not limited to thoselisted above ) who received more than $100,000 inreportabfe compensationfrom the organization 0

3 Did the organization list any former officer , director or trustee , key employee , or highest compensatedemployee on line 1o1 If'Yes ,' completeSchedule J tar such individual .. .

4 For any individual listed online 1a , is the sum of reportable compensation and other compensation from theorganization and related organizations greater than $150 ,0007 it 'Yes.' complete Schedule J for such

i ndrvrdual.. .. ... ... ... ... ... ... .. .. ... . ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .5 Did any person listed on line is receive or accrue compensation from any unrelated organization or individual

for services rendered to the organization)If 'Yes' complete Schedule J for such person

Section B. independent Contractors

1 Complete this table for yourfive highest compensated independent contractors that received mo ms than $100,000 ofcompensation from the organization.

Name w4 buat)ileas

address- 411110serr+ce: ()saaan

MAIL RESPONSE SERVICES 144 N

LAKE HIAWATHA NJ 07034

BEVBRWYCK ROAD , PMB 181

FUNDRAISING

478,91

8

2 Total number of independent contractors (including but not limited to those listed above ) who

received more than $100.000in com pen sation from the or ganization 1

1 7 ,1,1 7 }%

y gyp--: .=

Page 8

Form, 990 (2010)


22/48

2960105I09!2011 4:22 PM

Form 990(2010 ) BREAST CANCER SL ._ TIVORS FOUNDATION , Page 9b u ffl C4,hsmonf of Clnvan ia

F r y 1 r` r a a s a s ,

xz' a~ ` da sL k f i rY 'x ; s

r rr fi z E; '" er t

(A)Totaltevanue OI edo +

OIL )

exempt

(C)Unre1tedbunass

eve(D)R

f tCkrtled 6om taxyy < 3 rs c:k ` i i r rat tt rY'r}x!?

Junuwn revenue urtdarseclbns

efts f} '; a` Pa i , ` tr x3i

revenue 517- 513. or 514

c1e Federated cam Pai s 12

.. . ,

r . t a

( rf

J 5 r s 33 S r ` Fx rt ] `2' Y yr w

b Membership dues lb >< , i G ?! F_r h

r 3 4? R fl

t

- , . iC rs tr c?r

..... ,.c Fundralstng events 1a

?,} N

s Y7 t M7

yY kf Xt

4tt

t r cS

rx zBk- d Related organizations id ,}i ,2 r > pt *sr y ,r, gx Y{N GovemmaM wants(owirttnbns) Is } f r; (, 3 t r } s r _

m pj oft COrArwala , oft, tyeot5r S }?

M ;4 .p} { lr

3aid svnlsr srnaanN nd mWdfd above tf 531 ,04 1 '

aL

Y 'T M k' ; ,

9 lia mh eaWmubes inducted in tinesto-it.

y s 4r f a

V h Total Add Iles 1x-11 1, 04153 ,y ;,- .r C;. & :, :.

`' s

>. ,

Busn . Code43 G.^.!'4iyt'î".,a

's c

s h "54 ^`C^3 t' ì' f dfS

ja K

a3t s ea r L;Yk .tot kji ir'r ?F

sb Less: eoslordM ?1 , )Y 1`

yat{ R

r((' Â

r yf y'

a

1(

r i

base u im v .M. x'{x iLlN 55

+ r k `

` Q .S'b'r 3't

y

`f,,L

t (F

c Gain or(loss)

Ft" 3a t Flo' A

?k [ t

,4 C $ ( F p- , 3. al L

d Net gain or (toss) ........... .. .......

Be Groan frsoorrte from fundraising events-i t ' (f'

a rt 3 E a - s

sr'

tkF. tic ! )` p

f.r r ss - =

y

$l ii x r^t

. o lncudng(not

of co trfbulsrns reported onWe 1C).

See Pan IV, tine 18 a s s< i&i

fi t

s........

b Less : direct expenses b'fit _ >.. t ;S r> 1 3'< z _. s' 't 'c -- g

Zl"j` s F' yP k 'ate i s t

...c Net income or (loss ) from fundraisi events ..... , .

9a Gross intorrte born gaming activities. 3n t;3 r )

.4Z fN afiA s

12 5 3 1 , 0 4 1 0 0 0

Form 990 (2010)


23/48

28601 06/09/201 1 4 22 PM

Form 990 (2010) BREAST CANCER _&VIVORS FOUNDATION

2WIJ Statement of Functional ExpensesSection 501 (c)(3) and 501(e )(4) organizations must complete all columns.

All other organizations must complete column (A) but are not required to complete columns (B). (C), and (D).

Page 10

Do not include amounts reported on fines fib, fA) (m

7b $b 9b Vxpensestotal e proara serv ice Management and fundraci ig

,, and 10b of Part ill. expenses genera( expenses expenses

1 Grants and other assistance to governments and 3 rorganizations in the U.S. See Part N, line 21

2 Grants and other assistance to Individuals in M zf 1

the U.S. See Part N. fine 22 ' :. " r r 1

3 Grants and other assistance to governments, f } ', rorganizations, and individuals outsidethe a',S ,

'r r

U.S. See Part IV , tines 15 and 16 ,a

4 Benefits paid to or for members (J,-- q i". r

5 Compensation of current officers, directors.

trustees, andkey employees

6 Compensation not induded above, to disqualified

persons(as defined under section 4958(f)(1)) andparsons described in section 4958(cx3j(B)

7 Other salaries and wages

8 Pension plan contributions( nctrde section 401(k)

and section 403(b) employer contributions)

9 Other employee benefits

10 PayroN taxes ......... ............. ...

11 Fees for services (non-employees)-

a Management .. . .............. . . . .

b Legal

c Accounting . .... ..... .

d Lobbying

a Professional fundraising services. See Part 1V, line 17 4 7 8 918 , '


24/48

284101 05109/2011 4:72 PM

Form 990 (2010) BREAST CANCER AVIVORS FOUNDATION,

EN- U'l Balance sheetPage 11

(A) lf3)

Beginning of year End of year

1 Cash-- non-interest bearing... .. ...... ..

1 4 5 ,854. .2 Savings and temporary cash investments 2

3 Pledges and grants receivable, net. ...

3

4 Accounts receivable, nat 4 6 , 0765 Receivables from current and former officers, directors, trustees, key Y r u

,employees, and highest compensated employees. Complete Part 11 ofgx r s i# : ) l e ) ?r ;s.- s

Schedule L ..... .. . .......... .6 Receivables from other disqualified persons(as defined under. section

'4958(1)(1)), persons described in section 4958(cx3)(B), and contributing

t sry , ` + ,

employers andsponsoring organizations of section 501(c)(9) voluntary; }

Memployees' beneficiary organizations(see Instructions)

7 Notes and loans receivable, net - 7

Q 8 Inventories for sale or use

9 Prepaid expenses and deferred charges.. . .

g'108 Land, buildings, and equipment: cost or

other basis. Complete Part Vi of Schedule D 102

b Less. accumulated depreciation 10b 10c11 investments - publicy traded securities

... ... ....... ......... ... .. .. .. ...11

12 lnvestments- other securities. See Part IV, fine f f....... . ...... .... ... . . ..

12.13 investments- prograrr>-related. See Part IV, line 11 13

14 intangible assets....................... ...

14

15 Other assets. See Part IV, line 11 1516 Total assets . Add lines 1 through 15 (must e qual line 34 ............. .... ... 0 16 51 , 930

17 Accounts payable and accrued expenses 1718 Grants payable

..... ..... ...... .... ... ......... ...18

19 Deferred revenue.. . .. ............ ... ....

19

20 Tax -exempt bond liabilities 20

ai 21 Escrow or custodial account lability . Complete Part 1V of Schedule D 2122 Payables to current and former officers. directors, trustees. key Si tw

1xb , }s ks ,

employees, highest compensated employees, and disqualified persons. 5? 9

roComplete Part 11 of Schedule L 22

23 Secured mortgages and notes payable to unrelated third parties 23

24 Unsecured notes and loans payable to unrelated third parties 2425 Other liabilities Complete Part X of Schedule D 2526 Total liabilities. Add lines 17 ugh 25 0 26 0

U) Organizations that follow SFAS 117 , check here iXj and complete c a; r f Y a r : t3 }?rb y" 1;

lines 27 through 29, and lines 33 and 34.CO 27 Unrestricted net assets 27 51 , 930M 28 Temporarily restricted net assets 28C

29 Permanently restricled,net assets 29

U_Organizations that do not follow SFAS 111, check herej and s5 ` Xx s` l } i 3 ;nk fa

complete lines 30 through 34. si

d}

F

xr 30 Capital stock or trust principal. or current funds... ... .... .... .......... .

30U% 31 Paid-in or capital surplus , or land , building, or equipment fund 31

32 Retained earnings , endowment , accumulated Income , or other funds 32

33 Total net assets or fund balances 0 33 51 , 93 0

34 Total liabilities and net essets/fund balances.... ........ ......... . ... 0 34

51 9 3 0farm 990 [2010)


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28601 05i 9120114 22 PM

Form 9902010 BREAST CANCER S'....VIVORS FOUNDATION _ _ _ Page 12

Reconciliation of Net Assets

Check if Schedule 0 contains a response to any question in this Part X1. .

I Total revenue(must equal PartVIII, column (A), line 12)

2 Total expenses (must equal Part)X, column (A), line 25)

3 Revenue less expenses . Subtract line 2 from Mne 1

4 Net assets or fund balances at beginning of year (must equal Part X, line 33 , column (A))...... .... .........

5 Other changes in net assets or fund balances (explain in Schedule 0)

6 Net assets or fund balances at end ofyear. Combine lines 3, 4, and 5 (must equalPart X, line 33,

column 8

Financial Statements and ReportingCheck if Schedu le 0 contains a response to any question in this Part XII

1 Accounting method used to prepare the Form 990 ' ! Cash iX1 Accrual I . ; Other

If the organization changed its method of accounting from a prior year or checked 'Other,' explain in

Schedule O.

2s Were the organization's financial statements compiled or reviewed by an independent accountant?

b Were the organization 's financial statements audited by an independent accountant?

c if Yes' to line 2a or 2b , does the organization have a committee that assumes respons ibility for oversight

of the audit , review , or compilatlon of Its financial statements and selection of an independent accountant?

If the organization changed either Its oversight process or selection process during the tax year , explain in

Schedule O.

d It 'Yes " to tine 2a of 2b , check a box below to indicate whether the financial statements for the year were

issued on a separate basis , consolidated basis , o r both:

lI separate basis Consolidated basis Both consolidated and separate basis

3a As a result of a federal award, was the organizationrequired to undergoan audit oraudits as setforth to

the Single Audit Act and OMB Circular A-133?

b It'Yes' did the organization undergo the required audit or audits ? If the organization did not undergo the

required .auditor audits , explain etry in Schedule 0 a n d des c ri be any steps taken to undergo such audits.

IL

531, 041479,111

51,930

1

1 2

4

6

51, 930


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2B601(1510912011 4:22 PM

SCHEDULE A

(Form 990 or 990-F2)

Departrnenlol"treasuryIntema, Revenue Servioe

Public' Charity Status and Public Support

Complete If the organization Is a section 501(c}(3) organization or a section4947(2)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-E2. See separateinstructions.

usme of theorgenizattoe BREAST CANCER SURVIVORS FOUNDATION,INC.

F.....1..,.--',4-"ltcadon number

Reason for Public Charity Status (All organizations must complete this part,) See instructions.The org aniza tion is no t a private fo undation bec ause it is: (F or line s 1 through 11, check only one box.)

1 " A church, convention o(churches , or association of churches described in section 170(b)(1NA)(i).

2 A school described In section 170(b)(1)(A)(Ii). (Attach Schedule E.)

3 A hospital or a cooperative hospital service organization described In section 'T0 (b)(1j(A}(iil).4 fl A medical research organization operated In conjunction with a hospital described In section 170(b )(1)(A)(ili). Enter the hospital's name,

city,and state.

5 An organization operated for the benefit of a college or university ownedor operated by a governmental unit described in

section 170(b)(1)(A)(iv), (Complete Part 11.)

6 A federal. state. or local government or governmental unit described in section 170 (b)(i)(A)(v).

7 X An organization that normallyreceivesa substantial pail of its support from a governmental unit or from the general public

described In sects n 170(b)(IXA)(vl). (Complete Part It.)8 tt t A community trust described in section 170 (b)(1)(A)fvI). (Complete Pan ii.)

9 1 4 , An o rg anization thatnormally receives : ( 1) more than 33 11 3% of its support from contributions , membership fees, and gross

receipts from achvilles related to its exempt functions-subject to certain exceptions , and (2 ) no more than 33 113% of its

support from gross investment income and unrelated business taxable income ( less section 511 tax ) from businesses

acquired by the organization after June 30 , 1975 . See section 509(s )(2). (Complete Part It.)

10 An organization organized and operated exclusively to test for public safety See section 609(x)(4).

11 An organization organized and operatedexclusively for the benefit of, to perform the functions of, or to carry out the

purposes of one or more publicly supported organizations described in section 509 (a)(1) or section 509(a )(2). See section

509(a)(3). Check the box that describes the type of supporting organization and complete lines t 1e through 11 h.a [] Type l b E_ J. Type Il c J._! Type Ill-Functionally integrated d j Type hi Other

e By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons

other than foundation managers and other than one or morepubliclysupportedorganizationsdescribed in section 509(a)(1)

or section 509(x)(2).

If the organization received a written determination from the IRS that it is a Type I. Type II, or Type ill s upporting

organization , check this box I i

....0 Since August 17. 20M . has the organization accepted any gift or contribution from any of the

following persons?

(I) A person who directly or indirectly controls , either alone or together with persons described In (it) and Yes No

(iii) below , the governing body of the supported organization? _ 11

(ii) A family member of a person described In (I) above it of

(iii) A 35%controlled entity of a person described in (i) or (ii) above? 11 ii

.. .. ...In Provide the f ill information about the suorled anizat ion s .

(i) Nam of supported - i ll) Elk (R!) Type of orpenizalbn (iv) Is lie orgadzae ur (v) Did you notit/ (WI) is die (ull) Amount oforganization (described on lines 1-9 In rd. 0) feted in yourIM orgarora6on inegs uizsen n ork support

above at rRC section govemng doamte a? mu lii your () agasged n the

(sae Instructions)) d

Yes No Yes No Yes No

(A)

(B)

(C)

(D)

(E)

)) w ! a. } Total

EEf- . . . ." ` ear. ;? . *J:z, 1 l yr re'-4 l..K-'a,i" 'ki ;' - . . i, r? . `Y L sY .3 ,L ,tic f,.rs-!3a ..

)


27/48


28/48

28601 05)09M 11 4:22 PM

Calendar year(or fiscal year beginning In) (a) 2006 b 2007 (c) 2008 d) 2009 (e 2010 (f) Total1 Gif ts, grants. contributions , and membership

fees received. (Do not include any 'unusual

.. ....grants.'

... . . .... . . .. ... .2 Gross receiptsfrom admissions, merdtandise

sold tservices performed, or facilitiesfurnished in any activity that is related to theorganization's tax-exempt purpose

...... . .3 Gross receipts from aclnities that are not an

unrelated Veda or business under section 513

4 Tax revenues levied for the

organization's benefit and either paidto or expended on its behalf

5 The value of services or facilitiesfurnished by a governmental unit to the

organization without charge.

8 Total. Add lines 1 t hrough 5

7a Amounts included on lines 1, 2, and 3received from disqualified persons

to Amounts included on lines 2 and 3received from other than disqualifiedpersons that exceed the greater of $5,000or 1 % 01 the amount on line 13 for the year

c Add lines 7a and 7b

8 Public support(Subtract tine 7c fromline B.

.

t x a3 `.`''s $ c c. S

s Lx t #lam. iF f+iN k ?

;^ . F

'x i sr 'r4=, j '')f,gt'#,t.b

Z ," i e : g

f r 4 r} fl Sb

Y , r 'D"'.c

# :'fie ) t ")^a mac j

& arT F


29/48

2860) 05109l2O114.22 PM

Schedule A Forth 990 or990EZ 2010 BR&_ i CANCER SURVIVORS FOUNDAI _JN Page 4

Supplemental Information . Complete this part to provide the explanations required by Part it, line 10;Part It, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See

instructions).

OM Schaduie A (Forth 990 or 990.EZ) 2010


30/48

2806105+091201 i 1.22 PM

SCHE RULE D

(Form 990)

Depwlmanr of the TreasuryInternet Revenue Service

Lpplementai Financial Staterii, I-hits Complete N the organization answered " Yes," to Form 990,

Part IV , line 6, 7 , 8.9,10 , 11. or 12.

i! Attach to Form 990. i See separate Instructions.

Nam" of th e organizadon

BREAST CANCER SURVIVORS FOIINY)ATION,

INC.

OM9 No. 1545.0047

20103,tIbIid :

Employerldentflcation number

Alp If Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if theorganization answered "Yes" to Form 990, Part IV , fine 6.

I Total number of and of year.......... ......... .. .........2 Aggregatecontributions to (during year)

. .. . . . .. .. .. .. .. .. .. .3 Aggregate grants from (duringyear)

4 Aggregate value atend of year .... .... .

(a) Donor advised funds

5 Did the organization inform at donors and donor advisorsin writing that theassetsheld in donoradvised

funds arethe organization's property, subject to the organization's exclusive legal control?

B Did the organization inform all grantees , donors , and donor advisors at writing that grant funds can be used

only for charitable purposes and not for the benefit of the donor or donor advisor , or for any other purpose

(b) Funds and other accounts

I i Yes 1 I No

rconferring impermissible private benefit? I 1 Yea O NOc Conservation EasementsComplete if the organization answered "Yes" to Form 990, Part IV, line 7

1 Purpose(s) of conservation easements hetd by the organization (check all that apply).

rl Preservation of land for public use (e.g., recreation or education ) Preservation of an hlsrorically important land area

Protection of natural habitat Preservation o( a certi fied historic structure

Preservation of open space

2 Complete lines 2a t hrough 2d if the organization held a qualified conservation contribution In the form of a conservation

easement on the last day of the tax year.

a Total number of conservationeasements.....b Total acreage restricted by conservation easements

c Number of conservation easements on a certifiedhistoric structure included in (a)

d Number of conservation easements included in (c) acquired after 8117106, and not on a

hislwlc structure listed in the Nat ional Register .

Held at the End of the Tax Year

24

2b

2c

1 2d3 Number of conservation'easements modified , transferred , released , extinguished , or terminated by the organization during the

tax year

4 Number of states where property subject to conservation easement is located

5 Does the organization have a written policy regarding the periodic monitoring , inspection , handling of

violations , and enforcement of the conservation easements if holds? ii . you l : No

6 Staff and volunteer hours devoted to monitoring, inspecting , and enforcing conservation easements during the year

7 Amount of expenses incurred in monitoring , inspecting , and enforcing conservation-easements during the year

5

8 Does each conservation easement reported on line 2(d) above satisfy the requirementsofsection 1701h)(4)(B)

(i) and section170(h)(4)(B)( u)? _i Yes

9 In PartXIV, describe how the organization reports conservation easements in its revenue and expense statement, and

balance sheet . and include, itapplicable, the feat of the footnote to the organization's financial statements that describesdhe

organization's accounting for conservation easements.

err 4>1 organizations Maintaining Collections of Art, Historical Treasures , or Other Similar Assets.Complete if the organization answered 'Yes" to Form 990 , Part IV , line 8

1a It the organization elected , as permitted under SFAS 116 (ASC 958 ). not to report In its revenue statement and balance sheet

works of art, his torical treasures . or other similar assets held for public exhibition , education , or research in furtherance of

public servi e, provide , in Part XIV, the text of the footnote to its financial statements that describes these Items.

b if the organization elected , as permitted under SFAS 1 16 (ASC 958), to report in its revenue s tatement and balance sheet

works of art, historical treasures , or other similar assets held for public exhibition , education, or research in furtherance of

public service , provide the following amounts relating to these Items:

(i) Revenues included in Form 990, Pan Vill. line 1

(11) Assets included in Form 990, Part X s

2 If the organization received or held works of art, historical treasures, or other similar assets forfinancial gain, provide thefollowing amounts required to be reportedunder SFAS 1 18 (ASC9S8) relating to these items:

a Revenues included in Form 990, Part Vill line t 3

D Assets rnauoeo In corm 990 , Part X For Paperwork Reduction Act Notiea , See the Instructions for Form 990.OAA

Schedule D (Form 990) 2010


31/48

28801 03109/20114 22 PM

,. . r.

Schedu le D Fam 990 2010 BREAST C .::ER SURVIVORS FOUNDATION Pa 2I.;g3 ar . - -

Organizations Maintaining Collections of Art, Historical Treasures , or Other Similar Assets (continued)3

d Loan or exchange programs

e Other

4 Provide a description of the organization 's collections and explain how they further the organizations exempt purpose in Part

XIV,

5 During the year, did the organization solicit or receive donations of art. historical treasures, or other similar

assets to be sold to raise funds rather then to be maintained as part o( the organization 's collection ? Yes No

Escrow and Custodial Arrangements . Complete if the organization answered ' Yes' to Form 990, Part IV,line 9, or reported an amount on Form 990 , Part X, line 21.

la Is the organization an agent, trustee , custodian or other intermediary for contributions or other assets not

Using the organization 's acquisition , accession . and other records , check any of the following that are a significant use of itscollection Items (check aft that apply):

a I I Pub9c exhibit ionb t` Scholarly research

c NPreservation for future generations

included on Form 990, Part X?............ ......... .......

b lf'Yes .' explain the arrangement in Part XIV and complete the following table:

c Beginning balance

d Additions duringthe year

e Distributions during the year, .. . .... .....

f Ending balance .. .

1c

td

it

1e

Amount

r1__1 Yes{.i No

=;t?aittt , Endowment Funds . Complete if organization answered "Yes" to Form 990 , Part IV, line 10

2a Did the organization include an amounton Form 990, Part X, line 217 .

b If 'Yes,' explain the arrangementin Part XIV.

{ar uur. nr year

i a Beginning of year balance

b Contributions

c Net Investment earnings , gains, and

losses

d Grants or scholarships

a Other expenditures for facilities and

programs

_f Administrative expenses

g End of year balance_ .. _ ....... .

2 Provide the estimated percentage of the year end balance held as:

a Board'designated or quasi-endowment _ %

b Permanent endowment %

c Term endowment %

(b) Prioi year (C) Two years back d) Three years bac

K.

11

Yes EI No

:

(e) Four years back

3a Are there endowment funds not in the possession of the organization that are held and administered for the

organization by: Yes No

(i) unrelated organizations

t(q related organizations 3a 11 ''

b II 'Yes to 3a(0), are the related organizations listed as required on Schedule R? 31)4 Describe in Par XIV the intended uses of the organization's endowment funds

tP>arV`/Je land Buildin s and E ui ment See Form 990 Part X tine10Description of investment (a) Cost or other bas is

(Inveatmenl)

(b) Cost or other basis

(other)

(c) Accumulated

deorearalion

(d) Book value

1a Land

b Buildings

c Leasehold improvements

d Equipment

e Other . ... . . ........

Total. Add lines la through le. (Column(d) must equal Form 990, Part X, column(B). tine 10(c).)

Schedule D(Form 990) 2010

OAA


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28901 0510912011 4-22 PM

Schedule 0(Form 990 2010 BREAST G. ;.'E12 SURVIVORS FOUNDATION

Investments-=Other Securities. See Form 990, Part X line 12.Page 3

(a) Desatption of settaity a category

(indudmg Marne of security)

(b) Bookvelue - (c) Method o fvaluation'.

Cost or tnd-ol-year market value

(1) Financial derivatives

(2) Closely -held equity interests

(3) Other

(C) ..... ........ ......... ......... ........... .... .......

(O)..... ..... _ . .... ..............(F) ............................

IF) . .. .. .. .. .. .. .. . .. .. . . . .. .. .. .. .. .. .. . . . .. .. .. . .. .. .. .

...... .. .................. .......(H) .............. ........ ........... ......................

Total. Column b must equal Form M . Part X , col. 8 line 12. . tx : " a ., s, s

` .>i`31t. Investments - Pro ram Related . See Form 99 0 Part X , line 13.(a) Desalpbon of Investment type (b) Book value I N Method of velualron.

Cost or end-or- year market val ue

(1

2

3

5

6)

7

8

e

10

Total Column (b) must equal Form 990. Part X. cof. 8 titre 13. s Zt .iX3-'spf

Part ; Other As sets . See F or m 990 , Part X, line 15.

(a) Description lb) Book value

(2

3

5

(6)

(7)

(8

9

(10

Total. Column b mustequal Form 990, Pan X, cot (B)line 15. . , ..

; arf =Jf,: ' Other Liabrlrties. See F orm 990 . Part X, line 25.(a) Description of IlabitIty


33/48

26801 0519912011 4'22 PM

Schedule D (Form 990)2010 BREAST h. ..~,BR SURVIVORS FOUNDATI ON, Page 4

. Reconciliation of Chan ge in Net Assets from Form 990 to Audited Financial Statements

I Total revenue(Form 990, Part V)II, column(A), line 12) 12 Total expenses(Form 990, Part IX, column(A), line 25) . .. . . .. .. .. ..

. ... ................2

3 Excess or (deficit) for the year. Subtract line 2 from line t 34 Net unrealized gains(losses)on investments ...

.. ....... .... ... ....

4

5 Donated services and use of facilities 5

8 Investment expenses

7 Prior period adjustments

B Other (Describe in Pori XIV.) a9 Total adjustments(net). Add lines 4 through B ...... .... .... ... ...

. . . ... .. ...9

10 Excess or deficit for theyearpet audited financial statements. Combine lines 3 and 9. 10ti? .a .1 *;' Reconciliation of Revenue p er Audited Financial Statements With Revenue p er Retum

I Total revenue, gains, and other support per audited financial statements.. .... ............ ..... .2 Amounts included on line I but not on Form990, Part Vtll. line 12:

a Net unrealized gains on investments 2a

b Donated services and use of facilities 2b

c Recoveries of prior year grants 2c

d Other (Describe In PartXIV.) 2d.... ......... .. .. .. .... .. F

e Add lines 2a through 2d... ......... ... ........... 2e

3 Subtract line 2e from line 1 3

4 Amountsincluded on Form 990. Part Vill, line 12, but not on line 1

a Investment expenses not included on Form 990. Part Vlll, fine Tb

531 , 041

479 , 11151 , 930

51,930

b Other (Describe in Part XIV.) 4b -4 3s21

c Add lines 4a and 4b 4c5 Total revenue. Add lines 3 and 4c. (This must equal Form 990 Part I tine12.) 5 531,041

Reconciliation of Expenses per Audited Financial Statements With Expenses per Return1 Total expenses and losses per audited financial statements I 479,1122 Amounts includedon line1 but not on Form 990. Part IX, fine 25:

a Donated services and use of facilities 2ab Prior year adjustments 2b

c Other losses 2cd Other (Describe In Part XIV ) ................ 2d

a Add lines 2a through 2d ... 2e3 Subtract line 2e from line 1 3 479,111

4 Amounts included on Form 990,

Part IX,

line 25,but not on line 1:

a Investment expenses not included on Form 990, Part VIII, line 7b 4a

b Other (Describe in Part XIV) 4bc Add lines 4e and 4b 4c

5 Total expenses. Add lines 3 and 4c . (This must equal Form 990 , Part [ line 18 479,111a t' Supplemental Information

Complete this part to provide the descriptions required for Part it, lines 3, 5, and 9; Part Ill, lines Is and 4; Part IV, lines lb and 2b;

Part V, one 4; Part X, line 2; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, tines 2d and 4b. Also,complete this part to provide

any additional information.

Schedule D (Form 990) 2010

DAA


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2 8801 0 5009/101 1 4:22 PM

Schedule D Form 990 2010 BREAST M. .:ER SURVIVORS FOUNDATION, { M1 ,j

Su tementai Information continuedPage 5

Schedule 13(Form 990) 2010


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28601 05A)9120114'22 PM

SCHEDULE G supplemental Information Regar ili._.g OMB ND. 16s5-0o47(Form 990 or 990 -EZ){

IFundraising or Gaming Activities

Complete if the oroanl xatlon enewarad ' ran" to Fnrm eafl Part N Imes 17 1R nr 14 nr If the201 0

uepartrnenr or the Treasury organization entered more than $16,001 on Form 990-EZ , line Ga. alntefnal Revenue Service F Anash to Form 990 or Form 090-12- Sae se In trvcdons.

Name of the organzation BREASTINC.

CANCER SURVIVORS FOUNDATION, Erhptover 61enNn .. , Inn .. .'fiber

Fundraising

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