Do Do not not enter social security numbers on on this form as it it may be made public. Open topublic

Transcription

1 PUBLIC DISCLOSURE COPY Rturn of Orgniztion n ExmptFrom Inom I Tx 0 Unr stion 0(),,, or ()() ) of th Intrnl Rvnu Co (xpt privt fountions) 00 OMB. -00 Form 0 Dprtmnt of th Trsury Do Do not not ntr soil surity numrs on on this form s it it my m puli. Opn topuli Intrnl Rvnu Srvi Informtion out Form 0 n its instrutions is t Insption A For th 0 lnr yr, or tx yr ginning n ning B Chk if C Nm of orgniztion D Employr intifition numr pplil: RONALD MCDONALD HOUSE CHARITIES OF THE MIAMI VALLEY REGION, INC. Arss hng Nm hng Doing usinss s -0 Initil rturn Numr n strt (or P.O. ox if mil is not livr to strt rss) Room/suit E Tlphon numr Finl rturn/ VALLEY STREET --00 trmint City or town, stt or provin, ountry, n ZIP or forign postl o G Gross ripts $ Amn rturn DAYTON, OH 0 H() Is thisgroup rturn Appli- - tion F Nm n rss of prinipl offir: RITA CYR for suorints?~~ Ys pning - SAME AS C ABOVE H() Ar ll suorints inlu? Ys Tx-xmpt sttus: 0()() 0() ( ) (insrt no.) ()() or If "," tth list. (s instrutions) G Gross ripts $,,.. I J Wsit: ORG H() Group xmption numr K Form of orgniztion: Corportion Trust Assoition Othr L Yr of formtion: M Stt of lgl omiil: OH Prt I Summry Brifly sri th orgniztion's mission or most signifint tivitis: PROVIDES HOUSING TO FAMILIES OF HOSPITALIZED CHILDREN Ativitis & Govrnn vrnn GAii& itts vo Rvnu v n u s Expnss s n RE x p r o Nt Assts or Fun Blns Chk this ox if th orgniztion isontinu its oprtions or ispos of mor thn % % of its nt ssts. Numr of voting mmrs of th govrning oy (Prt VI, lin ) ~~~~~~~~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Numr of inpnnt voting mmrs of th govrning oy (Prt VI, lin ) ~ ~~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Totl numr of iniviuls mploy in lnr yr 0 (Prt V, lin ) ~ ~~~~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Totl numr of voluntrs (stimt t if if nssry) y ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Totl unrlt usinss rvnu from Prt VIII, olumn (C), lin ~~~~~~~~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 0 Contriutions n n grnts n (Prt VIII, lin h) ~ ~~~~~~~~~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Progrm srvi rvnu (Prt VIII, lin g) ~ ~~~~~~~~~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 0 Invstmnt inom (Prt t VIII, olumn (A), lins,,,, n n ) ~ ~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Othr rvnu (Prt t VIII, olumn (A), lins,,,,, 0, 0 n ) ~ ~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ Totl rvnu - lins through (must qul Prt t VIII, olumn (A), lin ) ) Grnts n ts n n similr mounts pi (Prt t I, olumn (A), lins -) ) ~ ~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Bnfits t s pi to or for mmrs (Prt t I, olumn (A), lin ) ) ~ ~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Slris, othr ompnstion, mploy nfits t s (Prt t I, olumn (A), lins -0) ) ~ ~~~ ~ ~ Profssionl funrising fs (Prt t I, olumn (A), lin ) ~~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Totl funrising xpnss (Prt I, olumn (D), lin ),0. 0 Totl funrising xpnss (Prt I, olumn (D), lin ), 0. Othr xpnss (Prt I, olumn (A), lins -, f-) f ~ ~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Totl xpnss. A lins - (must qul Prt I, olumn (A), lin ) ) ~ ~~~~~~~ ~ ~ ~ ~ ~ ~ 0 Totl ssts (Prt, lin ) ) ~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Totl liilitis (Prt, lin ) ) ~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Nt ssts or fun lns. Sutrt lin from lin 0 Prt II Signtur Blok Prior Yr Currnt Yr,,0.,,0.,,0,.,.,,.,,.,. 0,.,.,0,,.,,0,. -0,0. 0. Bginning nin g of Currnt Yr En of Yr,,..,,,. 0,.,,.,0,.,,., 0,. Unr pnltis of prjury, I lr tht I hv xmin this rturn, inluing ompnying shuls n sttmnts, n to th st of my knowlg n lif, it is tru, orrt, n omplt. Dlrtion of prprr (othr thn offir) is s on ll informtion of whih prprr hs ny knowlg. Sign = Signtur of offir Dt Hr AL HERZOG, TREASURER Typ or print nm n titl = Nt unrlt usinss txl inom from Form 0-T, lin Rvnu lss xpnss. Sutrt lin from lin = Print/Typ prprr's nm Prprr's signtur Dt Chk PTIN i iff slf-mploy Pi ANNA M HELFEN, CPA ANNA M HELFEN, CPA CPA /0/ s lf-mploy P0 Prprr Firm'snm CLARK, SCHAEFER, HACKETT & CO. Firm'sEIN Us Only Firm's rss 000 INNOVATION DRIVE DAYTON, OH Phonno no. My th IRS isuss this rturn with th prprr shown ov? (s instrutions) Ys My th IRS isuss this rturn with th prprr shown ov? (s instrutions) Ys LHA For Pprwork Rution At ti, s th sprt instrutions. Form 0 (0)

2 Form0(0) MIAMI VALLEY REGION, INC INC.. -0 Pg Prt III I Sttmnt of Progrm Srvi Aomplishmnts Chk if Shul O ontins rspons or or not to to ny ny lin lin in this this Prt Prt III III... Brifly sri th orgniztion's mission: RMHC-MVR PROVIDES A TEMPORARY "HOME AWAY FROM HOME" FOR FAMILIES OF CRITICALLY ILL, HOSPITALIZED CHILDREN AND SUPPORTS EFFORTS THAT IMPROVE CHILDREN'S HEALTH WITHIN OUR REGION. IMPROVE CHILDREN'S HEALTH WITHIN OUR REGION. Di th orgniztion unrtk ny signifint progrm srvis uring th yr whih wr not list on th prior Form 0 or 0-EZ? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ys If "Ys," sri ths nw srvis on Shul O. Di th orgniztion s onuting, or or mk signifint hngs in how in how it onuts, it ny ny progrm progrm srvis? srvis?~~~~~~ Ys If "Ys," sri ths hngs on Shul O. Dsri th orgniztion's progrm srvi omplishmnts for h of its thr lrgst progrm srvis, s msur y xpnss. Stion 0()() ) n 0()() ) orgniztions r rquir to rport th mount of grnts n llotions to othrs, th totl xpnss, n rvnu, if ny, for h progrm srvi rport. ( Co: ) ( Expnss $,0,. inluing grnts of $ ) ( Rvnu $ ) OPERATED RONALD MCDONALD HOUSE OF DAYTON (RMH),, WHICH PROVIDES TEMPORARY HOUSING FOR FAMILIES WITH HOSPITALIZED CHILDREN FROM THE GREATER MIAMI VALLEY REGION. DURING 0,, THE ORGANIZATION PROVIDED, NIGHTS OF SERVICE TO FAMILIES FROM OHIO COUNTIES, STATES, AND TWO COUNTRIES (CANADA AND CHINA). (Co: ), 0,. (Expnss $ inluing grnts of $ ) (Rvnu $ ) STATES, AND TWO COUNTRIES (CANADA AND CHINA). DONATED VOLUNTEER SERVICES VALUED AT $, IN 0 ALSO ENABLED RONALD MCDONALD HOUSE CHARITIES OF THE MIAMI VALLEY REGION TO PROVIDE A PLACE FOR FAMILIES TO STAY WHILE THEIR CHIDREN ARE HOSPITALIZED. THE RONALD MCDONALD FAMILY ROOM LOCATED INSIDE DAYTON CHILDREN'S HOSPITAL PROVIDES COMPLIMENTARY SNACKS, BEVERAGES, A RESPITE/RELAATION (Co:( ) (Expnss( $ inluing grnts of $ ) (Rvnu( $ ) (Co:( ) (Expnss( $ inluing grnts of $ ) (Rvnu( $ ) Othr progrm srvis (Dsri in Shul O.) (Expnss( $ inluing grnts of $ ) (Rvnu( $ ) Totl progrm srvi xpnss,0,. Form 0 (0) ( ) SEE SCHEDULE O FOR CONTINUATION(S) RONALD MCDONALD HOUSE CHA RONALD MCDONALD HOUSE CHA 00000

3 Form 0 (0) MIAMI VALLEY REGION, INC. -0 Pg Prt IV Is th orgniztion sri in stion 0()() ) or ()() ) (othr thn privt fountion)? If "Ys," omplt Shul A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Is th orgniztion rquir to omplt Shul B, Shul of Contriutors??... ~~~~~~~~~~~~~~~~~~~~~~ Di th orgniztion ngg in irt or inirt politil mpign tivitis on hlf of or in opposition to nits for puli offi? If "Ys," omplt Shul C, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Stion 0()() ) orgniztions. Di th orgniztion ngg in loying tivitis, or hv stion 0(h) ltion in fft uring th tx yr? If "Ys," omplt Shul C, PrtII ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Is th orgniztion stion 0()(), ), 0()(), ), or 0()() ) orgniztion tht rivs mmrship us, ssssmnts, or similr mounts s fin in Rvnu Prour -?? If "Ys," omplt Shul C, Prt III ~~~~~~~~~~~~~~... Di th orgniztion mintin ny onor vis funs or ny similr funs or ounts for whih onors hv th right to provi vi on th istriution or invstmnt of mounts in suh funs or ounts? If "Ys," omplt Shul D, Prt I Di th orgniztion riv or hol onsrvtion smnt, inluing smnts to prsrv opn sp, th nvironmnt, histori ln rs, or histori struturs? If "Ys," omplt Shul D, Prt II~~~~~~~~~~~~~~... Di th orgniztion mintin olltions of works of rt, historil trsurs, or othr similr ssts? If "Ys," omplt ShulD, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion rport n mount in Prt, lin,, for srow or ustoil ount liility, srv s ustoin for mounts not list in Prt ; or provi rit ounsling, t mngmnt, rit rpir, or t ngotition srvis? If "Ys," omplt Shul D, Prt IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th orgniztion, irtly or through rlt orgniztion, hol ssts in tmporrily rstrit nowmnts, prmnnt nowmnts, or qusi-nowmnts? - If "Ys," omplt Shul D, Prt V ~~~~~~~~~~~~~~~~~~~~~~~~... If th orgniztion's nswr to ny of th following qustions is "Ys," thn omplt Shul D, D, Prts VI, VI, VII, VIII, I, or s pplil. Di th orgniztion rport n mount for ln, uilings, n quipmnt in Prt, lin 0?? If "Ys," omplt Shul D, PrtVI ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion rport n mount for invstmnts - othr suritis in Prt, lin tht is % % or mor of its totl ssts rport in Prt, lin?? If "Ys," omplt Shul D, Prt VII ~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion rport n mount for invstmnts - progrm rlt in Prt, lin tht is % % or mor of its totl ssts rport in Prt, lin?? If "Ys," omplt Shul D, Prt VIII ~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion rport n mount for othr ssts in Prt, lin tht is % % or mor of its totl ssts rport in Prt, lin?? If "Ys," omplt Shul D, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion rport n mount for othr liilitis in Prt, lin?? If "Ys," omplt Shul D, Prt ~~~~~~... f Di th orgniztion's sprt or onsolit finnil sttmnts for th tx yr inlu footnot tht rsss th orgniztion's liility for unrtin tx positions unr FIN (ASC 0)? If "Ys," omplt Shul D, Prt ~~~~... f Di th orgniztion otin sprt, inpnnt uit finnil sttmnts for th tx yr? If "Ys," omplt ShulD, Prts I n II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Ws th orgniztion inlu in onsolit, inpnnt uit finnil sttmnts for th tx yr? If "Ys," n n if if th th orgniztion nswr "" to to lin lin,, thn thn omplting Shul D, D, Prts I I n II is optionl ~~~~~... Is th orgniztion shool sri in stion 0()()(A)(ii)? )(A)(ii)? If "Ys," omplt Shul E ~~~~~~~~~~~~~~... Di th orgniztion mintin n n offi, mploys, or or gnts outsi of th of th Unit Unit Stts? Stts? ~~~~~~~~~~~~~~~~ Di th orgniztion hv ggrgt rvnus or xpnss of mor thn $0,000 $, 000 from grntmking, funrising, usinss, invstmnt, n progrm srvi tivitis outsi th Unit Stts, or ggrgt forign invstmnts vlu t $00,000 $, 000 or mor? If "Ys," omplt Shul F, Prts In I IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion rport on Prt I, olumn (A), lin,, mor thn $,000 $, of grnts or othr ssistn to or for ny forign orgniztion? If "Ys," omplt Shul F, F, Prts II II n IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion rport on Prt I, olumn (A), lin,, mor thn $,000 $, of ggrgt grnts or othr ssistn to or for forign iniviuls? If "Ys," omplt Shul F, F, Prts III n IV ~~~~~~~~~~~~~~~~~~~~~~~~~~... Chklist of Rquir Shuls Di th orgniztion rport totl of mor thn $,000 $, of xpnss for profssionl funrising srvis on Prt I, olumn (A), lins n? If "Ys," omplt Shul G, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion rport mor thn $,000 $, totl of funrising vnt gross inom n ontriutions on Prt VIII, lins n? If "Ys," omplt Shul G, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion rport mor thn $,000 $, of gross inom from gming tivitis on Prt VIII, lin? If "Ys," omplt Shul G, Prt III I Ys I 0 Ys Form 0 (0) RONALD MCDONALD HOUSE CHA 00000

4 Form 0 (0) MIAMI VALLEY REGION, INC. -0 Pg Prt IV Chklist of Rquir Shuls (ontinu) 0 Di th orgniztion oprt on or mor hospitl filitis? If "Ys," omplt Shul H ~~~~~~~~~~~~~~~~ If "Ys" to lin 0, i th orgniztion tth opy of its uit finnil sttmnts to this rturn?... ~~~~~~~~~~ Di th orgniztion rport mor thn $,000 $, of grnts or othr ssistn to ny omsti orgniztion or omsti govrnmnt on Prt I, olumn (A), lin?? If "Ys," omplt Shul I, Prts I InII II ~~~~~~~~~~~~~~... Di th orgniztion rport mor thn $,000 $, of grnts or othr ssistn to or for omsti iniviuls on Prt I, olumn (A), lin?? If "Ys," omplt Shul I, Prts I InIII III ~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion nswr "Ys" to to Prt VII, Stion A, lin,,,, or out ompnstion of th orgniztion's urrnt n formr offirs, irtors, trusts, ky mploys, n highst ompnst mploys? If "Ys," omplt ShulJ J ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion hv tx-xmpt - on issu with n outstning prinipl mount of mor thn $00,000 $, 000 s of th lst y of th yr, tht ws issu ftr Dmr,, 00?? If "Ys," nswr lins through n omplt ShulK. If "",, go to to lin ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th orgniztion invst ny pros of tx-xmpt - ons yon tmporry prio xption? ~~~~~~~~~~~ Di th orgniztion mintin n srow ount othr thn rfuning srow t ny tim uring th yr to fs ny tx-xmpt - ons? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th orgniztion t s n "on hlf of of" issur issur for for ons ons outstning t ny t ny tim tim uring uring th th yr? yr? ~~~~~~~~~~~ Stion 0()(), ), 0()(), ), n 0()() ) orgniztions. Di th orgniztion ngg in n xss nfit trnstion with isqulifi prson uring th yr? If "Ys," omplt Shul L, Prt I ~~~~~~~~~~~~~~~~... Is th orgniztion wr tht it ngg in n xss nfit trnstion with isqulifi prson in prior yr, n tht th trnstion hs not n rport on ny of th orgniztion's prior Forms 0 or 0-EZ? If "Ys," omplt ShulL, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th orgniztion rport ny mount on Prt, lin,,,, or for rivls from or pyls to ny urrnt or formr offirs, irtors, trusts, ky mploys, highst ompnst mploys, or isqulifi prsons? If "Ys," ompltshul L, PrtII ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion provi grnt or othr ssistn to n offir, irtor, trust, ky mploy, sustntil ontriutor or mploy throf, grnt sltion ommitt mmr, or to % % ontroll ntity or fmily mmr of ny of ths prsons? If "Ys," omplt Shul L, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Ws th orgniztion prty to usinss trnstion with on of th following prtis (s Shul L, Prt IV instrutions for pplil filing thrshols, onitions, n xptions): A urrnt or formr offir, irtor, trust, or ky mploy? If "Ys," omplt Shul L, L, Prt IV ~~~~~~~~~~~ A fmily mmr of urrnt or formr offir, irtor, trust, or ky mploy? If "Ys," omplt Shul L, L, Prt IV ~~... An ntity of whih urrnt or formr offir, irtor, trust, or ky mploy (or fmily mmr throf) ws n offir, irtor, trust, or irt or inirt ownr? If "Ys," omplt Shul L, Prt IV ~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion riv mor thn $,000 $, in non-sh - ontriutions? If "Ys," omplt Shul M ~~~~~~~~~... 0 Di th orgniztion riv ontriutions of rt, historil trsurs, or othr similr ssts, or qulifi onsrvtion ontriutions? If "Ys," omplt Shul M ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion liquit, trmint, or issolv n s oprtions? If "Ys," omplt Shul N, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion sll, xhng, ispos of, or trnsfr mor thn % % of its nt ssts? If "Ys," omplt ShulN, PrtII ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion own 00% % of n ntity isrgr s sprt from th orgniztion unr Rgultions stions 0-. n 0-?.? If "Ys," omplt Shul R, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~... Ws th orgniztion rlt to ny tx-xmpt - or txl ntity? If "Ys," omplt Shul R, R, Prt II, II, III, or IV, n PrtV,lin ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion hv ontroll ntity within th mning of stion ()()? )? ~~~~~~~~~~~~~~~~~~ If "Ys" to lin, i th orgniztion riv ny pymnt from or ngg in ny trnstion with ontroll ntity within th mning of stion ()()? )? If "Ys," omplt Shul R, R, Prt V, lin ~~~~~~~~~~~~~~~~~~~... Stion 0()() ) orgniztions. Di th orgniztion mk ny trnsfrs to n xmpt non-hritl - rlt orgniztion? If "Ys," omplt Shul R, Prt V, lin ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~... Di th orgniztion onut mor thn % % of its tivitis through n ntity tht is not rlt orgniztion n tht is trt s prtnrship for frl inom tx purposs? If "Ys," omplt Shul R, Prt VI ~~~~~~~~... Di th orgniztion omplt Shul O n provi xplntions in Shul O for Prt VI, lins n?? t. All Form 0 filrs r rquir to omplt Shul O 0 0 Ys 0 Form 0 (0) ) RONALD MCDONALD HOUSE CHA 00000

5 Form0(0) MIAMI VALLEY REGION, INC. -0 Pg Prt V Sttmnts Rgring Othr IRS Filings n Tx Complin Chk if Shul O ontins rspons or not to ny lin in this Prt V Entr th numr rport in Box of Form 0. Entr -0- if not pplil ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 0 Entr th numr of Forms W - G inlu in lin. Entr -0- if not pplil ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 0 Di th orgniztion omply with kup withholing ruls for rportl pymnts to vnors n rportl gming (gmling) winnings to priz winnrs? Entr th numr of mploys rport on Form W -, Trnsmittl of Wg n Tx Sttmnts, fil for th lnr yr ning with or within th yr ovr y this rturn ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If t lst on is rport on lin, i th orgniztion fil ll rquir frl mploymnt tx rturns? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ t. If th sum of lins n is grtr thn 0, you my rquir to -fil (s instrutions) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion hv unrlt usinss gross inom of $, 000 or mor uring th yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, hs it fil Form 0- T for this yr? If, to lin, provi n xplntion in Shul O ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ At ny tim uring th lnr yr, i th orgniztion hv n intrst in, or signtur or othr uthority ovr, finnil ount in forign ountry (suh s nk ount, suritis ount, or othr finnil ount)? ~ ~ ~ ~ ~ ~ ~ If Ys, ntr th nm of th forign ountry: J S instrutions for filing rquirmnts for FinCEN Form, Rport of Forign Bnk n Finnil Aounts (FBAR). Ws th orgniztion prty to prohiit tx shltr trnstion t ny tim uring th tx yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di ny txl prty notify th orgniztion tht it ws or is prty to prohiit tx shltr trnstion? ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, to lin or, i th orgniztion fil Form - T? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Dos th orgniztion hv nnul gross ripts tht r normlly grtr thn $ 00, 000, n i th orgniztion soliit ny ontriutions tht wr not tx util s hritl ontriutions? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, i th orgniztion inlu with vry soliittion n xprss sttmnt tht suh ontriutions or gifts wr not tx util? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Orgniztions tht my riv util ontriutions unr stion 0 (). Di th orgniztion riv pymnt in xss of $ m prtly s ontriution n prtly for goos n srvis provi to th pyor? If Ys, i th orgniztion notify th onor of th vlu of th goos or srvis provi? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion sll, xhng, or othrwis ispos of tngil prsonl proprty for whih it ws rquir to fil Form?... If Ys, init th numr of Forms fil uring th yr ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion riv ny funs, irtly or inirtly, to py prmiums on prsonl nfit ontrt? ~ ~ ~ ~ ~ ~ ~ f Di th orgniztion, uring th yr, py prmiums, irtly or inirtly, on prsonl nfit ontrt? ~ ~ ~ ~ ~ ~ ~ ~ ~ g If th orgniztion riv ontriution of qulifi intlltul proprty, i th orgniztion fil Form s rquir? ~ h If th orgniztion riv ontriution of rs, ots, irplns, or othr vhils, i th orgniztion fil Form 0- C? Sponsoring orgniztions mintining onor vis funs. Di onor vis fun mintin y th N/A sponsoring orgniztion hv xss usinss holings t ny tim uring th yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Sponsoring orgniztions mintining onor vis funs. Di th sponsoring orgniztion mk ny txl istriutions unr stion? ~~~~~~~~~~~~~~~N ~~ /A ~ ~ Di th sponsoring orgniztion mk istriution to onor, onor visor, or rlt prson? ~~~~~~~~~N ~ / ~ A ~ ~ 0 Stion 0 ()( ) orgniztions. Entr: Initition fs n pitl ontriutions inlu on Prt VIII, lin ~~~~~~~~~~~N ~~ /A ~ ~ 0 Gross ripts, inlu on Form 0, Prt VIII, lin, for puli us of lu filitis ~ ~ ~ ~ ~ ~ 0 Stion 0 ()( ) orgniztions. Entr: Gross inom from mmrs or shrholrs ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~N ~~ /A ~ ~ Gross inom from othr sours (Do not nt mounts u or pi to othr sours ginst mounts u or riv from thm.) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Stion ()( ) non - xmpt hritl trusts. Is th orgniztion filing Form 0 in liu of Form 0? If Ys, ntr th mount of tx - xmpt intrst riv or ru uring th yr...ṇ.. /... A Stion 0 ()( ) qulifi nonprofit hlth insurn issurs. Is th orgniztion lins to issu qulifi hlth plns in mor thn on stt? ~~~~~~~~~~~~~~~~~N ~~ /A ~ ~ t. S th instrutions for itionl informtion th orgniztion must rport on Shul O. Entr th mount of rsrvs th orgniztion is rquir to mintin y th stts in whih th orgniztion is lins to issu qulifi hlth plns ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Entr th mount of rsrvs on hn ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion riv ny pymnts for inoor tnning srvis uring th tx yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, hs it fil Form 0 to rport ths pymnts? If, provi n xplntion in Shul O... Form 0 ( 0 ) f g N / A h N / A RONALD MCDONALD HOUSE CHA RONALD MCDONALD HOUSE CHARITIES OF THE Form0(0) MIAMI VALLEY REGION, INC. -0 Pg Prt V Sttmnts Rgring Othr IRS Filings n Tx Complin Chk if Shul O ontins rspons or not to ny lin in this Prt V Entr th numr rport in Box of Form 0. Entr -0- if not pplil ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 0 Entr th numr of Forms W - G inlu in lin. Entr -0- if not pplil ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 0 Di th orgniztion omply with kup withholing ruls for rportl pymnts to vnors n rportl gming (gmling) winnings to priz winnrs? Entr th numr of mploys rport on Form W -, Trnsmittl of Wg n Tx Sttmnts, fil for th lnr yr ning with or within th yr ovr y this rturn ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If t lst on is rport on lin, i th orgniztion fil ll rquir frl mploymnt tx rturns? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ t. If th sum of lins n is grtr thn 0, you my rquir to -fil (s instrutions) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion hv unrlt usinss gross inom of $, 000 or mor uring th yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, hs it fil Form 0- T for this yr? If, to lin, provi n xplntion in Shul O ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ At ny tim uring th lnr yr, i th orgniztion hv n intrst in, or signtur or othr uthority ovr, finnil ount in forign ountry (suh s nk ount, suritis ount, or othr finnil ount)? ~ ~ ~ ~ ~ ~ ~ If Ys, ntr th nm of th forign ountry: J S instrutions for filing rquirmnts for FinCEN Form, Rport of Forign Bnk n Finnil Aounts (FBAR). Ws th orgniztion prty to prohiit tx shltr trnstion t ny tim uring th tx yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di ny txl prty notify th orgniztion tht it ws or is prty to prohiit tx shltr trnstion? ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, to lin or, i th orgniztion fil Form - T? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Dos th orgniztion hv nnul gross ripts tht r normlly grtr thn $ 00, 000, n i th orgniztion soliit ny ontriutions tht wr not tx util s hritl ontriutions? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, i th orgniztion inlu with vry soliittion n xprss sttmnt tht suh ontriutions or gifts wr not tx util? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Orgniztions tht my riv util ontriutions unr stion 0 (). Di th orgniztion riv pymnt in xss of $ m prtly s ontriution n prtly for goos n srvis provi to th pyor? If Ys, i th orgniztion notify th onor of th vlu of th goos or srvis provi? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion sll, xhng, or othrwis ispos of tngil prsonl proprty for whih it ws rquir to fil Form?... If Ys, init th numr of Forms fil uring th yr ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion riv ny funs, irtly or inirtly, to py prmiums on prsonl nfit ontrt? ~ ~ ~ ~ ~ ~ ~ f Di th orgniztion, uring th yr, py prmiums, irtly or inirtly, on prsonl nfit ontrt? ~ ~ ~ ~ ~ ~ ~ ~ ~ g If th orgniztion riv ontriution of qulifi intlltul proprty, i th orgniztion fil Form s rquir? ~ h If th orgniztion riv ontriution of rs, ots, irplns, or othr vhils, i th orgniztion fil Form 0- C? Sponsoring orgniztions mintining onor vis funs. Di onor vis fun mintin y th N/A sponsoring orgniztion hv xss usinss holings t ny tim uring th yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Sponsoring orgniztions mintining onor vis funs. Di th sponsoring orgniztion mk ny txl istriutions unr stion? ~~~~~~~~~~~~~~~N ~~ /A ~ ~ Di th sponsoring orgniztion mk istriution to onor, onor visor, or rlt prson? ~~~~~~~~~N ~ / ~ A ~ ~ 0 Stion 0 ()( ) orgniztions. Entr: Initition fs n pitl ontriutions inlu on Prt VIII, lin ~~~~~~~~~~~N ~~ /A ~ ~ 0 Gross ripts, inlu on Form 0, Prt VIII, lin, for puli us of lu filitis ~ ~ ~ ~ ~ ~ 0 Stion 0 ()( ) orgniztions. Entr: Gross inom from mmrs or shrholrs ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~N ~~ /A ~ ~ Gross inom from othr sours (Do not nt mounts u or pi to othr sours ginst mounts u or riv from thm.) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Stion ()( ) non - xmpt hritl trusts. Is th orgniztion filing Form 0 in liu of Form 0? If Ys, ntr th mount of tx - xmpt intrst riv or ru uring th yr...ṇ.. /... A Stion 0 ()( ) qulifi nonprofit hlth insurn issurs. Is th orgniztion lins to issu qulifi hlth plns in mor thn on stt? ~~~~~~~~~~~~~~~~~N ~~ /A ~ ~ t. S th instrutions for itionl informtion th orgniztion must rport on Shul O. Entr th mount of rsrvs th orgniztion is rquir to mintin y th stts in whih th orgniztion is lins to issu qulifi hlth plns ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Entr th mount of rsrvs on hn ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion riv ny pymnts for inoor tnning srvis uring th tx yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, hs it fil Form 0 to rport ths pymnts? If, provi n xplntion in Shul O... Form 0 ( 0 ) f g N / A h N / A RONALD MCDONALD HOUSE CHA RONALD MCDONALD HOUSE CHARITIES OF THE Form0(0) MIAMI VALLEY REGION, INC. -0 Pg Prt V Sttmnts Rgring Othr IRS Filings n Tx Complin Chk if Shul O ontins rspons or not to ny lin in this Prt V Entr th numr rport in Box of Form 0. Entr -0- if not pplil ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 0 Entr th numr of Forms W - G inlu in lin. Entr -0- if not pplil ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 0 Di th orgniztion omply with kup withholing ruls for rportl pymnts to vnors n rportl gming (gmling) winnings to priz winnrs? Entr th numr of mploys rport on Form W -, Trnsmittl of Wg n Tx Sttmnts, fil for th lnr yr ning with or within th yr ovr y this rturn ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If t lst on is rport on lin, i th orgniztion fil ll rquir frl mploymnt tx rturns? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ t. If th sum of lins n is grtr thn 0, you my rquir to -fil (s instrutions) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion hv unrlt usinss gross inom of $, 000 or mor uring th yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, hs it fil Form 0- T for this yr? If, to lin, provi n xplntion in Shul O ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ At ny tim uring th lnr yr, i th orgniztion hv n intrst in, or signtur or othr uthority ovr, finnil ount in forign ountry (suh s nk ount, suritis ount, or othr finnil ount)? ~ ~ ~ ~ ~ ~ ~ If Ys, ntr th nm of th forign ountry: J S instrutions for filing rquirmnts for FinCEN Form, Rport of Forign Bnk n Finnil Aounts (FBAR). Ws th orgniztion prty to prohiit tx shltr trnstion t ny tim uring th tx yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di ny txl prty notify th orgniztion tht it ws or is prty to prohiit tx shltr trnstion? ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, to lin or, i th orgniztion fil Form - T? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Dos th orgniztion hv nnul gross ripts tht r normlly grtr thn $ 00, 000, n i th orgniztion soliit ny ontriutions tht wr not tx util s hritl ontriutions? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, i th orgniztion inlu with vry soliittion n xprss sttmnt tht suh ontriutions or gifts wr not tx util? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Orgniztions tht my riv util ontriutions unr stion 0 (). Di th orgniztion riv pymnt in xss of $ m prtly s ontriution n prtly for goos n srvis provi to th pyor? If Ys, i th orgniztion notify th onor of th vlu of th goos or srvis provi? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion sll, xhng, or othrwis ispos of tngil prsonl proprty for whih it ws rquir to fil Form?... If Ys, init th numr of Forms fil uring th yr ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion riv ny funs, irtly or inirtly, to py prmiums on prsonl nfit ontrt? ~ ~ ~ ~ ~ ~ ~ f Di th orgniztion, uring th yr, py prmiums, irtly or inirtly, on prsonl nfit ontrt? ~ ~ ~ ~ ~ ~ ~ ~ ~ g If th orgniztion riv ontriution of qulifi intlltul proprty, i th orgniztion fil Form s rquir? ~ h If th orgniztion riv ontriution of rs, ots, irplns, or othr vhils, i th orgniztion fil Form 0- C? Sponsoring orgniztions mintining onor vis funs. Di onor vis fun mintin y th N/A sponsoring orgniztion hv xss usinss holings t ny tim uring th yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Sponsoring orgniztions mintining onor vis funs. Di th sponsoring orgniztion mk ny txl istriutions unr stion? ~~~~~~~~~~~~~~~N ~~ /A ~ ~ Di th sponsoring orgniztion mk istriution to onor, onor visor, or rlt prson? ~~~~~~~~~N ~ / ~ A ~ ~ 0 Stion 0 ()( ) orgniztions. Entr: Initition fs n pitl ontriutions inlu on Prt VIII, lin ~~~~~~~~~~~N ~~ /A ~ ~ 0 Gross ripts, inlu on Form 0, Prt VIII, lin, for puli us of lu filitis ~ ~ ~ ~ ~ ~ 0 Stion 0 ()( ) orgniztions. Entr: Gross inom from mmrs or shrholrs ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~N ~~ /A ~ ~ Gross inom from othr sours (Do not nt mounts u or pi to othr sours ginst mounts u or riv from thm.) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Stion ()( ) non - xmpt hritl trusts. Is th orgniztion filing Form 0 in liu of Form 0? If Ys, ntr th mount of tx - xmpt intrst riv or ru uring th yr...ṇ.. /... A Stion 0 ()( ) qulifi nonprofit hlth insurn issurs. Is th orgniztion lins to issu qulifi hlth plns in mor thn on stt? ~~~~~~~~~~~~~~~~~N ~~ /A ~ ~ t. S th instrutions for itionl informtion th orgniztion must rport on Shul O. Entr th mount of rsrvs th orgniztion is rquir to mintin y th stts in whih th orgniztion is lins to issu qulifi hlth plns ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Entr th mount of rsrvs on hn ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Di th orgniztion riv ny pymnts for inoor tnning srvis uring th tx yr? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ If Ys, hs it fil Form 0 to rport ths pymnts? If, provi n xplntion in Shul O... Form 0 ( 0 ) f g N / A h N / A RONALD MCDONALD HOUSE CHA Ys t. f g h Orgniztions tht my riv util ontriutions unr stion 0(). f g h 0 Sponsoring orgniztions mintining onor vis funs. Sponsoring orgniztions mintining onor vis funs. Stion 0()() orgniztions. 0 0 Stion 0()() orgniztions. Stion ()() non-xmpt hritl trusts. Stion 0()() qulifi nonprofit hlth insurn issurs. t. -fil If "," to lin, provi n xplntion in Shul O If "," provi n xplntion in Shul O Di th orgniztion riv pymnt in xss of $ m prtly s ontriution n prtly for goos n srvis provi to th pyor? Form (0) Form 0 (0) Pg Chk if Shul O ontins rspons or not to ny lin in this Prt V Entr th numr rport in Box of Form 0. Entr -0- if not pplil ~~~~~~~~~~~ Entr th numr of Forms W-G inlu in lin. Entr -0- if not pplil ~~~~~~~~~~ Di th orgniztion omply with kup withholing ruls for rportl pymnts to vnors n rportl gming (gmling) winnings to priz winnrs? Entr th numr of mploys rport on Form W-, Trnsmittl of Wg n Tx Sttmnts, fil for th lnr yr ning with or within th yr ovr y this rturn ~~~~~~~~~~ If t lst on is rport on lin, i th orgniztion fil ll rquir frl mploymnt tx rturns? If th sum of lins n is grtr thn 0, you my rquir to (s instrutions) ~~~~~~~~~~ ~~~~~~~~~~~ Di th orgniztion hv unrlt usinss gross inom of $,000 or mor uring th yr? If "Ys," hs it fil Form 0-T for this yr? ~~~~~~~~~~~~~~ ~~~~~~~~~~ At ny tim uring th lnr yr, i th orgniztion hv n intrst in, or signtur or othr uthority ovr, finnil ount in forign ountry (suh s nk ount, suritis ount, or othr finnil ount)? ~~~~~~~ If "Ys," ntr th nm of th forign ountry: S instrutions for filing rquirmnts for FinCEN Form, Rport of Forign Bnk n Finnil Aounts (FBAR). Ws th orgniztion prty to prohiit tx shltr trnstion t ny tim uring th tx yr? Di ny txl prty notify th orgniztion tht it ws or is prty to prohiit tx shltr trnstion? ~~~~~~~~~~~~ ~~~~~~~~~ If "Ys," to lin or, i th orgniztion fil Form -T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dos th orgniztion hv nnul gross ripts tht r normlly grtr thn $00,000, n i th orgniztion soliit ny ontriutions tht wr not tx util s hritl ontriutions? If "Ys," i th orgniztion inlu with vry soliittion n xprss sttmnt tht suh ontriutions or gifts wr not tx util? ~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Ys," i th orgniztion notify th onor of th vlu of th goos or srvis provi? Di th orgniztion sll, xhng, or othrwis ispos of tngil prsonl proprty for whih it ws rquir to fil Form? ~~~~~~~~~~~~~~~ If "Ys," init th numr of Forms fil uring th yr Di th orgniztion riv ny funs, irtly or inirtly, to py prmiums on prsonl nfit ontrt? ~~~~~~~~~~~~~~~~ ~~~~~~~ ~~~~~~~~~ Di th orgniztion, uring th yr, py prmiums, irtly or inirtly, on prsonl nfit ontrt? If th orgniztion riv ontriution of qulifi intlltul proprty, i th orgniztion fil Form s rquir? If th orgniztion riv ontriution of rs, ots, irplns, or othr vhils, i th orgniztion fil Form 0-C? ~ Di onor vis fun mintin y th sponsoring orgniztion hv xss usinss holings t ny tim uring th yr? ~~~~~~~~~~~~~~~~~~~ Di th sponsoring orgniztion mk ny txl istriutions unr stion? Di th sponsoring orgniztion mk istriution to onor, onor visor, or rlt prson? ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Entr: Initition fs n pitl ontriutions inlu on Prt VIII, lin Gross ripts, inlu on Form 0, Prt VIII, lin, for puli us of lu filitis ~~~~~~~~~~~~~~~ ~~~~~~ Entr: Gross inom from mmrs or shrholrs Gross inom from othr sours (Do not nt mounts u or pi to othr sours ginst mounts u or riv from thm.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is th orgniztion filing Form 0 in liu of Form 0? If "Ys," ntr th mount of tx-xmpt intrst riv or ru uring th yr Is th orgniztion lins to issu qulifi hlth plns in mor thn on stt? S th instrutions for itionl informtion th orgniztion must rport on Shul O. ~~~~~~~~~~~~~~~~~~~~~ Entr th mount of rsrvs th orgniztion is rquir to mintin y th stts in whih th orgniztion is lins to issu qulifi hlth plns Entr th mount of rsrvs on hn ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th orgniztion riv ny pymnts for inoor tnning srvis uring th tx yr? If "Ys," hs it fil Form 0 to rport ths pymnts? ~~~~~~~~~~~~~~~~ Prt V Sttmnts Rgring Othr IRS Filings n Tx Complin 0 J 0 0 MIAMI VALLEY REGION, INC. -0 RONALD MCDONALD HOUSE CHARITIES OF THE N/A N/A N/A N/A N/A N/A N/A N/A N/A RONALD MCDONALD HOUSE CHA 00000

6 Form0(0) MIAMI VALLEY REGION, INC. -0 Pg Prt VI Govrnn, Mngmnt, n Dislosur For h Ys rspons to lins through low, n for rspons to lin,, or 0 low, sri th irumstns, prosss, or hngs in Shul O. S instrutions. Chk if Shul O ontins rspons or not to ny lin in this Prt VI Stion A. Govrning Boy n Mngmnt Entr th numr of voting mmrs of th govrning oy t th n of th tx yr If thr r mtril iffrns in voting rights mong mmrs of th govrning oy, or if th govrning oy lgt ro uthority to n xutiv ommitt or similr ommitt, xplin in Shul O. Entr th numr of voting mmrs inlu in lin, ov, who r inpnnt Di ny offir, irtor, trust, or ky mploy hv fmily rltionship or usinss rltionship with ny othr offir, irtor, trust, or ky mploy? Di th orgniztion lgt ontrol ovr mngmnt utis ustomrily prform y or unr th irt suprvision of offirs, irtors, or trusts, or ky mploys to mngmnt ompny or othr prson? Di th orgniztion mk ny signifint hngs to its govrning oumnts sin th prior Form 0 ws fil? Di th orgniztion om wr uring th yr of signifint ivrsion of th orgniztion's ssts? Di th orgniztion hv mmrs or stokholrs? Di th orgniztion hv mmrs, stokholrs, or othr prsons who h th powr to lt or ppoint on or mor mmrs of th govrning oy? Ar ny govrnn isions of th orgniztion rsrv to (or sujt to pprovl y) mmrs, stokholrs, or prsons othr thn th govrning oy? Di th orgniztion ontmpornously oumnt th mtings hl or writtn tions unrtkn uring th yr y th following: Th govrning oy? Eh ommitt with uthority to t on hlf of th govrning oy? Is thr ny offir, irtor, trust, or ky mploy list in Prt VII, Stion A, who nnot rh t th Stion B. Poliis 0 Di th orgniztion hv lol hptrs, rnhs, or ffilits? If Ys, i th orgniztion hv writtn poliis n prours govrning th tivitis of suh hptrs, ffilits, n rnhs to nsur thir oprtions r onsistnt with th orgniztion's xmpt purposs? Hs th orgniztion provi omplt opy of this Form 0 to ll mmrs of its govrning oy for filing th form? Dsri in Shul O th pross, if ny, us y th orgniztion to rviw this Form 0. Di th orgniztion hv writtn onflit of intrst poliy? If, go to lin... Wr offirs, irtors, or trusts, n ky mploys rquir to islos nnully intrsts tht oul giv ris to onflits? Di th orgniztion rgulrly n onsistntly monitor n nfor omplin with th poliy? If Ys, sri inshul O how this ws on... Di th orgniztion hv writtn whistllowr poliy? Di th orgniztion hv writtn oumnt rtntion n strution poliy? Di th pross for trmining ompnstion of th following prsons inlu rviw n pprovl y inpnnt prsons, omprility t, n ontmpornous sustntition of th lirtion n ision? Th orgniztion's CEO, Exutiv Dirtor, or top mngmnt offiil ) Othr offirs or ky mploys of th orgniztion If Ys to lin or, sri th pross in Shul O (s instrutions). Di th orgniztion invst in, ontriut ssts to, or prtiipt in joint vntur or similr rrngmnt with txl ntity uring th yr? If Ys, i th orgniztion follow writtn poliy or prour rquiring th orgniztion to vlut its prtiiption in joint vntur rrngmnts unr pplil frl tx lw, n tk stps to sfgur th orgniztion's xmpt sttus with rspt to suh rrngmnts? - Stion C. Dislosur List th stts with whih opy of this Form 0 is rquir to fil J OH Stion 0 rquirs n orgniztion to mk its Forms 0 (or 0 if pplil), 0, n 0- T (Stion 0 ()( )s only) vill for puli insption. Init how you m ths vill. Chk ll tht pply. Own wsit Anothr's wsit Upon rqust Othr (xplin in Shul O) Dsri in Shul O whthr (n if so, how) th orgniztion m its govrning oumnts, onflit of intrst poliy, n finnil sttmnts vill to th puli uring th tx yr. 0 Stt th nm, rss, n tlphon numr of th prson who posssss th orgniztion's ooks n rors: RITA CYR VALLEY STREET, DAYTON, OH Form 0 ( 0 ) RONALD MCDONALD HOUSE CHA RONALD MCDONALD HOUSE CHARITIES OF THE Form0(0) MIAMI VALLEY REGION, INC. -0 Pg Prt VI Govrnn, Mngmnt, n Dislosur For h Ys rspons to lins through low, n for rspons to lin,, or 0 low, sri th irumstns, prosss, or hngs in Shul O. S instrutions. Chk if Shul O ontins rspons or not to ny lin in this Prt VI Stion A. Govrning Boy n Mngmnt Entr th numr of voting mmrs of th govrning oy t th n of th tx yr If thr r mtril iffrns in voting rights mong mmrs of th govrning oy, or if th govrning oy lgt ro uthority to n xutiv ommitt or similr ommitt, xplin in Shul O. Entr th numr of voting mmrs inlu in lin, ov, who r inpnnt Di ny offir, irtor, trust, or ky mploy hv fmily rltionship or usinss rltionship with ny othr offir, irtor, trust, or ky mploy? Di th orgniztion lgt ontrol ovr mngmnt utis ustomrily prform y or unr th irt suprvision of offirs, irtors, or trusts, or ky mploys to mngmnt ompny or othr prson? Di th orgniztion mk ny signifint hngs to its govrning oumnts sin th prior Form 0 ws fil? Di th orgniztion om wr uring th yr of signifint ivrsion of th orgniztion's ssts? Di th orgniztion hv mmrs or stokholrs? Di th orgniztion hv mmrs, stokholrs, or othr prsons who h th powr to lt or ppoint on or mor mmrs of th govrning oy? Ar ny govrnn isions of th orgniztion rsrv to (or sujt to pprovl y) mmrs, stokholrs, or prsons othr thn th govrning oy? Di th orgniztion ontmpornously oumnt th mtings hl or writtn tions unrtkn uring th yr y th following: Th govrning oy? Eh ommitt with uthority to t on hlf of th govrning oy? Is thr ny offir, irtor, trust, or ky mploy list in Prt VII, Stion A, who nnot rh t th Stion B. Poliis 0 Di th orgniztion hv lol hptrs, rnhs, or ffilits? If Ys, i th orgniztion hv writtn poliis n prours govrning th tivitis of suh hptrs, ffilits, n rnhs to nsur thir oprtions r onsistnt with th orgniztion's xmpt purposs? Hs th orgniztion provi omplt opy of this Form 0 to ll mmrs of its govrning oy for filing th form? Dsri in Shul O th pross, if ny, us y th orgniztion to rviw this Form 0. Di th orgniztion hv writtn onflit of intrst poliy? If, go to lin... Wr offirs, irtors, or trusts, n ky mploys rquir to islos nnully intrsts tht oul giv ris to onflits? Di th orgniztion rgulrly n onsistntly monitor n nfor omplin with th poliy? If Ys, sri inshul O how this ws on... Di th orgniztion hv writtn whistllowr poliy? Di th orgniztion hv writtn oumnt rtntion n strution poliy? Di th pross for trmining ompnstion of th following prsons inlu rviw n pprovl y inpnnt prsons, omprility t, n ontmpornous sustntition of th lirtion n ision? Th orgniztion's CEO, Exutiv Dirtor, or top mngmnt offiil ) Othr offirs or ky mploys of th orgniztion If Ys to lin or, sri th pross in Shul O (s instrutions). Di th orgniztion invst in, ontriut ssts to, or prtiipt in joint vntur or similr rrngmnt with txl ntity uring th yr? If Ys, i th orgniztion follow writtn poliy or prour rquiring th orgniztion to vlut its prtiiption in joint vntur rrngmnts unr pplil frl tx lw, n tk stps to sfgur th orgniztion's xmpt sttus with rspt to suh rrngmnts? - Stion C. Dislosur List th stts with whih opy of this Form 0 is rquir to fil J OH Stion 0 rquirs n orgniztion to mk its Forms 0 (or 0 if pplil), 0, n 0- T (Stion 0 ()( )s only) vill for puli insption. Init how you m ths vill. Chk ll tht pply. Own wsit Anothr's wsit Upon rqust Othr (xplin in Shul O) Dsri in Shul O whthr (n if so, how) th orgniztion m its govrning oumnts, onflit of intrst poliy, n finnil sttmnts vill to th puli uring th tx yr. 0 Stt th nm, rss, n tlphon numr of th prson who posssss th orgniztion's ooks n rors: RITA CYR VALLEY STREET, DAYTON, OH Form 0 ( 0 ) RONALD MCDONALD HOUSE CHA RONALD MCDONALD HOUSE CHARITIES OF THE Form0(0) MIAMI VALLEY REGION, INC. -0 Pg Prt VI Govrnn, Mngmnt, n Dislosur For h Ys rspons to lins through low, n for rspons to lin,, or 0 low, sri th irumstns, prosss, or hngs in Shul O. S instrutions. Chk if Shul O ontins rspons or not to ny lin in this Prt VI Stion A. Govrning Boy n Mngmnt Entr th numr of voting mmrs of th govrning oy t th n of th tx yr If thr r mtril iffrns in voting rights mong mmrs of th govrning oy, or if th govrning oy lgt ro uthority to n xutiv ommitt or similr ommitt, xplin in Shul O. Entr th numr of voting mmrs inlu in lin, ov, who r inpnnt Di ny offir, irtor, trust, or ky mploy hv fmily rltionship or usinss rltionship with ny othr offir, irtor, trust, or ky mploy? Di th orgniztion lgt ontrol ovr mngmnt utis ustomrily prform y or unr th irt suprvision of offirs, irtors, or trusts, or ky mploys to mngmnt ompny or othr prson? Di th orgniztion mk ny signifint hngs to its govrning oumnts sin th prior Form 0 ws fil? Di th orgniztion om wr uring th yr of signifint ivrsion of th orgniztion's ssts? Di th orgniztion hv mmrs or stokholrs? Di th orgniztion hv mmrs, stokholrs, or othr prsons who h th powr to lt or ppoint on or mor mmrs of th govrning oy? Ar ny govrnn isions of th orgniztion rsrv to (or sujt to pprovl y) mmrs, stokholrs, or prsons othr thn th govrning oy? Di th orgniztion ontmpornously oumnt th mtings hl or writtn tions unrtkn uring th yr y th following: Th govrning oy? Eh ommitt with uthority to t on hlf of th govrning oy? Is thr ny offir, irtor, trust, or ky mploy list in Prt VII, Stion A, who nnot rh t th Stion B. Poliis 0 Di th orgniztion hv lol hptrs, rnhs, or ffilits? If Ys, i th orgniztion hv writtn poliis n prours govrning th tivitis of suh hptrs, ffilits, n rnhs to nsur thir oprtions r onsistnt with th orgniztion's xmpt purposs? Hs th orgniztion provi omplt opy of this Form 0 to ll mmrs of its govrning oy for filing th form? Dsri in Shul O th pross, if ny, us y th orgniztion to rviw this Form 0. Di th orgniztion hv writtn onflit of intrst poliy? If, go to lin... Wr offirs, irtors, or trusts, n ky mploys rquir to islos nnully intrsts tht oul giv ris to onflits? Di th orgniztion rgulrly n onsistntly monitor n nfor omplin with th poliy? If Ys, sri inshul O how this ws on... Di th orgniztion hv writtn whistllowr poliy? Di th orgniztion hv writtn oumnt rtntion n strution poliy? Di th pross for trmining ompnstion of th following prsons inlu rviw n pprovl y inpnnt prsons, omprility t, n ontmpornous sustntition of th lirtion n ision? Th orgniztion's CEO, Exutiv Dirtor, or top mngmnt offiil ) Othr offirs or ky mploys of th orgniztion If Ys to lin or, sri th pross in Shul O (s instrutions). Di th orgniztion invst in, ontriut ssts to, or prtiipt in joint vntur or similr rrngmnt with txl ntity uring th yr? If Ys, i th orgniztion follow writtn poliy or prour rquiring th orgniztion to vlut its prtiiption in joint vntur rrngmnts unr pplil frl tx lw, n tk stps to sfgur th orgniztion's xmpt sttus with rspt to suh rrngmnts? - Stion C. Dislosur List th stts with whih opy of this Form 0 is rquir to fil J OH Stion 0 rquirs n orgniztion to mk its Forms 0 (or 0 if pplil), 0, n 0- T (Stion 0 ()( )s only) vill for puli insption. Init how you m ths vill. Chk ll tht pply. Own wsit Anothr's wsit Upon rqust Othr (xplin in Shul O) Dsri in Shul O whthr (n if so, how) th orgniztion m its govrning oumnts, onflit of intrst poliy, n finnil sttmnts vill to th puli uring th tx yr. 0 Stt th nm, rss, n tlphon numr of th prson who posssss th orgniztion's ooks n rors: RITA CYR VALLEY STREET, DAYTON, OH Form 0 ( 0 ) RONALD MCDONALD HOUSE CHA Ys Ys For h "Ys" rspons to lins through low, n for "" rspons to lin,, or 0 low, sri th irumstns, prosss, or hngs in Shul O. S instrutions. If "Ys," provi th nms n rsss in Shul O (This Stion B rqusts informtion out poliis not rquir y th Intrnl Rvnu Co.) If "," go to lin If "Ys," sri in Shul O how this ws on (xplin in Shul O) If thr r mtril iffrns in voting rights mong mmrs of th govrning oy, or if th govrning oy lgt ro uthority to n xutiv ommitt or similr ommitt, xplin in Shul O. Di th orgniztion ontmpornously oumnt th mtings hl or writtn tions unrtkn uring th yr y th following: Wr offirs, irtors, or trusts, n ky mploys rquir to islos nnully intrsts tht oul giv ris to onflits? Form (0) Form 0 (0) Pg Chk if Shul O ontins rspons or not to ny lin in this Prt VI Entr th numr of voting mmrs of th govrning oy t th n of th tx yr Entr th numr of voting mmrs inlu in lin, ov, who r inpnnt ~~~~~~ ~~~~~~ Di ny offir, irtor, trust, or ky mploy hv fmily rltionship or usinss rltionship with ny othr offir, irtor, trust, or ky mploy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th orgniztion lgt ontrol ovr mngmnt utis ustomrily prform y or unr th irt suprvision of offirs, irtors, or trusts, or ky mploys to mngmnt ompny or othr prson? ~~~~~~~~~~~~~~ Di th orgniztion mk ny signifint hngs to its govrning oumnts sin th prior Form 0 ws fil? Di th orgniztion om wr uring th yr of signifint ivrsion of th orgniztion's ssts? Di th orgniztion hv mmrs or stokholrs? ~~~~~ ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th orgniztion hv mmrs, stokholrs, or othr prsons who h th powr to lt or ppoint on or mor mmrs of th govrning oy? Ar ny govrnn isions of th orgniztion rsrv to (or sujt to pprovl y) mmrs, stokholrs, or prsons othr thn th govrning oy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Th govrning oy? Eh ommitt with uthority to t on hlf of th govrning oy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is thr ny offir, irtor, trust, or ky mploy list in Prt VII, Stion A, who nnot rh t th orgniztion's miling rss? Di th orgniztion hv lol hptrs, rnhs, or ffilits? If "Ys," i th orgniztion hv writtn poliis n prours govrning th tivitis of suh hptrs, ffilits, n rnhs to nsur thir oprtions r onsistnt with th orgniztion's xmpt purposs? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Hs th orgniztion provi omplt opy of this Form 0 to ll mmrs of its govrning oy for filing th form? Dsri in Shul O th pross, if ny, us y th orgniztion to rviw this Form Di th orgniztion hv writtn onflit of intrst poliy? ~~~~~~~~~~~~~~~~~~~~ ~~~~~~ Di th orgniztion rgulrly n onsistntly monitor n nfor omplin with th poliy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th orgniztion hv writtn whistllowr poliy? Di th orgniztion hv writtn oumnt rtntion n strution poliy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ Di th pross for trmining ompnstion of th following prsons inlu rviw n pprovl y inpnnt prsons, omprility t, n ontmpornous sustntition of th lirtion n ision? Th orgniztion's CEO, Exutiv Dirtor, or top mngmnt offiil Othr offirs or ky mploys of th orgniztion If "Ys" to lin or, sri th pross in Shul O (s instrutions). ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th orgniztion invst in, ontriut ssts to, or prtiipt in joint vntur or similr rrngmnt with txl ntity uring th yr? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Ys," i th orgniztion follow writtn poliy or prour rquiring th orgniztion to vlut its prtiiption in joint vntur rrngmnts unr pplil frl tx lw, n tk stps to sfgur th orgniztion's xmpt sttus with rspt to suh rrngmnts? List th stts with whih opy of this Form 0 is rquir to fil Stion 0 rquirs n orgniztion to mk its Forms 0 (or 0 if pplil), 0, n 0-T (Stion 0()()s only) vill for puli insption. Init how you m ths vill. Chk ll tht pply. Own wsit Anothr's wsit Upon rqust Othr Dsri in Shul O whthr (n if so, how) th orgniztion m its govrning oumnts, onflit of intrst poliy, n finnil sttmnts vill to th puli uring th tx yr. Stt th nm, rss, n tlphon numr of th prson who posssss th orgniztion's ooks n rors: Prt VI Govrnn, Mngmnt, n Dislosur Stion A. Govrning Boy n Mngmnt Stion B. Poliis Stion C. Dislosur 0 J RITA CYR VALLEY STREET, DAYTON, OH 0 MIAMI VALLEY REGION, INC. -0 RONALD MCDONALD HOUSE CHARITIES OF THE OH RONALD MCDONALD HOUSE CHA 00000