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A Employer i d e n t i f i c a t i o n numberLIFELINE HUMANITARIAN ORGANIZATION 36-3894439OF CHICAGO B T elephone n u m b e r ( se e t he i n s t r u c t i o n s )20 0 N. MICHIGAN AVE. SUITE 502 (312) 781-9300CHICAGO, IL 60601 C I f e x e m p t i o n a p p l i c a t i o n i s p e n d i n g , c h e c k h e r e 0 1

D 1 F o r e i g n o r g a n i z a t i o n s , c h e c k h e r eH C h e c k t y p e o f o r g a n i z a t i o n . Section 50 1 ( c ) ( 3 ) exempt p r i v a t e foundation 2 F o r e i g n o r g a n i z a t i o n s m e e t i n g t h e 85 % t e s t , c h e c k

Section 4 94 7 ( a ) ( 1 ) n o n e x e m p t c h a r i t a b l e t r u s t Other t a x a b l e p r i v a t e foundation h e r e a n d a t t a c h c o m p u t a t i o n1 F a i r m a r k e t v a l u e o f a l l a s s e t s a t e n d o f y e a r J Ac c o unti ng m e t h o d X C a s h Accrual E I f p r i v a t e f o u n d a t i o n s t a t u s w a s t e r m i n a t e d uu n d e r s e c t i o n 5 0 7 ( b ) ( 1 ) ( A ) c h e c k h e r e( f r o m P a r t l l , c o l u m n ( c ) , l i n e ] 6 ) O t h e e c f ) ,r ( s p y _ _ _ _ _ _ _ _ _ _ _ _ - F I f t h e f o u n d a t i o n i s i n a 6 0 - m o n t h t e r m i n a t i o n$ 178, 521. ( P a r t I , co l um n ( d ) m u s t b e on cash b as is ) u n d e r s e c t i o n 5 0 7 ( b ) ( 1 ) ( B ) , c h e c k h e r ePart I Ana ly si s of Revenue a n d

Expenses ( T h e t o t a l o f amounts i n ( a ) R e v e n u e a n db k ( b ) Ne t investment ( c ) Adjusted n e t ( d ) Disb ursem entsf h b lco l um n s ( b ) , ( c ) , a n d ( d ) may not n e c e s - expens e s p e r oo s in com e in com e o r c a r i t a epurposess a r i l y eq ua l t h e a m o u n t s i n column ( a ) (cash b a s i s o n l y )( s e e t h e i n s t r u c t io n s ) )1 C o n t r i b u t i o n s , g i f t s , g r a n t s , e t c , received ( a f t s c h ) 131 , 332.2 C k [f t h e foundn i s n ot r e q t o a ft Sc h B3 I n t e r e s t on savings a n d temporaryc a s h i n v e s t m e n t s 124. 124 . 124.4 D i v i d e n d s a n d i n t e r e s t f r o m s e c u r i t i e s - " - - ` 5a G r o s s r e n t s ' r ^ ^ ` ^ , ' :