Form

999-PF

Return of Private Foundation

or Section 4947(axl) Nonexempt Charitable Trust Treated as a Private Foundation
Note The foundation may be able to use a copy of this return to satisfy state reporting requirements , 2011 , and ending
A B

OMB No 1545 0052

^0.^ ,^

Department of the Tieaswy

Internal Revenue Service

For calendar year 2011 , or tax year beginning

LIFELINE HUMANITARIAN ORGANIZATION

Employer identification number

OF CHICAGO
155 N. MICHIGAN AVE. CHICAGO , IL 60601
G Check all that apply

36-3894439
Telephone number ( see the nstructions)

SUITE 409

(312)
C

781-9300

If exemption application is pending , check here 1 Foreign organizations , check here 2 Foreign organizations meeting the 85 % test, check u here and attach computation

H I

Initial return Initial Return of a former public charity Final return Amended return Name chan g e I Address change X Check type of organization X Section 501 (c)(3) exempt private foundation Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation Fair market value of all assets at end of year J Accounting method X Cash Accrual (from Part 11, column (c), line 16) 11 Other (specify) $ 124, 262. (Part 1, column (d) must be on cash basis)

E F

If private foundation status was terminated under section 507(b)( 1)(A), check here If the foundation is in a 60- month termmatton under section 507(b)( 1)(B), check here (c) Adjusted net income

Part I

Analysis of Revenue and Ex p enses (rhe total of amounts

rn columns (b), (c), and (d) may not neces sarfly equal the amounts in column (a) (see instructions)
Contributions , gifts, grants etc , received ( att sch ) Ck 1' 1-1 if the foundn is not req to all Sch B

( expenses per books

a) Revenue and

(b) Net investment income

(d) Disbursements for charitable purposes (cash basis only)

1 2

66 , 605.
110. 110. 110.

Interest on savings and temporary

cash investments
4 Dividends and interest from securities 5a Gross rents
b Net rental income
or (loss)

R E

6a Net gain /( loss) from sale of assets not on tine 10 b Gross sales price for all

E N
U

asse Capi ^ gain n

^ aj

(^e 2)

8 9

Net short -t'DI9Ni Inc me -1110U_1Il(_dLlUilb__

alto a

V
^

(^
!/^

E
N

10a retuI ds IesQU 8 of b Les Co

20^2 U)

goo s so

11

c Gro prof too mm Ot er tn c l ile

-t
12
Q 13

S
Total . Add lines 1 through 11
Compensation of officers , directors trustees, etc

186,712.
253 427.
, bUO.

110.

110.

w Z A

14 Other employee salaries and wages 15 Pension plans, employee benefits 16a Legal fees (attach schedule)

Z M N

b Accounting fees (attach sch) c Other prof fees (attach sch)

SEE ST 2 SEE ST 3
SEE STM 4

3, 295. 734 .

,
E R
A

17 Interest
18 Taxes ( attach schedulexsee instrs )

180.
2, 341.
1, 013.

180.

180.
23.

T
A

19 20 21 22 23 24 25 26

T N
G A N D

T
E E p

Depreciation (attach sch) and depletion Occupancy Travel, conferences, and meetings Printing and publications Other expenses (attach schedule)

g 929. 739.
2 , 546.

E S N
E

SEE STATEMENT 5
Total operating and administrative

26,230. 76, 607. 226 143. 180. 180. 329. 226 143.

expenses . Add lines 13 through 23

Contributions , gifts, grants paid STMT 6 Total expenses and disbursements. Add lines 24 and 25 27 Subtract line 26 from line 12: a Excess of revenue over expenses

302 750.
-49,323. 1

180.

180.

226,472.

and disbursements
b Net investment income ( if negative , enter 0 C Adjusted net income ( if negative , enter 0 )

0 . 0.

BAA For Paperwork Reduction Act Notice , see instructions .

TEEA0504L 12/05111

Form 990-PF (2011)

^C^

IV

Form 990,-PF (2011) LIFELINE HUMANITARIAN ORGANIZATIO N

P rt II

36-3894439
Beginning of year (a) Book Value

Page 2

Balance Sheets
1 2 3 4 5 6 7

Attached schedules and amounts in the description column should be for end of-year amounts only

(See instructions )

End of year (b) Book Value (c) Fair Market Value

Cash - non-interest-bearing Savings and temporary cash investments Accounts receivable ^ ----------Less allowance for doubtful accounts ^ ----------Pledges receivable ^ ----------Less allowance for doubtful accounts ^ ----------Grants receivable Receivables due from officers, directors, trustees, and other disqualified persons (attach schedule) (see instructions) Other notes and loans receivable (attach sch) ^ Less allowance for doubtful accounts ^ ----------Inventories for sale or use Prepaid expenses and deferred charges

122,642. 54,866.

69,836. 54,426.

69,836. 54,426.

S S E T S

8 9

10a Investments - U S and state government obligations (attach schedule) b Investments - corporate stock (attach schedule) c Investments - corporate bonds (attach schedule) 11 ^ ----------Less accumulated depreciation (attach schedule) ^ ----------Investments - mortgage loans Investments - other (attach schedule) Land, buildings, and equipment basis ^ _ _ _ _ _ 1 1 ,42 7 . Less accumulated depreciation (attach schedule) SEE STMT 7 ^ - 11,427. ----------Other assets (describe ^ ---------------Total assets (to be completed by all filers see the instructions Also, see page 1, item I) Accounts payable and accrued expenses Grants payable Deferred revenue Loans from officers, directors, trustees, & other disqualified persons Mortgages and other notes payable (attach schedule) Other liabilities (describe ^ ) Total liabilities (add lines 17 through 22) Foundations that follow SFAS 117 , check here complete lines 24 through 26 and lines 30 and 31. Unrestricted Temporarily restricted Permanently restricted Foundations that do not follow SFAS 117. check here and complete lines 27 through 31. Capital stock, trust principal, or current funds Paid-in or capital surplus, or land, building, and equipment fund Retained earnings, accumulated income, endowment, or other funds Total net assets or fund balances (see instructions) Total liabilities and net assets/fund balances Investments - land, buildings, and equipment basis

12 13 14

1,013. 178,521. 6,651.

15 16 L I A B I L 1 T E S 17 18 19 20 21 22 23

124,262. 1,715.

124,262.

6,651.
^ F X _

1,715.

N F E U T N o S S E T S B A L A N

24 25 26

171,306. 564.1
^

122,547. _1

O E R S

27 28 29 30 31

171,870. 178,521.

122,547. 124,262.

Part III Analy sis of Chan g es in Net Assets or Fund Balances

1 2 3 4 5 6 BAA Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year's return) Enter amount from Part I, line 27a Other increases not included in line 2 ( itemize) ^ -----------------------------Add lines 1, 2, and 3 Decreases not included in line 2 (itemize) _ ____________ Total net assets or fund balances at end of year (line 4 minus line 5) - Part II column (b), line 30 TEEA0302L 07/14111 1 2 3 171, 870. -49, 323.

4
5 6

122, 547. 122,547.

Form 990-PF (2011)

Form 990-PF 2011) LIFELINE HUMANITARIAN ORGANIZATION Part IV , Ca p ital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e g , real estate, 2-story brick warehouse, or common stock, 200 shares MLC Company)
( How acquired P - Purchase D - Donation

36-3894439
(C) Date acquired (month day, year)

Pa g e 3
(d) Date sold (month, day, year)

l a N/A
b

C
d

e
(e) Gross sales price (f) Depreciation allowed (or allowable) (g) Cost or other basis plus expense of sale (h) Gain or (loss) (e) plus (f) minus (g)

a
b

C
d

e
Complete onl y for assets showing gain in column (h) and owned by the foundation on 12/31/69 (i) Fair Market Value (j) Adjusted basis (k) Excess of column (l) as of 12/31/69 as of 12/31 /69 over column (j), if any a b (I) Gains (Column (h) gain minus column (k), but not less than -0-) or Losses (from column (h))

C
d

e
2 3 Capital gain net income or (net capital loss) {lf gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7 2

Net short-term capital gain or (loss) as defined in sections 1222(5) and (6) If gain, also enter in Part I, line 8, column (c) (see instructions) If (loss), enter -0in Part I, line 8 3

Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income Part V (For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income )
If section 4940(d)(2) applies, leave this part blank Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base perlod7 Yes X No If 'Yes,' the foundation does not qualify under section 4940 (e) Do not complete this part 1 Enter the appropriate amount to each column for each year , see the instructions before making any entries (a) (b) (c) (d) Base period years Adjusted qualifying distributions Net value of Distribution ratio Calendar year (or tax year noncharitable-use assets (column (b) divided by column (c)) beginning in)

2010
2009 2008 2007

52,973.
35,414. 346,323. 196,336.

40,028.
88,236. 116,501. 137,222.

1.323399
0.401355 2.972704 1.430791

2006
2 3 Total of line 1, column (d)

149,236.

233,480.
2

0.639181
6. 767430

Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the number of years the foundation has been in existence if less than 5 years Enter the net value of noncharitable-use assets for 2011 from Part X, line 5 Multiply line 4 by line 3 Enter 1 % of net investment income (1 %a of Part I, line 27b) Add lines 5 and 6 Enter qualifying distributions from Part XII, line 4

3
4 5 6 7 8

1.353486
72,607. 98,273.

4 5 6 7 8

98,273. 226,472.

If line 8 is equal to or greater than line 7, check the box in Part VI, line 1 b, and complete that part using a 1 % tax rate See the Part VI instructions Form 990-PF (2011) BAA
TEEA0303L 07/14/11

Form 99Q-PF (2011) LIFELINE HUMANITARIAN ORGANIZATION

Part VI
1 a Exempt operating foundations described in section 4940(d)(2), check here and enter 'N/A' on line 1 Date of ruling or determination letter -__--(attach copy of letter if necessary - see instrs) b Domestic foundations that meet the section 4940(e) requirements in Part V,
11-1 and enter 1 % of Part I, line 27b All other domestic foundations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I, line 12, column (b) c 2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) check here

3 6-3894439

Pa ge 4

Excise Tax Based on Investment Income (section 4940(a), 4940(b), 4940 (e ), or 4948 - see instructions)

0.

2 Add lines 1 and 2 3 3 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) 4 5 5 Tax based on investment income . Subtract line 4 from line 3 If zero or less, enter -0Credits/Payments 6 6a a 2011 estimated tax pmts and 2010 overpayment credited to 2011 Exempt foreign organizations - tax withheld at source 6b b Tax paid with application for extension of time to file (Form 8868) 6c c 6d d Backup withholding erroneously withheld 7 Total credits and payments Add lines 6a through 6d 7 Enter any penalty for underpayment of estimated tax Check here n if Form 2220 is attached 8 8 ^ 9 9 Tax due If the total of lines 5 and 8 is more than line 7, enter amount owed 10 Overpayment If line 7 is more than the total of lines 5 and 8, enter the amount overpaid 10 ^ Refunded 11 Enter the amount of line 10 to ne Credited to 2012 estimated tax 11

. 0. 0. 0.

0. 0.

Part VII -A Statements Reg ardin g Activities

1 a Durin g the tax y ear , did the foundation attem p t to influence an y national , state , or local le g islation or did it participate or intervene in any political campaign? b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see the instructions for definition) If the answer is 'Yes' to la or 1b, attach a detailed description of the activities and copies of any materials published or distributed by the foundation in connection with the activities c Did the foundation file Form 1120 -POL for this year? d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year I. $ B. $ (1) On the foundation 0. (2) On foundation managers e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed on 0. $ foundation managers 0. 2 Has the foundation engaged in any activities that have not previously been reported to the IRS) If 'Yes,' attach a detailed description of the activities Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or bylaws, or other similar instruments? If 'Yes,' attach a conformed copy of the changes 4a Did the foundation have unrelated business gross income of $1,000 or more during the year? b If 'Yes,' has it filed a tax return on Form 990 -T for this year? 5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? If 'Yes,' attach the statement required by General Instruction T 6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either By language in the governing instrument, or 3 By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law remain in the governing instrument? 7 Did the foundation have at least $5,000 in assets at any time during the year? If ' Yes,' complete Part Il, column (c), and PartXV 8a Enter the states to which the foundation reports or with which it is registered (see instructions) Yes la 1b No X X

lc

--

-X

3 4a 4b 5

X X N /A X

- 6 7

X X

IL
b If the answer is 'Yes' to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate ) of each state as required by General Instruction G2 If 'No,' attach explanation 9 10 BAA Is the foundation claiming status as a private operating foundation within the meaning of section 4942 (1)(3) or 4942(j)(5) for calendar year 2011 or the taxable year beginning in 2011 (see instructions for Part XIV)7 If ' Yes,' complete Part XIV Did any persons become substantial contributors during the tax year? If 'Yes,' attach a schedule listing their names Form 990-PF (2011) 8b 9 X

TEEA0304L

07/14111

orm 99Q-PF (2011) LIFELINE HUMANITARIAN ORGANIZATION

36-3894439

Page 5

'art VH-A
11 12 13

Statements Reg ardin g Activities continued

11 12 13 X X X

At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of section 512(b)(13)' If 'Yes', attach schedule (see instructions) Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges? If 'Yes,' attach statement (see instructions) Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

Website address ^ WWW.LIFELINEAID.INFO ---------------------------- --- - --------14 The books are in care of ^ VICKI ZAMMICHIEL Telephone no ^ (312) 781-9300 -------------------------------- -------Located at ^ 155 N. MICHIGAN AVE. SUITE 409 CHICAGO IL ZIP+4 ^ 60601
15 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 - Check here and enter the amount of tax-exempt interest received or accrued during the year N/A ^ 15 Yes 16 ^ ET N/A No X

16

At any time during calendar year 2011, did the foundation have an interest in or a signature or other authority over a bank, securities, or other financial account in a foreign country? See the instructions for exceptions and filing requirements for Form TD F 90-22 1 foreign country If 'Yes,' enter the name of the

Part VII-B

Statements Reg ardin g Activities for Which Form 4720 May Be Req uired
Yes Yes Yes Yes Yes []Yes No X No M No N No No No

File Form 4720 if any item is checked in the ' Yes' column, unless an exception applies. 1 a During the year did the foundation (either directly or indirectly) (1) Engage in the sale or exchange, or leasing of property with a disqualified person? (2) Borrow money from, lend money to or otherwise extend credit to (or accept it from) a disqualifieo person) (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? (5) Transfer any income or assets to a disqualified person (or make any of either available for the benefit or use of a dis q ualified p erson )? (6) Agree to pay money or property to a government official? (Exception . Check 'No' if the foundation agreed to make a grant to or to employ the official for a period after termination o f governme nt se rvice, i f t erm inat i n g wi th in 90 da y s )

El Y es

No lb ^ El 1c X

b If any answer is 'Yes' to 1 a( 1)-(6), did any of the acts fail to qualify under the exceptions described in Regulations section 53 4941 (d)- 3 or in a current notice regarding disaster assistance (see instructions)? Organizations relying on a current notice regarding disaster assistance check here c Did the foundation engage in a prior year in any of the acts described in la, other than excepted acts, that were not corrected before the first day of the tax year beginning in 2011' 2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private operating foundation defined in section 49420)(3) or 4942(1)(5)) a At the end of tax year 2011 , did the foundation have any undistributed income ( lines 6d and 6e , Part XIII ) for tax year (s) beginning before 2011 20_ 20 - , 20 - , 20 If 'Yes,' list the years ^ El Yes

N A

No

b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets ) to the year's undistributed income? ( If applying section 4942 (a)(2) to all years listed, answer 'No ' and attach statement - see instructions) c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here , 20 , 20 , 20 10, 20 3a Did the foundation hold more than a 2% direct or indirect interest in any business en t erprise a t any t ime d uring th e year ? 11 Ye s No

-- -2b

--NVA

b If 'Yes ,' did it have excess business holdings in 2011 as a result of (1) any purchase by the foundation or disqualified persons after May 26, 1969, (2) the lapse of the 5-year period (or longer period approved the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest, or R the lapse of the 10-, 15- , or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine If the foundation had excess business holdings in 2011) 4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes? b Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 20117 BAA

3b 4a

N A
X

----4b X Form 990-PF (2011)

TEEA0305L

07114111

Form 990, PF (2011)

LIFELINE HUMANITARIAN ORGANIZATION

36-3894439

Page 6

Part VI!-B Statements Reg ardin g Activities for Which Form 4720 May Be Req uired continued
5a During the year did the foundation pay or incur any amount to (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? (2) Influence the outcome of any specific public election (see section 4955), or to carry on, directly or indirectly, any voter registration drive? (3) Provide a grant to an individual for travel, study, or other similar purposes? (4) Provide a grant to an organization other than a charitable, etc, organization described in section 509(a)(1), (2), or (3), or section 4940(d)(2)'' (see instructions) (5) Provide for any purpose other than religious, charitable, scientific, literary, or ed u cational pu r poses, or f or th e preven t ion o f crue lt y t o c h i ld ren or anima l s ? b If any answer is 'Yes' to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions described in Regulations section 53 4945 or in a current notice regarding disaster assistance Yes Yes H Yes Yes Yes No No X No No No - -- -- -

(see instructions)?
Organizations relying on a current notice regarding disaster assistance check here c If the answer is 'Yes' to question 5a(4), does the foundation claim exemption from the tax because it maintained expenditure responsibility for the grant? If 'Yes,' attach the statement required by Regulations section 534945-5(d) N/A 11 Yes No

5b

N A

6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? []Yes b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? If 'Yes' to 6b, file Form 8870 7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? Yes b If 'Yes,' did the foundation receive an y proceeds or have any net income attributable to the transact ion?

No 6b XNo N/A 7b X

Part VIII
1

Information About Officers , Directors , Trustees , Foundation Managers , Highly Paid Employees, and Contractors
(b) Title, and average (c) Compensation hours per week (If not paid , enter -0-) devoted to position (d) Contributions to employee benefit plans and deferred compensation (e) Expense account, other allowances

List all officers . directors . trustees . foundation managers and their comoensatinn ( see instructinnci

(a) Name and address

SEE STATEMENT-8 _-------____

30,600. ------------------------

0.

0.

------------------------

-------------------------

Compensation of five hiahest-paid emolovees (other than those included on line 1- see inctructinns)- If none- entpr'NONF' (a) Name and address of each employee (b) Title, and average (d) Contributions to (e) Expense account, (c) Compensation paid more than $50,000 hours per week employee benefit other allowances devoted to position plans and deferred compensation

NONE --------------------

------------------------

------------------------

----------------------------------------------Total number of other employees paid over $50,000

t5AA TEEA0306L 12/05/11

0
Form 990 -PF (2011)

Form 990PF (2011) LIFELINE HUMANITARIAN ORGANIZATION 36-3894439 Part VPII Information About Officers , Directors, Trustees, Foundation Managers, Highly Paid Employees,

Page 7

and Contractors (continued)

3 Five highest- paid inde pendent contractors for p rofessional services (see instructions). If none , enter ' NONE.' (a) Name and address of each person paid more than $50,000 (b) Ty pe of service (c) Compensation

NONE --------------------------------------

--------------------------------------

--------------------------------------

--------------------------------------

--------------------------------------

Total number of others receiving over $50,000 for professional services

Part IX-A Summary of Direct Charitable Activities

List the foundation's four largest direct charitable activities during the tax year Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc Expenses

CONTRIBUTIONS-TO PRINCESS-KATHERINE FOUNDATION-SERBIA- - HOSPITAL -------------------------------------------------EQUIPMENT-AND-MEDICAL-SUPPLIES-- DISTRIBUTED TO VARIOUS HOSPITALS-IN ------------------------------------------------SERBIA 2 CONTRIBUTION TO PRINCESS KATHERINE FOUNDATION - SERBIA ---------------------------------------------------------------------------------------------------------3
-----------------------------------------------------------------------------------------------------------

33,512.

170, 909.

-----------------------------------------------------Part IX-B Summary of Program - Related Investments (see instructions)

Amount

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2 1 -----------------------------------------------------N/A -----------------------------------------------------2 -----------------------------------------------------------------------------------------------------------

All other program-related investments See instructions 3 ----------------------------------------------------------------------------------------------------------Total . Add lines 1 through 3 BAA 0- 1 0. Form 990-PF (2011)

TEEA0307L

09/01/11

Form 990.PF (2011) LIFELINE HUMANITARIAN ORGANIZATION

36- 3894439

Page 8

Part X
1 a b c d e 2 3 4 5 6

Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
1a 1b 1c ld 0. 2 3 0. 73,713. 73,713. 73,713.

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc, purposes Average monthly fair market value of securities Average of monthly cash balances Fair market value of all other assets (see instructions) Total (add lines 1 a, b, and c) Reduction claimed for blockage or other factors reported on lines 1a and lc (attach detailed explanation) Acquisition indebtedness applicable to line 1 assets Subtract line 2 from line ld

1e

Cash deemed held for charitable activities Enter 1-1/2% of line 3 (for greater amount, see instructions) Net value of noncharitable - use assets . Subtract line 4 from line 3 Enter here and on Part V, line 4 Minimum investment return . Enter 5% of line 5

4
5 6

1, 106.
72,607.

Part XI
1 2a b c 3 4 5 6

3,630. Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain forei g n or g anizations check here ^ and do not com p lete this art.
3,630. 2a
2b 2c

Minimum investment return from Part X, line 6 Tax on investment income for 2011 from Part VI, line 5 Income tax for 2011 (This does not include the tax from Part VI ) Add lines 2a and 2b Distributable amount before adjustments Subtract line 2c from line 1 Recoveries of amounts treated as qualifying distributions Add lines 3 and 4 Deduction from distributable amount (see instructions)

3
4

3,630.
3,630. 3,630.

7 Distributable amount as adjusted Subtract line 6 from line 5 Enter here and on Part XIII, line 1 Part XII
1

5 6 7

Qualifying Distributions (see instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc, purposes a Expenses, contributions, gifts, etc - total from Part I, column (d), line 26 b Program-related investments - total from Part IX-B 2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc, purposes Amounts set aside for specific charitable projects that satisfy the a Suitability test (prior IRS approval required) b Cash distribution test (attach the required schedule) 4 Qualifying distributions . Add lines la through 3b Enter here and on Part V, line 8, and Part XIII, line 4 3 5 6 Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income Enter 1 % of Part I, line 27b (see instructions) Adjusted qualifying distributions . Subtract line 5 from line 4

1a 1 b 2 3a 3b 4 5 6

226,472.

226,472.

226,472.

Note . The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years BAA Form 990-PF (2011)

TEEA0308L

12/05/11

Form 990-PF (2011) LIFELINE HUMANITARIAN ORGANIZATION

36-3894439

Page 9

Part XIII Undistributed Income (see instructions)

(a) Corpus 1 2 Distributable amount for 2011 from Part XI, b Years p rio to 2010 r 2 010 1^ 1 20d

line 7
Undistributed income, if any, as of the end of 2011 a Enter amount for 2010 only b Total for prior years 20 20 20 3 Excess distributions carryover, if any, to 2011 0. 0.

3,630.

aFrom2006
bFrom2007

137,596.
189,475.

c From 2008
d From 2009

340,498.
31,002.

--

e From 2010

50,972.

If Total of lines 3a through e 4 Qualifying distributions for 2011 from Part

749, 543.

XII, line 4 ^

226,472.
0. 0. 0.

a Applied to 2010, but not more than line 2a b Applied to undistributed income of prior years (Election required - see instructions) c Treated as distributions out of corpus (Election required - see instructions) d Applied to 2011 distributable amount e Remaining amount distributed out of corpus 5 Excess distributions carryover applied to 2011 (If an amount appears in column (d), the same amount must be shown in column (a) ) 6 Enter the net total of each column as indicated below: a Corpus Add lines 3f, 4c, and 4e Subtract line 5 b Prior years' undistributed income Subtract line 4b from line 2b Enter the amount of prior years' undistributc ed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed d Subtract line 6c from line 6b Taxable

3,630. 222, 842.

0. 0.

972,385.
0.

0.

amount - see instructions

e Undistributed income for 2010 Subtract line 4a from line 2a Taxable amount - see instructions f Undistributed income for 2011 Subtract lines 4d and 5 from line 1 This amount must be distributed in 2012 7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3)

0.
0.

0.

(see instructions)
8 9 10 Excess distributions carryover from 2006 not applied on line 5 or line 7 (see instructions) Excess distributions carryover to 2012. Subtract lines 7 and 8 from line 6a Analysis of line 9

0.
137, 596. 834, 789.

a Excess from 2007

b Excess from 2008 c Excess from 2009 d Excess from 2010

189,475.
340, 498. 31,002. 50,972.

e Excess from 2011

BAA

222, 842.
Form 990-PF (2011)
TEEA0309L 07/14/11

Form 99Q-PF (2011) LIFELINE HUMANITARIAN ORGANIZATION Part XIV Private O p eratin g Foundations (see instructions and Part VII-A, q uestion 9

36-3894439 N/A

Page 10

1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2011, enter the date of the ruling b Check box to indicate whether the foundation is a private o erating foundation described in section 4942(1)(3) or 7 4942(1)(5) 2a Enter the lesser of the adjusted net Tax y ear Prior 3 y ears income from Part I or the minimum (c) 2009 (a) 2011 (b) 2010 (d 2008 (e) Total ) investment return from Part X for each year listed b 85% of line 2a c Qualifying distributions from Part XII, line 4 for each year listed d Amounts included in line 2c not used directly for active conduct of exempt activities e Qualifying distributions made directly for active conduct of exempt activities Subtract line 2d from line 2c 3 Complete 3a, b, or c for the alternative test relied upon a 'Assets' alternative test - enter (1) Value of all assets (2) Value of assets qualifying under section 49420)(3)(B)(i) b 'Endowment' alternative test - enter 2/3 of minimum investment return shown in Part X, line 6 for each year listed c 'Support' alternative test - enter (1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) (2) Support from general public and 5 or more exempt organizations as provided in section 4942(I)(3)(B)(ni) (3) Largest amount of support from an exempt organization (4) Gross investment income

Part XV
1

Supplementary Information ( Complete this part only if the organization had $5 , 000 or more in assets at any time during the year - see instructions.)

Information Regarding Foundation Managers: a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation before the close of any tax year (but only if they have contributed more than $5,000) (See section 507(d)(2)

NONE
b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the owne a partnership or other entity) of which the foundation has a 10% or greater interest

NONE
2 Information Regarding Contribution , Grant , Gift, Loan , Scholarship , etc, Programs: Check here " 1-1 if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds If the foundation makes gifts, grants, etc, (see instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d a The name, address, and telephone number of the person to whom applications should be addressed

SEE STATEMENT 9
b The form in which applications should be submitted and information and materials they should include SEE STATEMENT FOR LINE 2A c Any submission deadlines

SEE STATEMENT FOR LINE 2A

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors

SEE STATEMENT FOR LINE 2A

BAA TEEA0310L 07/14/11 Form 990-PF (2011)

Form 990-PF (2011) LIFELINE HUMANITARIAN ORGANIZATION Part XV Supplementary Information (continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment If recipient is an individual, Recipient show any relationship to Foundation any foundation manager or status of recipient substantial contributor Name and address (home or business) a Paid during the year

36-3894439

Page 11

Purpose of grant or con t ri b u t ion

Amount

Total b Approved for future payment

3a

Total BAA TEEA0501L 07/14/11

lb'

3bi Form 990-PF (2011)

Form 990-PF (2011) Part XV'I-A

LIFELINE HUMANITARIAN ORGANIZATION

36-3894439

Page 12

Analysis of Income - Producing Activities

Unrelated business income (a) (b) Business Amount code Excluded by section 512, 513, or 514 (c) (d) ExcluAmount sion code (e) Related or exempt function income (See instructions)

Erite gross amounts unless otherwise indicated

rogram service revenue

c Fees and contracts from government agencies Membership dues and assessments Interest on savings and temporary cash investments Dividends and interest from securities Net rental income or (loss ) from real estate Debt-financed property Not debt-financed property 6 Net rental income or (loss ) from personal property 7 Other investment income 8 Gain or ( loss) from sales of assets other than inventory 9 Net income or ( loss) from special events 10 Gross profit or (loss) from sales of inventory 11 Other revenue 2 3 4 5

14

110.

173, 567.

12 Subtotal Add columns ( b), (d), and (e) 13 Total . Add line 12, columns (b), (d), and (e) (See worksheet in line 13 instructions to verify calculations )

173, 677 . 13

173, 677.

Part XVI -B Relationship of Activities to the Accomplishment of Exempt Purposes

BAA

TEEA0502L

07/14/11

Form 990-PF (2011)

Form 990-PF (2011)

LIFELINE HUMANITARIAN ORGANIZATION

36-3894439

Page 13

Part X-VII

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
Yes No

Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting foundation to a noncharltable exempt organization of (1) Cash (2) Other assets b Other transactions (1) Sales of assets to a noncharitable exempt organization (2) Purchases of assets from a noncharitable exempt organization (3) Rental of facilities, equipment, or other assets (4) Reimbursement arrangements (5) Loans or loan guarantees (6) Performance of services or membership or fundraising solicitations c Sharing of facilities, equipment, mailing lists, other assets, or paid employees

a 1 1 a (2) 1 1 1 1 1 1 1 b ( 1) b (2) b (3) b (4) b (5) b (6) c

X X X X X X X X X

d If the answer to any of the above is 'Yes,' complete the following schedule Column (b) should always show the fair m arket val ue of the goods, other assets, or services given by the reportin foundation If the foundation received less than fair marke t value in any transaction or sharing arrangement, show in column d) the value of the goods, other assets, or services receive d (d) Description of transfers, transactions, and sharing arrangements (b) Amount involved (c) Name of noncharltable exempt organization (a) Line no

N/A

2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax - exempt organizations
described in section 501 (c) of the Code ( other than section 501(c)(3)) or in section 527 h If 'Ypc ' cmmnlete the fnllowinn schedule E Yes No

(a) Name of organization

(b) Ty pe of organization

c Description of relationshi p

N/A

amined this return, including acco Under penalties of perjury, I declare that I has than taxpayer) is based on all i correct, and complete D laration of preparer of

Sign Here
signature of offic r trustee  D e PrinV7ype preparer's name parer's signature

Paid
Preparer
Use Only

RUSSELL P. CANNIZZO,CPA

RUSSELL P. C

Firm's name
Firm's address

^
^

RUSSELL P. CANNIZZO & COMPANY

415 E. GOLF ROAD SUITE 119 ARLINGTON HEIGHTS, IL 60005

BAA

Schedule B (Form 990 , 990-EZ ,

or990- PF)
Department of the Treasury Internal Revenue Service Name of the organization

OMB No 1545.0047

Schedule of Contributors
^ Attach to Form 990, Form 990 - EZ, or Form 990-PF 201
Employer identification number

LIFELINE HUMANITARIAN ORGANIZATION

OF CHICAGO
Organization type (check one) Filers of: Form 990 or 990-EZ

136-3894439
Section: 501(c)( ) (enter number) organization 4947(a)(1) nonexempt charitable trust not treated as a private foundation 527 political organization X 501(c)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated as a private foundation 501 (c)(3) taxable private foundation

Form 990-PF

Check if your organization is covered by the General Rule or a Special Rule Note . Only a section 501 (c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule See instructions General Rule For an organization filing Form 990 , 990-EZ, or 990 -PF that received , during the year, $5,000 or more ( in money or property) from any one contributor (Complete Parts I and II )

Special Rules For a section 501(c)(3 ) organization filing Form 990 or 990-EZ that met the 33 - 1/3% support test of the regulations under sections 509(a )( 1) and 170 (b)(1)(A)(vi), and received from any one contributor , during the year , a contribution of the greater of (1) $5,000 or (2) 2% of the amount on ( i) Form 990, Part VIII, line 1 h or ( it) Form 990-EZ, line 1 Complete Parts I and II For a section 501 (c)(7), (8), or ( 10) organization filing Form 990 or 990 - EZ that received from any one contributor , during the year, total contributions of more than $ 1,000 for use exclusively for religious , charitable , scientific, literary , or educational purposes, or the prevention of cruelty to children or animals Complete Parts I, II , and III For a section 501(c)(7 ), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, contributions for use exclusively for religious , charitable, etc, purposes , but these contributions did not total to more than $1000 If this box is checked , enter here the total contributions that were received during the year for an exclusively religious, charitable, etc, purpose Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable , etc, contributions of $5,000 or more during the year W $ Caution : An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 990-PF) but it must answer 'No' on Part IV, line 2, of its Form 990, or check the box on line H of its Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF) BAA For Pa perwork Reduction Act Notice , see the Instructions for Form 990 , 990EZ , or 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

TEEA0701L

01116112

Schedule. B (Form 990, 990-EZ, or 990-PF) (2011) Name of organization

Page 1 of 1 Employer identification number

of Part 1

LIFELINE HUMANITARIAN ORGANIZATION

Part 1 (a) Number Contributors (see instructions) Use duplicate copies of Part I if additional space is needed (b) Name , address , and ZIP + 4

36-3894439

(c) Total contributions

(d) Type of contribution

RICHARD AND KATHY FANSLOW ------------------------------- _ _ _ _ 2314 LINCOLN PARK- WEST - - - - - - - - - - - - - - - - - - - - - $ - - - - - - 6,195. CHICAGO,-IL 60614_________________________

Person
Payroll

Noncash (
is

Part 1 if there
ao opncashcon l tribuion)

(a) Number

(b) Name , address , and ZIP + 4

(c) Total

contributions 2
FRED KREHBIEL -------------------------------------

(d) Type of contribution

Person
Payroll

505 S_COUNTYLINE RD_______________________ $----- 35, 000.

Noncash
o

H
i

HINSDALE, IL 60521_________________
(a) Number (b) Name , address, and ZIP + 4 (c) Total contributions

isao n ncashcon ltribut on)

(d) Type of contribution

SCUPE FOUNDATION ------------------------------------5722 DEMPSTER ___________________________ $36,000. MORTON -GROVE ,- IL 60053

Person
Payroll

Noncash

Part 1 if there
is ao nopncash con ltribut on (c) Total contributions (d) Type of contribution

(a) Number

(b) Name , address , and ZIP + 4

LESTER_CROWN ____________________________ 1155 MOHAWK RD WILMETTE, IL 60091

(b) Name , address , and ZIP + 4 (c) Total contributions

Person
Payroll

7,500.

Noncash

lete Part 1 if there

is ao no cash con ltribut on (d) Type of contribution
n

(a) Number

DRIEHAUS CHARITABLE TRUST 25 E ERIE CHICAGO,- IL 60611_________________________ $ 10, 000.

Person
Payrol l

Noncash
(Complete Part II if there

is anoncashcontribution )
(c) Total contributions (d) Type of contribution

(a) Number

(b) Name , address, and ZIP + 4

DAVID-STEVENS -----------------------------------2255 BORDEAUX WALK HIGHLAND , _IN 46322 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ $ 7, 372.

Person
Payroll

Noncash
(Complete Part II if there

is a noncash contribution )
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

BAA

TEEA0702L 08/30/11

Schedule.B (Form 990, 990-EZ, or 990-PF) (2011) Name of organization

Page

1 to 1 of Part II Employer identification number

LIFELINE HUMANITARIAN ORGANIZATION

Part II (a) No. from Part I Noncash Property (see instructions) Use duplicate copies of Part II if additional space is needed (b) Description of noncash property given

36-3894439

(c) FMV (or estimate) (see instructions)

(d) Date received

N/A

(a) No. from Part I

(b) Description of noncash property given

(c) FMV (or estimate) (see instructions)

(d) Date received

(a) No. from Part I

(b) Description of noncash property given

(C) FMV (or estimate) (see instructions)

(d) Date received

(a) No. from Part I

(b) Description of noncash property given

(C) FMV (or estimate ) (see instructions)

(d) Date received

(a) No. from Part I

(b) Description of noncash property given

(c) FMV (or estimate ) (see instructions)

(d) Date received

(a) No. from Part I

(b) Description of noncash property given

(c) FMV (or estimate) (see instructions)

(d) Date received

BAA

Sche dule B (Form 990. 990-EZ. or 990-PF) (2011)

TEEA0703L

08/30/11

Schedule B (Form 990, 990-EZ, or 990-PF) ( 2011) Name of organization

Pa g e

1 to 1 of Part III Employer identification number

LIFELINE HUMANITARIAN ORGANIZATION 36-3894439 Part III I Exclusively religious , charitable , etc, individual contributions to section 501(c)(7), (8), or (10) organizations that total more than $ 1,000 for the year .Complete cols (a) through (e) and the following line entry For organizations completing Part III, enter total of exclusively religious, charitable, etc,
(a) No. from Part I contributions of $1,000 or less for the year (Enter this information once See instructions) Use duplicate copies of Part III if additional space is needed (b) (c) Purpose of gift Use of gift $ (d) Description of how gift is held N/A

N/A

(e) Transfer of gift Transferee's name , address , and ZIP + 4 Relationship of transferor to transferee

(a) No. from Part l

(b) Purpose of gift

(c) Use of gift

(d) Description of how gift is held

(e) Transfer of gift Transferee ' s name , address , and ZIP + 4 Relationship of transferor to transferee

(a) No. from Part I

(b) Purpose of gift

(c) Use of gift

(d) Description of how gift is held

(e) Transfer of gift Transferee ' s name, address , and ZIP + 4 Relationship of transferor to transferee

(a) No. from Part I

(b) Purpose of gift

(c) Use of gift

(d) Description of how gift is held

(e) Transfer of gift Transferee ' s name, address , and ZIP + 4 Relationship of transferor to transferee

BAA TEEA0704L 0813011

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

2011
CLIENT 1601
7/24/12

FEDERAL STATEMENTS
LIFELINE HUMANITARIAN ORGANIZATION OF CHICAGO

PAGE 1
36-3894439
05 23PM

STATEMENT1 FORM 990-PF , PART I , LINE 11 OTHER INCOME

(A) REVENUE PER BOOKS INCOME FROM SPECIAL EVENTS $ TOTAL $ 186,712. 186,712.$ (B) NET I NVESTMENT INCOME (C) ADJUSTED NET INCOME

0.$

0.

STATEMENT 2 FORM 990-PF , PART I , LINE 16B ACCOUNTING FEES

(A) EXPENSES PER BOOKS ACCOUNTING FEE TOTAL $ 3 , 295. 3,295. (B) NET INVESTMENT INCOME 0. (C) ADJUSTED NET INCOME 0. $ (D) CHARITABLE PURPOSES 0.

STATEMENT 3 FORM 990-PF , PART I , LINE 16C OTHER PROFESSIONAL FEES

(A) EXPENSES PER BOOKS PROFESSIONAL FEES $ TOTAL $ 734. 734. $ (B) NET INVESTMENT INCOME 0. $ (C) ADJUSTED NET INCOME 0. $ (D) CHARITABLE PURPOSES 0.

STATEMENT 4 FORM 990-PF , PART I , LINE 18 TAXES

(A) EXPENSES PER BOOKS PAYROLL TAXES $ TOTAL $ 2,341. 2,341. $ (B) NET INVESTMENT INCOME 0. $ (C) ADJUSTED NET INCOME 0. $ $ (D) CHARITABLE PURPOSES 23. 23.

2011
CLIENT 1 601 7/24/12

FEDERAL STATEMENTS
LIFELINE HUMANITARIAN ORGANIZATION OF CHICAGO

PAGE 21
36-38944391
05 23PM

STATEMENT 5 FORM 990-PF, PART I, LINE 23 OTHER EXPENSES

(A) EXPENSES PER BOOKS ADVERTISING BOOKS & SUBSCRIPTIONS CREDIT CARD FEE EQUIPMENT RENTAL AND REPAIR INSURANCE MISCELLANEOUS OUTSIDE SERVICES PAYROLL SERVICES POSTAGE & SHIPPING SPECIAL EVENT EXPENSES STATE REGISTRATION FEES SUPPLIES TELEPHONE $ 365. 273. 1,176. 3,005. 970. 599. 1,177. 291. 803. 13,145. 604. 1,094. 2,728. 26,230. (B) NET INVESTMENT INCOME (C) ADJUSTED NET INCOME (D) CHARITABLE PURPOSES

TOTAL $

0.

0.

0.

STATEMENT 6 FORM 990-PF, PART I, LINE 25 CONTRIBUTIONS, GIFTS, AND GRANTS

CASH GRANTS AND ALLOCATIONS CLASS OF ACTIVITY: DONEE'S NAME: DONEE'S ADDRESS: RELATIONSHIP OF DONEE: ORGANIZATIONAL STATUS OF DONEE: AMOUNT GIVEN: NONCASH GRANTS AND ALLOCATIONS CLASS OF ACTIVITY: DONEE ' S NAME: DONEE ' S ADDRESS: RELATIONSHIP OF DONEE: ORGANIZATIONAL STATUS OF DONEE: FMV OF PROPERTY: DESCRIPTION OF PROPERTY: DATE OF GIFT: MEDICAL ASSISTANCE HRH CROWN PRINCESS KATHERINE FOUNDATION THE ROYAL PALACE BELGRADE, BELGRADE 11040 RB NONE GRANT 55,234. MEDICAL EQUIP & SUPPLIES 55,234. PURCHASED RESALE VALUE TOTAL $ 226,143. MEDICAL ASSISTANCE FOUNDATION OF HRH CROWN PRICESS KATHERIN THE ROYAL PALACE BELGRADE, BELGRADE 11040 RB NONE GRANT $ 170,909.

BOOK VALUE:
METHOD USED TO DETERMINE BV: METHOD USED TO DETERMINE FMV:

2011
CLIENT 1601 7/24/12 STATEMENT 7

FEDERAL STATEMENTS
LIFELINE HUMANITARIAN ORGANIZATION
OF CHICAGO

PAGE 3
36-3894439 05 23PM

FORM 990-PF , PART II , LINE 14 LAND, BUILDINGS , AND EQUIPMENT

CATEGORY FURNITURE AND FIXTURES MACHINERY AND EQUIPMENT $ TOTAL $ BASIS 7,848. 3,579. 11,427. $ $ ACCUM. DEPREC. 7,848. 3,579. 11,427. $ $ BOOK VALUE 0. 0. 0. $ $ FAIR MARKET VALUE 0. 0. 0.

STATEMENT 8 FORM 990-PF, PART VIII, LINE 1 LIST OF OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES
TITLE AND AVERAGE HOURS PER WEEK DEVOTED PRESIDENT 20.00 $ COMPENSATION 0. CONTRIBUTION TO EBP & DC $ 0. $ EXPENSE ACCOUNT/ OTHER 0.

NAME AND ADDRESS KATHY FANSLOW 155 N MICHIGAN AVE, SUITE 409

CHICAGO,

IL 60601
SUITE 409 TREASURER 5.00 0. 0. 0.

MELANIE SEVER 155 N MICHIGAN AVE,

CHICAGO,

IL 60601
SUITE 409 SECRETARY 30.00 30,600. 0. 0.

VICKI ZAMMICHIELI 155 N MICHIGAN AVE,

CHICAGO,

IL 60601
SUITE 409 DIRECTOR 0 0. 0. 0.

ANDRIANA IVANOVIC 155 N MICHIGAN AVE,

CHICAGO,

IL 60601
DIRECTOR 0 0. 0. 0.

MARINA MIHAILOVIC CATO 155 N MICHIGAN AVE SUITE 409

CHICAGO, IL 60601
DRAGANA CUPIC 155 N MICHIGAN AVE, SUITE409 DIRECTOR 0 0. 0. 0.

CHICAGO, IL 60601
THOMAS KARACIC 155 N MICHIGAN AVE, CHICAGO, IL 60601 SUZANNE LEMIGNOT SUITE 409 DIRECTOR 0 0. 0. 0.

DIRECTOR

0.

0.

0.

155 N MICHIGAN AVE, SUITE 409 CHICAGO, IL 60601

NADA MLINAREVIC 155 N MICHIGAN AVE, CHICAGO, IL 60601 SUITE 409

0
DIRECTOR 0 0. 0.

0.

2011
CLIENT 1601 7/24/12 STATEMENT 8 (CONTINUED)

FEDERAL STATEMENTS
LIFELINE HUMANITARIAN ORGANIZATION
OF CHICAGO

PAGE 4
36-3894439 05 23PM

FORM 990-PF , PART VIII, LINE 1 LIST OF OFFICERS , DIRECTORS , TRUSTEES , AND KEY EMPLOYEES
TITLE AND AVERAGE HOURS PER WEEK DEVOTED DIRECTOR 0 $ COMPENSAT ION 0. CONTRIBUTION TO EBP & DC $ 0. $ EXPENSE ACCOUNT/ OTHER 0.

NAME AND ADDRESS SANDY RADOJA 155 N MICHIGAN AVE, SUITE 409

CHICAGO,

IL 60601 DIRECTOR
SUITE 409 0

ZIKA PAVLOVIC
155 N MICHIGAN AVE, CHICAGO, IL 60601 NADEZDA D. RAKIC 155 N MICHIGAN AVE,

0.

0.

0.

SUITE 409

DIRECTOR 0

0.

0.

0.

CHICAGO, IL 60601
JELENA STOJAKOVIC 155 N MICHIGAN AVE, SUITE 409 DIRECTOR 0 0. 0. 0.

CHICAGO,

IL 60601
SUITE4 09 VICE PRESIDENT 0 0. 0. 0.

VESNA ZAFIROVSKI 155 N MICHIGAN AVE, CHICAGO, IL 60601 LYNN SVILAR 155 N MICHIGAN AVE, CHICAGO, IL 60601 DEJAN VUCIC 155 N MICHIGAN AVE,

SUITE 409

DIRECTOR 0

0.

0.

0.

SUITE 409

DIRECTOR 0

0.

0.

0.

CHICAGO,

IL 60601 DIRECTOR
SUITE 409 0

LJUBA STOJILJKOVIC
155 N MICHIGAN AVE, CHICAGO, IL 60601

0.

0.

0.

VERA BJELOPETROVICH 155 N. MICHIGAN AVE. SUITE 409 LINCOLNWOOD, IL 6071 2

DIRECTOR 0

0.

0.

0.

TOTAL $

30, 600. $

0. $

0.

STATEMENT 9 FORM 990-PF , PART XV, LINE 2A-D APPLICATION SUBMISSION INFORMATION
NAME OF GRANT PROGRAM: NAME: CARE OF: STREET ADDRESS: CITY, STATE, ZIP CODE: TELEPHONE: FORM AND CONTENT: SUBMISSION DEADLINES: GRANT REQUESTS VICKI ZAMMICHIELI 155 NORTH MICHIGAN AVE SUITE 409 CHICAGO, IL 60601-5908 (312) 781-9300 WRITTEN DESCRIPTION OF NEED, AMOUNT NEEDED, TO ENSURE PROPER AUTHORIZATION OF FUNDS NONE

AND PROCEDURE

2011
CLIENT 1601 7/24/12 STATEMENT 9 (CONTINUED)

FEDERAL STATEMENTS
LIFELINE HUMANITARIAN ORGANIZATION
OF CHICAGO

PAGE 5
36-3894439 05 23PM

FORM 990-PF, PART XV, LINE 2A-D APPLICATION SUBMISSION INFORMATION

RESTRICTIONS ON AWARDS: AWARDS ARE MADE BASED UPON NEED AND IN THE SPIRIT OF THE ORGANIZATION'S CHARITABLE PURPOSE.

12/31/11
CLIENT 1601
7/24/12

2011 FEDERAL BOOK DEPRECIATION SCHEDULE

LIFELINE HUMANITARIAN ORGANIZATION OF CHICAGO
PRIOR 179/
BONUS/ SP DFPR

PAGE 1
36-3894439
05 23PM

CUR
DFSCRIPTION FORM 990/990-PF DATE A(COIIIRFD DATE 501 D COST/ RASIS BUS Pf.T 179 BONUS

SPECIAL
DEPR Al I OW

PRIOR
DEC BAL DFPR

SALVAG
/BASIS RFOIICT DEPR BASIS PRIOR DFPR MFTHOD RATF CURRENT DFP

FURNITURE AND FIXTURES 1 FURNITURE TOTAL FURNITURE AND FIXTURE MACHINERY AND EQUIPMENT COPY MACHINE TELEPHONE COMPUTER TOTAL MACHINERY AND EQUIPME 1/01/03 1/01/03 1/01/03 370 212 2,997 3,579 0 0 0 0 0 370 212 2,997 3,579 360 204 2,914 3,478 200DB HY 200DB HY 200DB HY 5 5 5 10 8 83 101 1/01/03 7,848 7,848 0 0 0 0 0 7,848 7,848 6,936 6,936 200DB HY 7 912 912

2 3 4

TOTAL DEPRECIATION

11,427

11,427

10,414

1,013

GRAND TOTAL DEPRECIATION

11,427

11,427

10,414

1,013

Form

8868

(Rev January 2012) Department of the Treasury

Application for Extension of Time To File an Exempt Organization Return

^ File a separate application for each return.

OMB No 1545-1709

Internal Revenue Service

If you are filing for an Automatic 3-Month Extension , complete only Part I and check this box If you are filing for an Additional (Not Automatic) 3-Month Extension , complete only Part 11 (on page 2 of this form) Do not complete Part // unless you have already been granted an automatic 3-month extension on a previously filed Form 8868

^ X

Electronic filing (e-fi/e). You can electronically file Form 8868 if you need a 3-month automatic extension of time to file (6 months for a corporation required to file Form 990-T), or an additional (not automatic) 3-month extension of time You can electronically file Form 8868 to request an extension of time to file any of the forms listed in Part I or Part II with the exception of Form 8870, Information Return for Transfers Associated With Certain Personal Benefit Contracts, which must be sent to the IRS in paper format (see instructions). For more details on the electronic filing of this form, visit www us go viefrle and click on a-file for Charities & Nonprofits

Part I

Automatic 3-Month Extension of Time . Onl y submit ori g inal (no cop ies needed) .
^

A corporation required to file Form 990-T and requesting an automatic 6-month extension - check this box and complete Part I only

All other corporations (including 1120-C filers), partnerships, REMICS, and trusts must use Form 7004 to request an extension of time to file income tax returns Enter filer's identifying number, see instructions
Name of exempt organ i zat i on or other filer , see instructions Type or Employer identif i cation number ( EIN) or LIFELINE HUMANITARIAN ORGANIZATION

print
File by the due date for t re rn See returnyour

OF CHICAGO
Number , street , and room or suite number If a P 0 box, see instructions

X136-38 94439
Social security number (SSN)

155 N. MICHIGAN AVE.

SUITE 409

instructions

City, town or post office, state , and ZIP code For a foreign address , see instructions

CHICAGO, IL 60601
Enter the Return code for the return that this application is for (file a separate application for each return) Application Is For Form Form Form Form Form Form 990 990-BL 990-EZ 990-PF 990-T (section 401(0 or 408(a) trust) 990-T (trust other than above ) Return Code 01 02 01 04 05 06 Ap plication Is For Form Form Form Form Form Form 990-T (corporation) 1041-A 4720 5227 6069 8870

04
Return Code 07 08 09 10 11 12

The books are in the care of TelephoneNo

^ VICKI- ZAMMICHIEL ----------------------------------9300 -____ FAX No ^

---------------^ 9 If the organization does not have an office or place of business in the United States, check this box If this is for the whole group, If this is for a Group Return, enter the organization ' s four digit Group Exemption Number (GEN) ^ 9 and attach a list with the names and EINs of all members ^ 9 If it is for part of the group , check this box check this box for. the extension is 1 I request an automatic 3 - month (6 months for a corporation required to file Form 990 - T) extension of time until , 20 12 _ , to file the exempt organization return for the organization named above 8/15 The extension is for the organization ' s return for ^ ^ 2 XX calendar year 20 11 tax y ear beg innin g or , 20 , and endin g , 20 9Initial return 9 Final return

If the tax year entered in line 1 is for less than 12 months , check reason 9 Change in accounting period

3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax pa y ments made Include an y p rior year overpayment allowed as a credit c Balance due . Subtract line 3b from line 3a Include your payment with this form, if required, by using EFTPS (Electronic Federal Tax Pa y ment S ystem) See instructions

3a $ 3b l $

0. 0. 0.

3c 1 $ Caution . If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instructions
BAA For Paperwork Reduction Act Notice , see Instructions . FIFZ0501L 01/04/12

Form 8868 (Rev 1-2012)