SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
AHSC QALICB
 
Employer identification number

81-4978022
Return Reference Explanation
FORM 990 PARTI(1) STATEMENT THE CORPORATION'S PRIMARY MISSION IS TO ACQUIRE AND DEVELOP A HEALTH AND SERVICE CENTER THAT WILL INCLUDE A HEALTH CLINIC, OFFICES AND COMMUNITY SPACE FOR CLASSES, MEAL PROGRAMS, AND OTHER COMMUNITY ACTIVITIES.
FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION HAS PROVIDED COPIES OF FORM 990 TO ALL MEMBERS OF ITS GOVERNING BODY BEFORE FILING FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER IS PROVIDED A COPY OF THE POLICY ANNUALLY AND IT IS REVIEWED AT THE ANNUAL MEETING.
FORM 990, PART VI, SECTION C, LINE 19 THE CORPORATION WILL PROVIDE ITS GOVERNING DOCUMENT, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9: ACCRUED RENT REVENUE PER BOOKS 133,672.
FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES IN THE ORGANIZATION'S AUDIT OVERSIGHT PROCESS DURING THE YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2016


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