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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
LUNG CANCER INITIATIVE
 
Employer identification number
26-2300885
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) THE V FOUNDATION
106 TOWERVIEW CT
CARY,NC275133595 		13-3705951 501(C)(3) 150,000       LUNG CANCER RESEARCH
(2) DUKE UNIVERSITY
PO BOX 602651
CHARLOTTE,NC28260 		56-0532129 501(C)(3) 35,000       LUNG CANCER RESEARCH
(3) ATRIUM HEALTH FOUNDATION
208 EAST BOULEVARD
CHARLOTTE,NC28203 		56-6060481 501(C)(3) 35,000       LUNG CANCER RESEARCH
(4) WAKE FOREST UNIVERSITY HEALTH SCIENCES
MEDICAL CENTER BOULEVARD
WINSTONSALEM,NC27157 		22-3849199 501(C)(3) 50,000       LUNG CANCER RESEARCH
(5) WIND RIVER SERVICES
430 LARSEN LANE
TRYON,NC28782 		20-5941056 501(C)(3) 10,000       LUNG CANCER RESEARCH
(6) PITT COUNTY MEMORIAL HOSPITAL INC
2100 STANTONSBURG RD
GREENVILLE,NC27835 		56-0585243 501(C)(3) 25,000       LUNG CANCER RESEARCH
(7) UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
PO BOX 402420
ATLANTA,GA30384 		56-6001393 STATE OF NC 25,000       LUNG CANCER RESEARCH
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
7
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2018
Page 2

Schedule I (Form 990) 2018
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) GAS CARDS 401 22,900      
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
PART I, LINE 2: GRANTS MADE TO VARIOUS NON-PROFIT ORGANIZATIONS TO FUND RESEARCH GRANTS. ALL ORGANIZATIONS HAVE EXTENSIVE POLICIES IN PLACE TO MONITOR THE USE OF GRANT FUNDS. THE CRITERIA FOR A PATIENT TO RECEIVE A GAS CARD IS THAT THEY ARE A RESIDENT OF NORTH CAROLINA AND THAT THEY ARE CURRENTLY RECEIVING TREATMENT FOR A LUNG CANCER DIAGNOSIS. THERE IS AN APPLICATION THAT THE PATIENT FILLS OUT WITH THEIR NURSE/PATIENT NAVIGATOR WHO MUST ALSO SIGN-OFF ON THE APPLICATION. THE NURSE/PATIENT NAVIGATOR SENDS THE FORMS TO OUR OFFICE. OUR PROGRAMS STAFF REVIEW THE APPLICATIONS TO ENSURE THEY MEET THE CRITERIA OF LIVING IN NC AND CURRENTLY IN TREATMENT AND TO TRACK THEIR DISTRIBUTION. IN 2018, PATIENTS COULD RECEIVE ONE $50 GAS CARD EVERY QUARTER.
Schedule I (Form 990) 2018



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