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          <StateAbbreviationCd>GA</StateAbbreviationCd>
          <ZIPCd>30322</ZIPCd>
        </USAddress>
        <RecipientEIN>580566256</RecipientEIN>
        <IRCSectionDesc>501(C)(3)</IRCSectionDesc>
        <CashGrantAmt>25000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <ValuationMethodUsedDesc>CASH</ValuationMethodUsedDesc>
        <PurposeOfGrantTxt>RESEARCH GRANT</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>UCLA RESEARCHEXTRAMURAL FUND MANAGEMENT</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>10889 WILSHIRE BLVD STE 600 BOX</AddressLine1Txt>
          <AddressLine2Txt>951406</AddressLine2Txt>
          <CityNm>LOS ANGELES</CityNm>
          <StateAbbreviationCd>CA</StateAbbreviationCd>
          <ZIPCd>90095</ZIPCd>
        </USAddress>
        <RecipientEIN>956006143</RecipientEIN>
        <IRCSectionDesc>501(C)(3)</IRCSectionDesc>
        <CashGrantAmt>25000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <ValuationMethodUsedDesc>CASH</ValuationMethodUsedDesc>
        <PurposeOfGrantTxt>RESEARCH GRANT</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>ASSOCIATION OF VA SURGEONS FOUNDATION</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 2459</AddressLine1Txt>
          <CityNm>LYNNWOOD</CityNm>
          <StateAbbreviationCd>WA</StateAbbreviationCd>
          <ZIPCd>98036</ZIPCd>
        </USAddress>
        <RecipientEIN>203061458</RecipientEIN>
        <IRCSectionDesc>501(C)(3)</IRCSectionDesc>
        <CashGrantAmt>100000</CashGrantAmt>
        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <ValuationMethodUsedDesc>CASH</ValuationMethodUsedDesc>
        <PurposeOfGrantTxt>SEED MONEY FOR SCHOLARSHIP FUND</PurposeOfGrantTxt>
      </RecipientTable>
    </IRS990ScheduleI>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>ANY ACTIVE MEMBER IN GOOD STANDING SHALL BE ELIGIBLE FOR ELECTION TO OFFICE. THE ELECTION SHALL TAKE PLACE IN THE EXECUTIVE SESSION OF THE ANNUAL MEETING. THE NOMINATING COMMITTEE SHALL PRESENT TO THE MEMBERSHIP A SLATE OF THE CANDIDATES FOR EACH OFFICE DUE TO BE VACATED BY EXPIRATION OF THE TERM OR OFFICE OF THE INCUMBENT OR VACATED BY THE DEATH OR TERMINATION OF AFFILIATION WITH THE DEPARTMENT OF VETERANS AFFAIRS OF THE PREVIOUS INCUMBENT. ADDITIONAL CANDIDATES MAY BE PROPOSED FROM THE FLOOR. CONTESTED ELECTIONS SHALL BE DECIDED BY A SECRET BALLOT. A SIMPLE MAJORITY OF THE MEMBERS PRESENT AND VOTING SHALL ELECT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>QUORUM: FOR THE TRANSACTION OF ORDINARY BUSINESS, THE MEMBERS PRESENT AT ANY EXECUTIVE SESSION SHALL CONSTITUTE A QUORUM. TO EFFECT CHANGES IN THE CONSTITUTION AND BY- LAWS, FOR ASSESSMENTS, APPROPRIATIONS, OR EXPENDITURES OF MONEY OTHER THAN THOSE REQUIRED IN THE ROUTINE BUSINESS OF THE ASSOCIATION, OR FOR THE EXPULSION OF A MEMBER, A MINIMUM OF 40 ACTIVE MEMBERS SHALL BE REQUIRED TO FORM A QUORUM.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>WHEN PRACTICAL, THE 990 WILL BE REVIEWED BY THE EXECUTIVE BOARD. HOWEVER WHEN LOGISTICS PREVENT SUCH A REVIEW, SOMEONE WITHIN THE ORGANIZATION WILL REVIEW THE FORM 990 AND ACCEPT RESPONSIBILTY FOR IT ON THE BOARD'S BEHALF.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 18</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S FORM 1024 AND FORM 990 ARE AVAILABLE FROM THE ORGANIZATION UPON WRITTEN REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE ON ITS WEBSITE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC</FormAndLineReferenceDesc>
        <ExplanationTxt>MARY HAWN, MD - 300 PASTEUR DRIVE, M121 ALWAY, STANFORD, CT 94305. RONNIE ROSENTHAL, MD - 950 CAMPBELL AVE, WEST HAVEN, CT 06515. GEORGE SAROSI, MD - 1601 SW ARCHER RD, GAINSEVILLE, FL 32608. NADER MASSARWEH, MD - 1670 CLAIRMONT RD, DECATUR, GA 30033. DANNY CHU, MD - 200 LOTHROP STREET C-700, PITTSBURGH, PA 15213. EDITH TZENG, MD - 200 LOTHROP STREET, PITTSBURGH, PA 15214. BRIAN SMITH, MD - 5901 EAST 7TH ST, BOX 12112, LONG BEACH, CA 90822. SETH SPECTOR, MD - 1201 NW 16TH STREET, MIAMI, FL 33176.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>ASSOC OF VA SURGEONS FOUNDATION</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>PO BOX 2459</AddressLine1Txt>
          <CityNm>LYNNWOOD</CityNm>
          <StateAbbreviationCd>WA</StateAbbreviationCd>
          <ZIPCd>98036</ZIPCd>
        </USAddress>
        <EIN>203061458</EIN>
        <PrimaryActivitiesTxt>SUPPORT CHARITABLE AND EDUCATIONAL ACTIVITIES OF ASSOC OF VA SURGEONS</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>WA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 7</PublicCharityStatusTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>1</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>0</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>ASSOCIATION OF VA SURGEONS FOUNDATION</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>B</TransactionTypeTxt>
        <InvolvedAmt>100000</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>CASH DONATION</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
