OMB No. 1545-0047
SCHEDULE D
(Form 990)
Supplemental Financial Statements
2009
Department of the Treasury
Internal Revenue Service
G Complete if the organization answered 'Yes,' to Form 990,
Part IV, lines 6, 7, 8, 9, 10, 11, or 12.
G Attach to Form 990. G See separate instructions
Open to Public
Inspection
Name of the organization
Employer Identification number
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts Complete if
the organization answered 'Yes' to Form 990, Part IV, line 6.
(a) Donor advised funds
(b) Funds and other accounts
1
Total number at end of year
. . . . . . . . . . . . . . . . .
2
Aggregate contributions to (during year)
. . . . .
3
Aggregate grants from (during year)
. . . . . . . . .
4
Aggregate value at end of year
. . . . . . . . . . . . . .
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control?
. . . . . . . . . . . . . . . . . . . . . .
Yes
No
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor or for any other
purpose conferring impermissible private benefit??
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets
Complete if the organization answered 'Yes' to Form 990, Part IV, line 8.
1 a If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of art, historical
treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIV,
the text of the footnote to its financial statements that describes these items.
b If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art, historical
treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following
amounts relating to these items:
(i) Revenues included in Form 990, Part VIII, line 1
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
$
(ii) Assets included in Form 990, Part X
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
$
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following
amounts required to be reported under SFAS 116 relating to these items:
a Revenues included in Form 990, Part VIII, line 1
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
$
b Assets included in Form 990, Part X
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
$
TEEA3301 02/02/10
Part II Conservation Easements Complete if the organization answered 'Yes' to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of land for public use (e.g., recreation or pleasure)
Preservation of an historically important land area
Protection of natural habitat
Preservation of certified historic structure
Preservation of open space
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the
last day of the tax year.
Held at the End of the Year
a Total number of conservation easements
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 a
b Total acreage restricted by conservation easements
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 b
c Number of conservation easements on a certified historic structure included in (a)
. . . . . . . . . . . . . .
2 c
d Number of conservation easements included in (c) acquired after 8/17/06
. . . . . . . . . . . . . . . . . . . . . .
2 d
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax
year G
4
Number of states where property subject to conservation easement is located G
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations,
and enforcement of the conservation easement it holds?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements
during the year G
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements
during the year G
$
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and
include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for
conservation easements.
BAA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Schedule D (Form 990) 2009
MEDICAL TOURISM ASSOCIATION, INC
26-0753785