Form 4562 (2011) Part V MEDICAL TOURISM ASSOCIATION, INC 26-0753785 Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for entertainment, recreation, or amusement.) Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable. Page 2 Section A ' Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.) 24 a Do you have evidence to support the business/investment use claimed? Yes No 24b If ’Yes,’ is the evidence written? Yes No (a) (b) (c) (d) (e) (f) (g) (h) (i) Type of property (list vehicles first) Date placed in service Business/ investment use percentage Cost or other basis Basis for depreciation (business/investment use only) Recovery period Method/ Convention Depreciation deduction Elected section 179 cost 25 26 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 50% in a qualified business use (see instructions) Property used more than 50% in a qualified business use: 25 27 Property used 50% or less in a qualified business use: 28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 28 29 Add amounts in column (i), line 26. Enter here and on line 7, page 1 29 Section B ' Information on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other ’more than 5% owner,’ or related person. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. 30 Total business/investment miles driven during the year (do not include commuting miles) Total commuting miles driven during the year Total other personal (noncommuting) miles driven Total miles driven during the year. Add lines 30 through 32 Yes 34 35 36 Was the vehicle available for personal use during off-duty hours? Was the vehicle used primarily by a more than 5% owner or related person? Is another vehicle available for personal use? Section C ' Questions for Employers Who Provide Vehicles for Use by Their Employees No Yes No Yes No Yes No Yes No Yes No (a) Vehicle 1 (b) Vehicle 2 (c) Vehicle 3 (d) Vehicle 4 (e) Vehicle 5 (f) Vehicle 6 31 32 33 Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons (see instructions). 37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees? 38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners 39 Do you treat all use of vehicles by employees as personal use? 40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received? 41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.) Note: If your answer to 37, 38, 39, 40, or 41 is ’Yes,’ do not complete Section B for the covered vehicles. Yes No Part VI Amortization (a) Description of costs (b) Date amortization begins (c) Amortizable amount (d) Code section (e) Amortization period or percentage (f) Amortization for this year 42 Amortization of costs that begins during your 2011 tax year (see instructions): 43 44 Amortization of costs that began before your 2011 tax year Total. Add amounts in column (f). See the instructions for where to report FDIZ0812 05/20/11 43 44 217. 217. Form 4562 (2011)