American College of Lifestyle Medicine, IRS 990s 2008 + 2011-Present

OMB No 1545-1150
Short Form
Return of Organization Exempt From Income Tax
Form 99^ÊZ Under section 501 ( c), 527 , or 4947(a)(1) of the Internal Revenue Code 2008
(except black lung benefit trust or pirate foundation)
^ Sponsoring org anizations of donor advised funds and controlling organizations as defined in section _ ■
512(bx13) must file Form 990 All other organizations vnth gross receipts less than $1 , 000 , 000 and total
Department of the Treasury assets less than $2 , 500,000 at the end of the year may use this form.
internal Revenue Service ^ The organiz ation may have to use a copy of this return to satisfy state r ortng requirements., a e
A For the 2008 calendar year, or tax year beginning , 2008, and ending , 20
B Check if applicable Please C Name of organization D Employer identification number
❑ Address change use IRS --
❑ Name change
label or 4^ I 1= SiE_QF__-CIE _ Ê MEDICINE x:.32 (pr 5 =>= =''
Ind pdM or Number and street (or P.O box, if mail is not delivered to street address Room/suite E Telephone number
retur n t ype'
❑ Te„nmauon see 1475 Mt. Hood Avenue
❑ Amended ratan specific City or town, state or country, and ZIP + 4
Instruc F Group Exemption
❑ Appr onpendng Sons. Woodburn , OR 97071 Number . ^
• Section 501 (c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach G Accounting method, © Cash ❑ Accrual
a completed Schedule A (Form 990 or 990-EZ). Other (specify) 10-
reCheck Do- 0 if not

I Website : ^ Ilfestylemedicme.org H quired toattachtSchedule Bfi(Form
J Organization type (check only one)- © 501 c 6 t (insert no. ) ❑ 4947 a 1 or ❑ 527 990-EZ. or 990-PF)
K Check ^ ❑ if the organization is not a section 509(aX3) supporting organization and its gross receipts are normally not more than $25,000 A return is
not required, but if the organization chooses to file a return, be sure to file a complete return.
L Add lines 5b„ 6b, and 7b, to line 9 to determine gross receipts; if $1,000,000 or more, file Form 990 instead of Form 990-EZ ^ $ 33237
Revenue, Expe nses, and Chan ges in Net Assets or Fund Balances (See the instruct ions for Part I.
I Contributions , gifts , grants , and similar amounts received . . . . . . . . . . . . . . 1 10000
2 Program service revenue including government fees and contracts . . . . . . . . . 2
3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . 3 23065
4 Investment income . . . . . . . . . . . . . . . . . . . . 4 172
5a Gross amount from sale of assets other than inventory . . . 5a -
bLess: cost or other basis and sales expenses . . . . _ . 5b
cGain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) (attach schedule) . 5C
6 Special events and activities (complete applicable parts of Schedule G). If any amount is from gaming , check here ^ ❑
aGross revenue (not including $ of contributions
cc reported on line 1 ) . . . . . . . . . . . . . . . . 6a
b Less: direct expenses other than fundraising expenses . . . 6b
c Net income or (loss) from special events and activities (Subtract line 6b from line 6a) . . 6c
7a Gross sales of inventory , less returns and allowances . . . . 7a
b Less: cost of goods sold . . . . . . . . . . . . . . 7b
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) . . . . 7c
8 Other revenue (describe ^ ) 8
9 Total revenue . Add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8. . ^ 9 33237
10 Grants and similar amounts paid (attach schedule) . . . . . . . . . . . . . 10
11 Benefits paid to or for members . . . . . . . . . . . . . . . . . . . . 11
12 Salanes, other compensation , and employee benefits . . . . . . . . . . . . . . 12 10013
13 Professional fees a other payments to independent contractors 13
x 14 Occupancy , rent , ilities , p- s 14
W 15 g , publicatlo s ,
Printing e
16 Other expenses ( `r' be ^ S T ) 16 5403
17 Total expenses. ad lin h 16 110- 17 15416
c 17821
18 Excess or (deficit fbi the year (Sub e 1 m line 9) . . 18
19 Net assets or fu d b têgi n of r (from line 27, column (A)) (must agree with -----
a end-of-year figu y etu ) . . . . . . . . . . . . . . . . 19 -336
20 Other changes in net assets or a ach explanation) . . . . . . . . .
'a 21 Net assets or fund balances at end of year. Combine lines 18 through 20 . ^ 21 17485
Balance Sheets . If Total assets on line 25, column (B) are $2,500,000 or more, file Form 990 instead of Form 990-EZ.
(See the instructions for Part II.) (A) Beginning of year (B) End of year
L -22 Cash , savings , and investments . . . . . . . . . . . . . . . 4664 22 20485

23 Land and buildings . . . . . . . . . . . . . . . . . . . . . . 231
t24 Other assets (describe ^ ) 24
25 Total assets . . . . . . . . . . . 4664 25 20485
. . . . . . . . . .
26 Total liabilities (describe ^ SEE STATEMENT ) 5000 26 3000
27 Net assets or fund balances (l ine 27 of colum n ( B) must agree with line 21) -336 27 17485
For Privacy Act and Paperwork Reduction Act Notice , see the Instruction for Form 990. Cat No 106421 Form 99U -LZ (2008)
From 99n-EZ 120081 Page 2
ON= Statement of Prog ram Service Accom plishments (See the instructions for Part III. Expenses
(Required for 501(cx3)
What is the organization's primary exempt purpose? Bus. Asso. of Doctors and (4) organizations
Describe what was achieved in carrying out the organization ' s exempt purposes. I n a c l ear an d conc i se manne r , an d 4947(aXl) trusts ;
describe the services provided, the number of persons benefited, or other relevant information for each program title. optional for others.)
28 Training, educating physician in health medicine techniques __________________________________ ;
--------------------------------------------------------------------------------------------------------------------------
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Grants $ If this amount includes foreign grants , check here ^ ❑ 28a 15416
29 --------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------
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Grants If this amount includes forei g n g rants , check here ^ ❑ 29a
30 --------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------
Grants $ If this amount includes forei gn grants , check here - ^ ❑ 30a
31 Other program services (attach schedule) . . . . . . . . . . . . . . . . . . . . .
(Grants $ If this amount includes foreign grants , check here ^ ❑ 31a
32 Total program service expenses (add lines 28a through 31a) . ^ 32 15416
JZMMt List of Officers. Directors, Trustees, and Key Employees. List each one even if not compensated. (See the Instructions for Part IV)
(b) Title and average (c) Compensation (d) Contributions to (e) Expense
(a) Name and address hours per week Of not paid, mployee benefit plans 8 account and
devoted to position enter -0-.) deterred compensation other allowances
See List
Form 990 EZ (2ooe)

0
Form 990-EZ (2008) Page 3
statement requirements in the instructions for Part VI
33 `Did the organization engage in any activity not previously reported to the IRS? If "Yes," attach a detailed
description of each activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 ✓
34 Were any changes made to the organizing or governing documents but not reported to the IRS? If "Yes,"
attach a conformed copy of the changes . . . . . . . . . . . . . . . . . . . . . . 34 ✓
35 If the organization had income from business activities, such as those reported on lines 2, 6a, and 7a (among others), but
not reported on Form 990-T, attach a statement explaining your reason for not reporting the income on Form 990-T.
a Did the organization have unrelated business gross income of $1,000 or more or section 6033(e) notice, reporting,
and proxy tax requirements ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35a ✓
b If "Yes," has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . . b ✓
36 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If "Yes,"
complete applicable parts of Schedule N . . . . . . . . . . . . . . 36 ✓
37a Enter amount of political expenditures, director indirect, as described in the instructions . ^ 37a 0 i
b Did the organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . . . 37b ✓
38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were
any such loans made in a prior year and still unpaid at the start of the period covered by this return? . . . ✓
b If "Yes," complete Schedule L, Part II and enter the total amount involved . . . . 38113
39 Section 501(c)(7) organizations. Enter
a Initiation fees and capital contributions included on line 9 :
b Gross receipts, included on line 9, for public use of club facilities . . . . . . . . ..!
40a Section 501(c)(3) organization Enter amount of tax imposed on the organization during the year under:
section 4911 ^ ;section 4912 ^ ; section 4955 ^
b Section 501 (c)(3) and (4) organizati s. Did the organization engage in any section 4958 excess benefit transaction
during the year or did it become awar of an excess benefit transaction from a prior year? If Yes," complete Schedule
L, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T4Obr
c Enter amount of tax imposed on orga ation managers or disqualified persons during
the year under sections 4912, 4955, an 4958 . . . . . . . . . . . . . ^
d Enter amount of tax on line 40c reimburs by the organization . . . . . . . . ^
e All organizations. At any time during the ear, was the organization a party to a prohibited tax shelter .
transaction? If `Yes," complete Form 8886- . . . . . . . . . . . . . . . . . . . . . 40e
41 List the states with which a copy of this return is filed ^ California
42a The books are in care of ^ _ Dr.-Braman Telephone no. ^ ------ ----------__-----__
Located at ^ Addresspa9e I--------------------------------------------------------------
--------------------------------------------------- ZIP + 4 ^ ---------------------------
b At any time during the calendar year, did the organization have an interest in or a signature or other authonty
over a financial account in a foreign country (such as a bank account, securities account, or other financial Yes No
account)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42b ✓
If "Yes," enter the name of the foreign country: ^ Y
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank
and Financial Accounts.
c At any time during the calendar year, did the organization maintain an office outside of the U.S.? . . 42c ✓
If "ryes," enter the name of the foreign country: ^
43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 -Check here . . . . . . ^ ❑
and enter the amount of tax-exempt interest received or accrued during the tax year . . . . . ^ 143 I
Yes No
44 Did the organization maintain any donor advised funds? If "Yes," Form 990 must be completed instead of --
Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 ✓
45 Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)? If
"y'es." Form 990 must be completed instead of Form 990-EZ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 45 ✓
Form 990-EZ (2008)
V
Form g90-EZ (2008) Page 4
Section 501 (b (3) organizations only. All section 501 must answer quest
and complete tke tables for lines 50 and 51.
4,6 Did the organization enga in direct or indirect political campaign activities on behalf of or in opposition to Yes No
candidates for public office f "Yes," complete Schedule C, Part
47 Did the organization engage i obbying activities? If "Yes," Complete Schedule C, Part II . . . . . . . 47
48 Is the organization operating a s' ool as described in section 170(b)(1)(A)()? If "Yes," complete Schedule E 48
49a Did the organization make any tra fens to an exempt non-charitable related organization? . . . . . . 49a
b If "Yes," was the related organizatio s) a section 527 organization ? . . . . . . . . . . . . . . 49b
50 Complete this table for the five high compensated employees (other than officers, directors, trustees and key employees) who
each received more than $100,000 of pensation from the organization. If there is none, enter "None."
(b) Title and average (c) Compensation (d) Contributions to (e) Expense
(a) Name and address of each employee paid more hours per week employee benefit plans & account and
than $ 100,000 devoted to position deferred compensation other allowances
--------------------------------------------------------------
--------------------------------------------------------------
--------------------------------------------------------------
--------------------------------------------------------------
---------------------------------------------------------------
Total number of other employees paid over $100,000 ^

51 Complete this table for the five highest compensated independent oo ctors who each received more than $100,000 of
compensation from the organization . If there is none, enter "None."
(a) Name and address of each independent contractor paid more than $ 100,000 (b) Type of service (c) Compensation
------------ ------------------------------------------------------------------------------- ----
------------ ------------------------------------------------------------------------------- --------
------------ ------------------------------------------------------------------------------- --------
------------ ------------------------------------------------------------------------------- --------
------------ ------------------------------------------------------------------------------- --------
Total number of other independent contractors each receiving over $ 100,000 . . ^

Under penalties of pequry, I declare that I have examined this return , including accompanying schedules and statements, and to the best of my knowledge
and belief , it i true, correct , and complete . Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge-
Sign
Here signatu re of officer
W"AW
' Type or pnnt name and tit le.
Paid Preparer's
signature
Pmm $ nrm 's name (or yours
Use Only if self-employed). 34629 Q=ina Tr,
address, and ZIP + 4 Ia MLrada Ca . 63$
May the IRS discuss this return with the oreoarer shown above?
Page 1 of 3
LCarl Corsi
From: Kathy Cater [kcater@fifestylemedicine.org]

Sent: Friday, February 27, 2009 3:52 PM
To: Carl Corsi
Subject : ACLM requested information
Dear Mr. Corsi,
Here is the information you requested for our tax statement. I have not heard from all of our board
members. Can we use an average time for them?
We had an election in May that was finalized in June. At that point, some members were added, and in
the case of John Kelly, his official status changed from President to Immediate Past President.
John Kelly
Presidendlmmediate Past President
For 2008
Jan - 8h
Feb - 8h
Mar-8h
Apr - 9h
May - 10h
Jun - 9h
Jul - 9h
Aug-12h.
Sep - 20h
Oct - 8h
Nov - l0h
Dec - 9h
Total 120h
467 Misty Lane

Boones Mill, VA 24065
Marc Braman
Secretary/President
Estimated hours per month: 50
1475 Mt. Hood Ave

Woodburn, OR 97071
Wayne Dysinger
President Elect
24785 Stewart Street. EH 101

Page 2 of'3
Gordon Betting
Treasurer
401 Taylor Blvd

Pleasant Hill , CA 94523
Hans Diehl
Director
11538 Anderson Street

Loma Linda, CA 92354
Joel Fuhrman
Director
22 Buchanan Way
Flemington , NJ 08822
Wes Youngberg
Director
43183 Corte Cabrera

Temecula , CA 92592
John Westerdahl
Director
Bragg Health Foundation

199 Winchester Canyon Rd
Santa Barbara, CA 93117
Ron Stout
Director (added in June election)
8700 Mason Montgomery Rd

Mason , OH 45040
Greg Steinke
Young Director (added in June election)
25231 La Mar Rd Apt C

Loma Linda, CA 92354
Liana Lianov
Director ('added in June election)
rage 1 01 r
.Carl Corsi
From : Kathy Cater [kcater@lifestylemedicine.org]

Sent: Sunday, March 01 , 2009 4:03 PM
To: Carl Corsi
Subject : Fwd: ACLM tax statement information needed from 2008 board members
Hi Mr Corsi,
Here is one more board member's estimate of hours spent.
Kathy
Begin forwarded message:
From : Greg Steinke <greg_steinke@gmail com>

Date : March 1, 2009 11:10:15 AM PST
To: Kathy Cater <kcater@ifestylernedicine_ org>
Subject : Re: ACLM tax statement information needed from 2008 board members
I estimate 2 hours per month so far.
Greg.
On Wed, Feb 25 , 2009 at 2 :27 PM. Kathy Cater <kcater0a lifcstylemedicine _ org> wrote:
Greetings,
Mr. Carl Corsi is preparing our tax statement, and needs an estimate of time spent on
ACLM from each of our 2048 board members . He suggested a monthly estimate/average
number of hours spent.
If you would send your best approximation to tne, I will compile it with all the
information Mr. Corsi has requested.
Thank you,
Kathy
kcatcrtc lifcstylcmedicinc.org
American Collc L c of Lifestyle Medicine
c/o Wellspring Medical Centci
1475 Mt Hood Ave.
Woodbuni. OR 9707 i
9 71-9S I-538_;
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Abcu: ACIM Find a Memoer Membership Education Events ACLM News Contact
Home What Is Lifestyle Medicine?
Baard of P.d V11^L5 I ors-2Lett4L5
About ACLM
The American College of Ufestyle Medicine (ACLM) Is a new national medical specialty
society. It has been formed In answer to the need for quality education and certification of
the practice In clinical lifestyle medidne.
As the ffnt national specialty society for clinicians emphasizing the use of lifestyle
interventions In the treatment and management of disease , the ACLM Is currently working
to develop formal recognition for this important field of medical practice and research. In
the future, It Is the goal of the ACLM to establish an official Board of Lifestyle Medicine that
wi'I grant board certification In Ufestyle Medfdne.
Formed in 2004 in California, the ACLM has member's across the United States and international membership Is growing
rapIdly. The value of Ufestyle Medicine is becoming recognized by all aspects of medical practice. and ACIM members
represent the broad diversity of the medical profession. Members Include primary care physicians, specialists, researchers,
professors, students, public spokespersons, hospital administrators, nutritionists, pu'Jtic health professionals, and many
others.
;rl, ti AC.'
American College of Lifestyle Medicine
I',•.veied by s/I d Apnr;'t - Membe,sh c nanôe'r'.^nt datah.I c' Online event renistratia.,
mteqra.ed wt'[)-, to fo ^,noc nt c, s cI^ h5, rhr.lirirs and other non-p outs
2/25/2009
http ://www.lifestylemedicine . org/aboutA.CLM
Amrican 00 lege of T i festy a MBdicine: 501 (c) (6) entity. 32 0204851
• SIYXIDM RE OIHER FMS:
I 1 fees, serums:( 1080
riaa.irg, gr hics 1048
Tn site 2400
Various fees, aaypal, lark etc 312
Office sullies, voice nail 563
total casts 5403
SDi'IE tEN OF PLUOCNIS PA)ME LM: $ 3000. Involves a loan frmn an officer of
this entity, which is being said laic by AQM at $ 10M per month.
It is an in^t free lean, nada wIm the entity was in effect
starting up in a r area, and men ri smL- flans.
Short Form OMB No 1545-1150
Fonn 990-EZ Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1)of the Internal Revenue Code ~(Q)11
(except black lung benefit trust or private foundation)
... Sponsoringorganizationsof donor advisedfunds, organizationsthat operateone or more hospitalfacllllles,
and certain controllingorganizationsas defined In section 512(b)(13)mustfile Form990 (see instructions) Open to Public
All other orqsmzanonawith gross receiptsless than $200,000and total assets less than $500,000
Departmentof theTreasury at the end of the year may use this form Inspection
InternalRevenueService ... The 0 emzsuon ma have to use a co of this return to ssns state re ortm re uuements
A For the 2011 calendar year, or tax year beginning ,2011, and ending ,20
B Checkd applicable, C Nameof orqamzatcn o Employer Identification number
o Addresschange American College of Lifestyle Medicine 32-0208451
o Namechange
D Imtlal return
Numberand street (or PObox, If mau is not deliveredto street address) I Room/SUite E Telephone number
o Termmated
612 Glatt Circle 971-983-5383
oo Amended return
Application
pending
City or town, state or country,and ZIP + 4
Woodburn, Oregon 97071
F Group Exemption
Number ...
G Accounting Method, IX! Cash o Accrual Other (specify) ... H Check ... 00 if the organization IS not
I Website: ... lifestylernedicine.org required to attach Schedule B
J Tax-exempt status (check only one) - 0 501 (c)(3) 00501 (c)( 6 )....
(Insert no ) 0 4947(a)(1) or 0527 (Form 990, 990-EZ, or 990-PF),
K Check" 0 If the crqaruzatron IS not a section 509(a)(3) supporting organization or a section 527 organization and its gross receipts are normally
not more than $50,000, A Form 990-EZ or Form 990 return IS not required though Form 990-N (e-postcard) may be required (see instructions) But If
the organization chooses to file a return, be sure to file a complete return,
L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts If gross receipts are $200,000 or more, or If total assets (Part II,
line 25, column (8) below) are $500,000 or more, file Form 990 Instead of Form 990-EZ ... $ 14 1, 84 6
Id.1 Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I.)
Ch ec k Ilf th e orgamza
izat Ion use d Sc he d ue Ion iIn thiIS Pa rt I
lOt o respon d to any ques tion IX!
1 Contributions, gifts, grants, and Similaramounts received 1
2 Program service revenue including government fees and contracts 2 93,271
3 Membership dues and assessments , 3 46,278
4 Investment income 4
5a Gross amount from sale of assets other than inventory l sal . (~';
b Less: cost or other basis and sales expenses , I 5b I ~...\(~.:,'
c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) 5c 0
S Gaming and fundraising events 4",:--tt,'''''
a Gross Income from gaming (attach Schedule G if greater than Y, }

" >
(II
::::I $15,000) , I Sa I"' ).
e
GI
> b Gross income from fundrarsmq events (not including $ of contributions hk(:
(II
a:: from fundraising events reported on line 1) (attach Schedule G if the
sum of such gross income and contributions exceeds $15,000) , ISb I 1,~~1~
c Less: direct expenses from gaming and fundraislng events I Sc I . '1
d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract ;\t h
- -line 6c) Sd 0
7a Gross sales of inventory, less returns and allowances 7a I I';
I"
,
b Less' cost of goods sold I 7b I

'E 0' -
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) , , 7c 0
8 ,
Other revenue (descnbe In Schedule 0) , , , , , " ,', 8 2,297
9 Total revenue. Add lines 1,2,3,4, 5c, 6d, 7c, iaa a ocr.F\V, '" 9 .... 141,846
10 Grants and Similar amounts paid (list in Schedu e O~:- --:-, , ,'w,10
11 Benefits paid to or for members , , , , , -g, , , 1 S 20W, ' q 11
III 12 Salaries, other compensation, and employee be t!{fj~" ~ 12 38,128
U1 ,- '1 '
(II
III
e 13 Professional fees and other payments to indepe ~ t contrastgrs ,- 13 9,317
w
(II
Q.
)(
14 Occupancy, rent, utilities, and maintenance \ OGOE\\\'. ' - , 14 6,728
15 Printing, publications, postage, and shippmq ._ 15 497
1S Other expenses (describe In Schedule 0) 1S 82,871
17 Total expenses. Add lines 10 through 16 17 .... 137,541
.I!l
18 Excess or (deflcit) for the year (Subtract line 17 from line 9) 18 4,305
(II
III
19 Net assets or fund balances at beginning of year (from line 27, column (A» (must agree with ~,~
III end-of-year figure reported on prior year's return) 19 9,040
...
c(
(II 20 Other changes in net assets or fund balances (explain In Schedule 0) , 20
z .... 21
21 Net assets or fund balances at end of year, Combine lines 18 through 20 13,345
For Paperwork Reduction Act Notice, see the separate instructions. Form 990-EZ (2011)
ISA
-r.
Form990·EZ(2011) Page 2
IGIII Balance Sheets. (see the instructions for Part II.)
Check if the organization used Schedule 0 to respond to any ques Ion in this Part II D
(A) Beginningof year (8) Endof year
22 Cash, savings, and investments 9,040 22 13,345

23 Land and buildings 23
24 Other assets (describe in Schedule 0) 24
25 Total assets 9,040 25 13,345
26 Total liabilities (describe in Schedule 0) 26
27 Net assets or fund balances (line 27 of column (8) must agree with line 21) 9,040 27 13,345
1::F.T11111 Statement of Program Service Accomplishments (see the instructions for Part III.)
Expenses
____ ....:C:..:h..:.:e:..:c..:.:k~if:....;t:..:h.=.e...:o..:"rg"'"'a:..:n....:lz::.:a....:ti:..:o....:n...:u:..:s.=.e.:;_d...:S...:c....:h.:;_ed.:...u:..:l,:_e...:O_t....:o-:,r.::..e..::.Jsp,,-lo=-:n_:d_t:..:o...
(Requiredfor section
What is the organization's primary exempt purpose? Medical education 501(c)(3)and501(c)(4)
organizationsand section
Describe the organization's program service accomplishments for each of its three largest program services, 4947(a)(1)trusts;optional
as measured by expenses, In a clear and concise manner, desenbe the services provided, the number of for others.)
persons benefited, and other relevant information for each program title.
28
29
30
31 Other program services (describe in Schedule 0)

(Grants $ ) If this amount includes foreign grants, check here .... D 31a
32 Total program service expenses (add lines 28a through 31a) .... 32
1:lffiIL'JI List of Officers, Directors, Trustees, and Key Employees. List each one even If not compensated. (see the instructions for Part IV)
Check If the organization used Schedule 0 to respond to an" question In this Part IV . . . . . . D
(e) Reportable (d) Healthbenefits,
(b)Title and average compensation contributionsto employee (e) Estimatedamountof
(a) Nameand address hoursperweek
devotedto positron (FormsW·211099·MISC) benefitplans,and othercompensation
(If not paid, enter ·0·) deferredcompensation
Liana Lianov
-------------------------------------------------------------------------- President
1 o o o
David L. Katz
-------------------------------------------------------------------------- Pres Elect
1 o o o
~.i?:y.I].~
...Qy.~.~!!_g~E........................................Pas t Pre s
1 o o o
§.~~E.g~
...~.~!:bEJ:.E?........................................ Sec /Trea s
1 o o o
Form 990-EZ (2011)

3
'C"
Form 990-EZ (2011)
Other Information (Note the Schedule A and personal benefit contract statement requirements in the
instructions for Part V.) Check if the organization used Schedule 0 to respond to any question in this Part V
Page
IX!
Yes No
33 Old the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a
detailed description of each activity in Schedule 0 33 X
34 Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed
copy of the amended documents If they reflect a change to the organization's name. Otherwise, explain the
change on Schedule 0 (see Instructions) 34 X
35a Did the organization have unrelated business gross income of $1,000 or more during the year from business
activities (such as those reported on lines 2, 6a, and 7a, among others)? 35a X
b If "Yes,"to line35a,hasthe organizationfileda Form990-T for the year?If UNo,"providean explanationin Schedule0 1-'3;_;5;.;;:b+-_-I-_
C Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice,
reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III 35c X
36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets
during the year? If "Yes," complete applicable parts of Schedule N 36 X
37a Enter amount of political expenditures,direct or Indirect,as describedIn the instructions. .... 1'-'3:....:7....:a:...JI 0-l _j
b Did the organization file Form 1120-POL for this year? 37b X
38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were _j
any such loans made in a prior year and stili outstanding at the end of the tax year covered by this return? 38a X
b If "Yes," complete Schedule L, Part II and enter the total amount involved 38b
1--;------1
39 Section 501(c)(7) organizations. Enter: __
a Initiation fees and capital contributions included on line 9 1-'3:....:9:.=a+- --I
b Gross receipts, included on line 9, for public use of club facihties '-'3:....:9;.;;:b:...J.... --I
40a Section 501(c)(3) organizations. Enter amount of tax Imposed on the organization during the year under:
section 4911 .... , section 4912.... , section 4955 ....
b Section 501(c)(3) and 501(c)(4) organizations Did the organization engage in any section 4958 excess benefit -----
transaction dunng the year, or did It engage In an excess benefit transaction in a pnor year that has not been
reported on any of Its prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I 40b
c Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on
organization managers or disqualified persons during the year under sections 4912,
4955, and 4958 . ....
d Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c
reimbursed by the organization ....
e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter
-----
transaction? lf 'Yes." complete Form 8886-T. 40e
41 List the states with which a copy of this return ISfiled. ....
42a The organization's books are in care of ....!'::1-'?:E_<?:.
-----------------~~~~~~~~
__.!?_~§~~!._l_________________________________ Telephone no. ....97 1- 9 8 3 - 5 3 8 3
Located at .... _?J~ ~J~!:_t 2~7~Q-7T::-96-7-5-----
f_~E_<?:.~.§_L __~~s?_s!~_I}._~!._l_!_ Q~.§_g~_I)_______________ ZIP + 4.... -------
b At any time dunng the calendaryear, did the organizationhave an interest in or a signatureor other authority over Yes No
a financial account in a foreign country (suchas a bank account,secunnesaccount,or other financial account)? 42b X
If "Yes," enter the name of the foreign country: ....
c
See the instructions for exceptions and filing requirements for Form TO F 90-22.1, Report of Foreign Bank
and Financial Accounts.
At any time dunng the calendar year, did the organization maintain an office outside the U.S.? .
-- ---
42c X
_J
If "Yes," enter the name of the foreign country· ....
43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041-Check here .... .... 0
and enter the amount of tax-exempt interest received or accrued during the tax year .... 143 I
Yes No
--- -- _j
44a Did the organization maintain any donor advised funds dunnq the year? If "Yes," Form 990 must be
completed instead of Form 990-EZ 44a X
b Old the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be
--- -- _I
completed instead of Form 990-EZ 44b X
c Old the organization receive any payments for indoor tanning services during the year? 44c X
d If "Yes" to line 44c, has the organization filed a Form 720 to report these payments? If "No," provide an --
-- _j
explanation in Schedule 0 44d
45a Did the organization have a controlled entity within the meaning of section 512(b)(13)? 45a X
45b Did the organization receive any payment from or engage in any transaction with a controlled entity within the
meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of
Form 990-EZ (see instructions) .
-- --
45b X
___
J
Form 990-EZ (2011)
Form990-EZ(2911) Page4
Yes No
46 Old the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition L ,,~
to candidates for public office? If "Yes," complete Schedule C, Part I . . . . . . ITs-- X
l::Iffiia'JI Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section
501 (c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47-49b
and 52, and complete the tables for lines 50 and 51.
Ch ec k If t h e orqaruza
. tlIon use d S c he d uelOt o respon d t o any ques tion
Ion lIn thiIS P a rt VI D
Yes No
47 Did the organization engage in lobbymq activities or have a section 501 (h) election in effect during the tax
year? If "Yes," complete Schedule C, Part II 47
48 Is the organization a school as descnbed in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E 48
49a Did the organization make any transfers to an exempt non-charitable related organization? 49a
b If "Yes," was the related organization a section 527 organization? 49b
50 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key
employees) who each received more than $100,000 of compensation from the organization. If there IS none, enter "None."
(b)Titleandaverage (d)Healthbenefits,
(a)Nameandaddressof eachemployee (c)Reportable contnbunons to employee (e)Estimatedamountof
paidmorethan$100,000 hoursperweek compensation
devotedto posinon (FormsW-2/1099-MISC)benefitplans,anddeferred othercompensation
compensation
f Total number of other employees paid over $100,000 . . . . ... _

51 Complete this table for the organization's five highest compensated independent contractors who each received more than
$100,000 of compensation from the organization If there IS none, enter "None."
(a)Nameandaddressof eachIndependent
contractorpaidmorethan$100,000 (b)Typeof service (e) Compensation
d Total number of other independent contractors each receiving over $100,000 . . ... _
52 Old the organization complete Schedule A? Note' All section 501 (c)(3) organizations and 4947(a)(1)
nonexempt charitable trusts must attach a completed Schedule A . . . . . ... DYes D No
Underpenaltiesof perjury, I declarethatI haveexaminedthiSretum,includingaccompanyingschedulesandstatements,andto thebestof myknowledgeandbelief,It IS
true,correct,andcompleteDeclaration of preparer(otherthanofficer)ISbasedonall informationof whichpreparerhasanyknowledge
S-/~-I:;2..
Sign ~ Signatureof officer Date
Here ~ Marc Braman, Executive Director
r Typeor pnntnameandtitle
Paid Pnnvrypepreparer'sname PTIN
Preparer~T~h~e~o~d~o~r~e~R~._A~h~r~e-= __ ~~~~~~ __ ~~~~~~~~~~~~~P~0~0~0~6~4~0~8~2~
UseOnly~F~lr~m~'s~n=am~e~~~_T~h~e~o~d~o_r~e~~~_~r_e_,~~_~ ~=-~~~ __ ~~~~~~~~~~~ __
Flrm'saddress~576 Glatt rcle, Woodburn, OR 97071
May the IRS discuss this return With the preparer shown above? See instructions
Form990-EZ (2011)
SCHEDULED OMB No 1545-0047
(FonY:I990 or 990-EZ) Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on ~(Q)11
Form 990 or 990-EZ or to provide any additional information. Open to Public
Department of the Treasury
Internal Revenue Service ~ Attach to Form 990 or 990-EZ. Inspection
Name of the orqaruzanon Employer Identification number
American Colle e of Lifest le Medicine 32-0208451
9_!:0_~_~~~.P.~!l_?.~_~_:_ _
Y..V_~£_~~b__~p ?.§_~_~.!?_? _
Publications 6.291
~_~~X~£_~~_~~
~~_!__~!l_9~_I2~_~ ~_~};?_? _
Insurance 267
Licenses 54
~_~£_~~~_~~_9.. ~_~_§_~_~ _
~_~~_~_~~_!:~_~~ ~_~_§_4_9 _
9_£!_~_~~ ~_~E~_~~_~ ~_~_§_~_? _
_l?_~~_~ ~_~~_~ ~_~_i_~_~ _
~_~~_~~_~_~~_I2~9_~~ ~_~_Qg_Q _
~-~~~---~~-I!~~--~~~~-~~-~----------~~-!-~.:?-!---------- _
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule 0 (Form 990 or 990-EZ) (2011)
ISA
203907/0212013907 AM
• 'Fo~ 990 Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung
OMBNo 154~047
2012
Department
oftheTreasury benefit trust or private foundation) Open to Public
tntemal
RevenueService ~ The organization may have to use a copy of this return to satisfy state reporting requirements Inspectlc)n
A For th e 2012 ca en d ar vear or tax~_ar besinruns an d en d'ma
Ifapplicable C4 Nameof orqaruzauon
B Check 0 Employer
identificationnumber
D Address
chan~e American College of Lifestyle Med
OolngBusiness
As 32-0208451
D
D
Name
change
Imbalretum
Numberandstreet(orPObox Ifmaillsnotdelivered
tostreetaddress) I Room/sUite E Telephone
number
612 Glatt Circle 971-983-5383
D Terrmnated City,townorpostoffice,state,andZIPcode
D Amended
return Woodburn OR 97071 G Gross
receipts
$ 206,180
F Nameandaddress
ofpnncipal officer
D Applicabon
pending H(a) IsthiSagroupreturn
foraffiliates? DYes ~ No
H(b) Areallaffiliates
Included? Dyes D No
If"No,"attachalist (seemstrucuons)
I Tax-exempt status I I 501(c)(3) IXI 501(c) ( 6 )<IlII (Insertno) I I 4947(a)(1)
or I I 527
J Website:~ lifestylemedicine.org H(c) Groupexemption
number~
K Formoforqamzauon l
IXI CorporationI Trust I AssocrauonJ I I Other~ IL Yearofformaaon I M StateofleQaldomicile
PartJ 5 ummary
1 Bnefly descnbe the organization's mission or most significant activities
GI To offer quality education and certification of the practice in clinical
u
c lifestyle medicine.
..
ca
c
GI
0
C!)
> 2 Check this box ~ 0
if the organization discontinued its operations or disposed of more than 25% of Its net assets.
011 3 Number of voting members of the governing body (Part VI, line 1a) 3 0
:;:;
1/1
GI 4 Number of Independent voting members of the governing body (Part VI, line 1b) 4 0
's
:;:;
5 Total number of Individuals employed In calendar year 2012 (Part V, line 2a) 5 0
<
u 6 Total number of volunteers (estimate If necessary) 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 7b 0
PriorYear CurrentYear
GI
8 Contnbutions and grants (Part VIII, line 1h) 0
:::I
c 9 Proqram service revenue (Part VIII. II,e 29) _- ~ 197,068
>
GI
a::
GI
10 Investment income (Part VIII, column ~ lines 3 6~~ 0
11 Other revenue (Part VIII, column (A) lin ~ , Oc, and 1 9,112
12 Total revenue - add lmes • IhrouQ~;r.k.t
ecual Part VlII,,"" .. ;~~
I
ti,e 12) 206,180

13 G""" and"mol" amountspaid(P~\~:'''3\W~ 0
14 Benefits paid to or for members (Part I, umn (A), lin \.fr' 0
1/1
GI
15 Salanes, other compensation, empIOye~~~ rrn , lines 5-10) 46,381
1/1
c 16aProfessionai fundraising fees (Part IX, co umn ~11e) 0
GI
D.
)C
b Total fundraising expenses (Part IX, column (0), line 25) ~ 0
w 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) 163,645
18 Total expenses Add lines 13-17 (must equal Part IX, column (A), line 25) 210,026
19 Revenue less expenses, Subtract line 18 from line 12 -3,846
~'"
0'" Beginningof CurrentYear EndofYear
,!!g
",,,,
:Cii 20 Total assets (Part X, line 16) 13,345 9,499
CfV';,C(~
""'"'-c;: 21 Total liabilities (Part X, line 26) 0 0
~~~ 22 Net assets or fund balances. Subtract line 21 from line 20 13,345 9,499
medthis retum, includingaccompanyingschedulesand statements,and to the best of my knowledgeand belief,It IS

arer otherthanofficer)ISbasedon all Informationof which preparerhas any knowledge.
__------~-n~~~--~------------------------------------------------,-----~~~------------
--~'-------r.----.~'_~
~ign ~
~Here ~ George Guthrie secretary-treasurer
TypeorpnntnameandbUe
~.------~~~----~-------------------,~--~--~---------------------,~-----r----~-r==~----
c;;{ PnnVType
preparer's
name Preparer's
signature PTIN
OPaid TheodoreR. Ahre, CPA Theodore R. Ahre, CPA P00064082
OOPreparer Firm'sname ~ Theodore R. Ahre, CPA
Use Only 576 Glatt Circle
Firm'saddress ~ Woodburn, OR 97071- 9675 Phoneno 503-982-5201
May the IRS diSCUSSthiS return With the preparer shown above? (see Instructions)
For Paperwork Reduction Act Notice, see the separate Instructions.
DAA
DYes
Form eO
DNo
(2012),f
------------------------------------------------------------------------------- ---------
203907/0212013907 AM
Form 990(2012) American College of Lifestyle Med 32-0208451 Page 2

Part III Statement of Program Service Accomplishments
Check if Schedule 0 contains a response to any question in this Part III
1 Briefly describe. the organization's mission:
To offer quality education and certification of the practice in clinical
lifestyle medicine.
2 Did the organization undertake any significant program services dunng the year which were not listed on the
pnor Form 990 or 990-EZ? DYes [!] No
If "Yes," descnbe these new services on Schedule O.
3 Did the organization cease conducting, or make significant changes in how It conducts, any program
services? DYes [!] No
If "Yes," descnbe these changes on Schedule 0
4 Descnbe the organization's program service accomplishments for each of ItS three largest program services, as measured by
expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others,
the total expenses, and revenue, If any, for each program service reported.
4a (Code: ) (Expenses $ 210 ,026 Including grants of $ ) (Revenue $

Provide workshops
4b (Code. ) (Expenses $ including grants of $ ) (Revenue $
4c (Code: ) (Expenses $ including grants of $ ) (Revenue $
4d Other program services. (Descnbe in Schedule 0.)

(Expenses $ including grants of $ ) (Revenue $
4e Total program service expenses ~ 210 ,026
OM Form 990 (2012)
203907/0212013907 AM
Form 990 (2012) American College of Lifestyle Med 32-0208451 Page 3

Part IV Checklist of ReQUiredSchedules
Yes No
1 Is the organizaijon described In section 501(c)(3) or 4947(a)(1) (other than a pnvate foundation)? If "Yes,"
complete Schedule A 1 X
2 Is the organization required to complete Schedule B, Schedule of Contnbutors (see instructions)? 2 X
3 Old the organization engage in direct or Indirect pohtical campaign activities on behalf of or In opposmon to
candidates for public office? If "Yes," complete Schedule C, Part I 3 X
4 Section 501(c)(3) organizations. Old the organization engage In lobbYing activities, or have a section 501(h)
election in effect during the tax year? If "Yes," complete Schedule C, Part II 4
5 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,
assessments, or similar amounts as defined In Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III 5 X
6 Old the organization maintain any donor advised funds or any similar funds or accounts for which donors
have the nght to provide advice on the distribution or investment of amounts In such funds or accounts? If
"Yes," complete Schedule 0, Part I 6 X
7 Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, hrstonc land areas, or hrstonc structures? If "Yes," complete Schedule 0, Part II 7 X
8 Old the organization maintain collections of works of art, rustoncal treasures, or other Similar assets? If "Yes,"
complete Schedule 0, Part III 8 X
9 Old the organization report an amount In Part X, line 21, for escrow or custodial account liability, serve as a
custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or
debt negotiation services? If "Yes," complete Schedule 0, Part IV 9 X
10 Old the organization, directly or through a related organization, hold assets in temporarily restricted
endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule 0, Part V 10 X
11 If the organization's answer to any of the followmq questions IS "Yes," then complete Schedule 0, Parts VI,
VII, VIII, IX, or X as applicable
a Old the organization report an amount for land, buildings, and equipment In Part X, line 10? If "Yes,"
complete Schedule 0, Part VI 11a X
b Did the organization report an amount for investments--other secunties in Part X, line 12 that is 5% or more
of ItStotal assets reported In Part X, line 16? If "Yes," complete Schedule 0, Part VII 11b X
c Old the organization report an amount for Investments--program related In Part X, line 13 that IS 5% or more
of ItStotal assets reported in Part X, line 16? If "Yes," complete Schedule 0, Part VIII 11c X
d Old the organization report an amount for other assets in Part X, line 15 that IS 5% or more of its total assets
reported In Part X, line 16? If "Yes," complete Schedule 0, Part IX 11d X
e Old the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X 11e X
f Old the organization's separate or consolidated financial statements for the tax year Include a footnote that addresses
the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule 0, Part X 11f X
12a Old the organization obtain separate, Independent audited financial statements for the tax year? If "Yes," complete
Schedule 0, Parts XI and XII 12a X
b Was the organization included In consolidated, Independent audited financial statements for the tax year? If "Yes," and If
the organization answered "No" to line 12a, then completing Schedule 0, Parts XI and XII ISoptional 12b X
13 Is the organization a school descnbed In section 170(b)(1)(A)(II)? If "Yes," complete Schedule E 13 X
14a Did the organization maintain an office, employees, or agents outside of the United States? 14a X
b Old the organization have aggregate revenues or expenses of more than $10,000 from grantmaklng,
fundraising, business. Investment, and program service activities outside the United States, or aggregate
foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV 14b X
15 Old the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any
organization or entity located outside the United States? If "Yes," complete Schedule F, Parts II and IV 15 X
16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance
to lndivrduals located outside the United States? If "Yes," complete Schedule F, Parts III and IV 16 X
17 Old the organization report a total of more than $15,000 of expenses for professional fundraising services on
Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instrucbons) 17 X
18 Did the organization report more than $15,000 total of fundratsmq event gross Income and contnbutlons on
Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II 18 X
19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?
If "Yes," complete Schedule G, Part III 19 X
20a Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H 20a X
b If "Yes" to line 20a did the orqanlzatlon attach a COpy of its audited financial statements to this return? 20b
Form 990 (2012)
OM
203907/0212013907 AM
Form 990 (2012) American College of Li festyle Med 32-0208451 Paqe 4

Part IV Checklist of Required Schedules (continued)
Yes No
21 Did the orqaruzanon report more than $5,000 of grants and other assistance to any govemment or organization
in the tinited States on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I and II 21 X
22 Did the organization report more than $5,000 of grants and other assistance to individuals In the United States
on Part IX, column (A), line 2? If "Yes," complete Schedule I, Parts I and III 22 X
23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the
organization's current and former officers, directors, trustees, key employees, and highest compensated
employees? If "Yes," complete Schedule J 23 X
24a Did the organization have a tax-exempt bond Issue With an outstanding principal amount of more than
$100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b
through 24d and complete Schedule K. If "No," go to line 25 24a X
b
Did the organization Invest any proceeds of tax-exempt bonds beyond a temporary period exception? 24b
c
Did the organization maintain an escrow account other than a refunding escrow at any time dunng the year
to defease any tax-exempt bonds? 24c
d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? 24d
25a Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage In an excess benefit transaction
With a disqualified person dunng the year? If "Yes," complete Schedule L, Part I 25a
b Is the organization aware that it engaged In an excess benefit transaction With a disqualified person In a pnor
year, and that the transaction has not been reported on any of the organization's pnor Forms 990 or 990-EZ?
If "Yes," complete Schedule L, Part I 25b
26 Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or
disqualified person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part II 26 X
27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee,
substantial contnbutor or employee thereof, a grant selection committee member, or to a 35% controlled
entity or family member of any of these persons? If "Yes," complete Schedule L, Part III 27 X
28 Was the organization a party to a business transaction With one of the follOWingparties (see Schedule L,
Part IV Instructions for applicable filing thresholds, conditions, and exceptions)
a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV 28a X
b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete
Schedule L, Part IV 28b X
c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)
was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV 28c X
29 Did the organization receive more than $25,000 in non-cash contributions? If "Yes." complete Schedule M 29 X
30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified
conservation contnbunons? If 'Yes," complete Schedule M 30 X
31 Did the organization hquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I 31 X
32 Did the organization sell, exchange, dispose of, or transfer more than 25% of ItS net assets? If "Yes,"
complete Schedule N, Part II 32 X
33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3? If ·Yes," complete Schedule R, Part I 33 X
34 Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Parts II, III,
or IV, and Part V, line 1 34 X
b If "Yes" to line 35a, did the organization receive any payment from or engage In any transaction with a
controlled entity Within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 35b
36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable
related organization? If "Yes," complete Schedule R, Part V, line 2 36
37 Did the organization conduct more than 5% of ItS activities through an entity that IS not a related organization
and that is treated as a partnership for federal Income tax purposes? If "Yes." complete Schedule R,
Part VI 37 X
38 Did the organization complete Schedule 0 and provide explanations In Schedule 0 for Part VI, lines 11b and
19? Note. All Form 990 filers are reauired to complete Schedule 0 38 X
Form 990 (2012)
OM
203907/0212013907 AM
Fdrm 990 (2012) American College of Lifestyle Med 32- 0208451 Page 5
PiilrtV Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule 0 contains a response to any Question In this Part V
Yes
o
No
1a Enter the number reported In Box 3 of Form 1096 Enter -0- If not applicable I 1a I
b Enter the number of Forms W-2G Included in line 1a. Enter -0- If not applicable 1b
c Did the organization comply with backup Withholding rules for reportable payments to vendors and
reportable gaming (gambling) Winnings to pnze Winners? 1c x
2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax
Statements, filed for the calendar year ending With or Within the year covered by this return
b If at least one is reported on line 2a, did the organization file all required federal employment tax returns? 2b
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
3a Old the organization have unrelated business gross Income of $1,000 or more during the year? 3a x
b If "Yes: has it filed a Form 990-T for this year? If "No: provide an explanation In Schedule 0 3b
4a At any time dunng the calendar year, did the organization have an interest in, or a signature or other authority
over, a financial account In a foreign country (such as a bank account, securities account, or other financial
account)? 4a x
b If "Yes: enter the name of the foreign country ....
See instructions for filing requirements for Form TO F 90-22 1, Report of Foreign Bank and Financial Accounts.
5a Was the organization a party to a prohibited tax shelter transaction at any time dunng the tax year? 5a x
b Old any taxable party notify the organization that It was or IS a party to a prohibited tax shelter transaction? 5b x
c If "Yes" to line 5a or 5b, did the organization file Form 8886-T? 5c
6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the
organization solicit any contributions that were not tax deductible as charitable contnbutions? 6a x
b If "Yes: did the organization Include with every solicitation an express statement that such contributions or
gifts were not tax deductible? 6b
7 Organizations that may receive deductible contributions under section 170(c).
a Did the organization receive a payment In excess of $75 made partly as a contnbunon and partly for goods
and services provided to the payor? 7a
b If "Yes," did the organization notify the donor of the value of the goods or services provided? 7b
c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which It was
required to file Form 8282? 7c
d If "Yes: Indicate the number of Forms 8282 filed dunng the year I 7d I
e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? 7e
f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? 7f
g If the organization received a contribution of qualified Intellectual property, did the organization file Form 8899 as required? 7a
h If the organization received a contnbution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? __ r-_
f-'7:..:h.=....f
8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting
organizations. Old the supporting organization, or a donor advrsed fund maintained by a sponsonng
organization, have excess business holdings at any time during the year? 8
9 Sponsoring organizations maintaining donor advised funds.
a Did the organization make any taxable distributions under section 4966? 9a
b Did the organization make a distnbution to a donor, donor advisor, or related person? 9b
10 Section 501(c)(7) organizations. Enter:
a Initiation fees and capital contnbunons included on Part VIII, line 12 l10a I
b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facmties 10b
a Gross income from members or shareholders 11a
b Gross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them.) L...:1..:.1=b...L.. --I
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 In lieu of Forml1041? 1-=-1=2a=-+-_-4-
__
b If "Yes: enter the amount of tax-exempt interest received or accrued dunng the year L...:1.=2=b-LI -{
13 Section 501(c)(29) qualified nonprofit health insurance issuers.
a Is the organization licensed to issue qualified health plans in more than one state? 13a
Note. See the Instructions for additional information the organization must report on Schedule O.
b Enter the amount of reserves the organization is required to maintain by the states in which
the organization ISlicensed to issue qualified health plans
c Enter the amount of reserves on hand 13c
14a Old the organization receive any payments for Indoor tanning services during the tax year? 14a x
b If "Yes," has it filed a Form 720 to report these pavments? If "No," provide an explanation In Schedule 0 14b
OM Form 990 (2012)
203907/0212013907 AM
Fdrm990(2012) American College of Lifestyle Med 32-0208451 Page 6

Part VI Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No"
response to line 8a, 8b, or 1Db below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule 0 contains a response to any question in this Part VI [L
Section A Governmg Body and Management
Yes No
1a Enter the number of voting members of the governing body at the end of the tax year 1a
If there are matenal differences in voting nghts among members of the governing body, or
if the governing body delegated broad authority to an executive committee or similar
committee, explain In Schedule O.
b Enter the number of voting members included In line 1a, above, who are Independent 1b
2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship With
any other officer, director, trustee, or key employee? 2 X
3 Did the organization delegate control over management duties customanly performed by or under the direct
supervision of officers, directors, or trustees, or key employees to a management company or other person? 3 X
4 Did the organization make any Significant changes to ItS governing documents since the prior Form 990 was filed? 4 X
5 Did the organization become aware dunng the year of a Significant diversion of the organization's assets? 5 X
6 Did the organization have members or stockholders? 6 X
7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint
one or more members of the governing body? 7a X
b Are any governance decisions of the organization reserved to (or subject to approval by) members,
stockholders, or persons other than the governing body? 7b X
8 Did the organization contemporaneously document the meetings held or wntten actions undertaken during the year by the following:
a The governing body? 8a X
b Each committee With authority to act on behalf of the governing body? 8b X
9 Is there any officer, director, trustee, or key employee listed In Part VII, Section A, who cannot be reached at
the organization's mailing address? If "Yes," provide the names and addresses In Schedule 0 9 X
Section B. Policies (This Section B reauests information about policies not required by the Internal Revenue Code.)
Yes No
10a Did the organization have local chapters, branches, or affiliates? 10a X
b If "Yes," did the organization have wntten policies and procedures governing the activities of such chapters,
affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? 10b
11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? 11a X
b Descnbe in Schedule 0 the process, If any, used by the organization to review thiS Form 990
12a Did the organization have a written conflict of Interest policy? If "No,' go to line 13 12a X
b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give nse to conflicts? 12b
c Did the organization regularly and consistently monitor and enforce compliance With the policy? If "Yes,"
describe In Schedule 0 how this was done 12c
13 Did the organization have a wntten whlstleblower policy? 13 X
14 Did the organization have a wntten document retention and destruction policy? 14 X
15 Did the process for determining compensation of the follOWingpersons Include a review and approval by
Independent persons, comparability data, and contemporaneous substantiation of the deliberation and decrslon?
a The organization's CEO, Executive Director, or top management official 15a X
b Other officers or key employees of the organization 15b X
If "Yes' to line 1Sa or 1Sb, descnbe the process in Schedule 0 (see instructions).
16a Did the organization Invest in, contribute assets to, or participate In a [omt venture or Similar arrangement
with a taxable entity dunng the year? 16a X
b If "Yes," did the organization follow a wntten policy or procedure requiring the organization to evaluate its
participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the
organization's exempt status With respect to such arranqements? 16b
Section C. Disclosure
17 List the states with which a copy of thrs Form 990 is required to be filed ~ None
18 Section 6104 requires an organization to make ItS Forms 1023 (or 1024 If applicable), 990, and 990-T (Section S01(c)(3)s only)
available for public inspection. Indicate how you made these available. Check all that apply.
o Own website 0 Another's website 0 Upon request 0Other (explain In Schedule 0)
19 Descnbe in Schedule 0 whether (and if so, how), the organization made ItS governing documents, conflict of interest policy,
and financial statements available to the public during the tax year
20 State the name, physical address, and telephone number of the person who possesses the books and records of the
organization: ~ Marc Braman 612 Glatt Circle
Woodburn OR 97071 971-983-5383
DM Form 990 (2012)
203907/0212013907
AM

Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and
Independent Contractors
Check if Schedule 0 contains a response to any question in this Part VII 0
Section A.' Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete trus table for all persons required to be listed. Report compensation for the calendar year ending with or within the
organization's tax year
• List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of
compensation. Enter -0- in columns (0), (E), and (F) If no compensation was paid
• List all of the organization's current key employees, If any. See Instructions for definition of "key employee."
• List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.
• List all of the organization's former officers, key employees, and highest compensated employees who received more than
$100,000 of reportable compensation from the organization and any related organizations.
• List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.
List persons In the folloWing order: Individual trustees or directors; institutional trustees; officers; key employees, highest
compensated employees; and former such persons
~ Check this box If neither the organization nor any related organizations compensated any current officer, director, or trustee.
(A) (8) (C) (0) (E) (F)
Name and Tltle Average Position Reportable Reportable Esbmated
hours per (do not check more than one compensation compensabon from amount of
week box, unless person IS both an from related other
(list any officer and a director/trustee) the organizations compensation
hours for orqarnzatron (W-211099-MISC) fromtlhe
related
~
c. ~ -e
~ 3~::r "T1
0 (W-211099-MISC) organization
o~ 3~
"0
organizations al ~ CD and related
below dotted
line)
51
~ "C
0"
'<
3
mS 3
organizations
CD "0
CD CD
::>
en
'"
!D
0.
(1)Liana Lianov
4.00
President 0.00 X 0 0 0
(2) David Katz
0.50
President Elect 0.00 X 0 0 0
(3) Wayne Dysinger
3.00
Past President 0.00 X 0 0 0
(4) George Guthrie
4.00
Secretary/Treasurer 0.00 X 0 0 0
(5)
(6)
(7)
(8)
(9)
(10)
(11)
DAA Fonm 990 (2012)

203907/0212013907
AM
Fonn 99.0(2012) American College of Lifestyle Med 32 - 0208451 Page 8
· Part VIr Section A. Officers , Directors , Trustees , Key Employees , and Highest Compensated Employees (continued)
(A) (8) (C) (0) (E) (F)
Nameandutle Average Posmon Reportable Reportable EstImated
hoursper (donotcheckmorethanone compensation cornpensanon from amount of
week box.unlesspersonISbothan from related other
(lostany officeranda director/trustee) the orqaruzauons compensahon
hoursfor orqaruzatron (W-211099-MtSC) fromthe
related ::0 a :;0<; CD:!: "T1
(W-211099-MtSC)
~ 3l CD
"<
3c5 0
3
orqaruzanon
orqaruzatrons s:0 n
!!! CD om
"0 :T
!!!
andrelated
belowdotted ::0
!!!.
3
'"
0
mg orqaruzanons
lone) -e
CD
3
"0
2" CD CD
::0
~
CD
'"
Q)
a;
c.
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
1b Sub-total ~
c Total from continuation sheets to Part VII, Section A ~
d Total (add lines 1band 1c) ~
2 Total number of tndividuals (including but not limited to those listed above) who received more than $100,000 In
reportable compensation from the orcaruzanon ~ 0
Yes No
3 Old the organization list any former officer, director, or trustee, key employee, or highest compensated
employee on line 1a? If "Yes," complete Schedule J for such individual 3 X
4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the
organization and related organizations greater than $150,OOO?If "Yes," complete Schedule J for such
individual 4 X
5 Old any person listed on line 1a receive or accrue compensation from any unrelated organization or lndrvrdual
for services rendered to the orqaruzanon? If "Yes," complete Schedule J for such person 5 X
Section B. Independent Contractors
1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of
cornoensanon from the organization. Report compensation for the calendar year ending WIth or within the organization's tax vear.
(A) (8) (e)
Nameandbusinessaddress Descl1Qbon
ofservices Cornrerisanon
2 Total number of independent contractors (including but not limited to those listed above) who
received more than $100,000 of compensation from the organization ~ 0
OM Form990 (2012)
203907/0212013907 AM
Foim 990 (~!o12) American College of Lifestyle Med 32 - 0208451 Page 9

Part VIII Statement of Revenue
Check if Schedule 0 contains a response to any question in this Part VIII. o
. (A)
Total revenue
(B)
Related or
exempt
(C)
Unrelated
business
(D)
Revenue
exduded from tax
function revenue under sections
--
(/)m
I:I: 1a Federated campaigns
ftI::::J
"0
~E
b Membership dues
1a
1b
revenue 512.513. or 514
c Fundralsmq events 1c
~~ d Related organizations 1d
(!)~
uiE e Government grants (conlnbubons) 1e
1:'-
-
.011)
-G)
..
::::J.e:
..a_
f All other conlnbubons. gifts. grants •
and similar amounts not Included above 1f
EO 9 Noncash contnbubons Included In lines 1a-1t $
1:"
01:
Oftl h Total. Add lines 1a-1f ~
G>
::::I Busn Code
c:
G>
> 2a Conference 127,818 127,818
G>
0::: b Membership dues 61,315 61,315
G>
u
.~ C Workshop 7,935 7,935
G>
VJ d
E e
E
C)
f All other program service revenue
e
a.. Q Total. Add lines 2a-2f ~ 197,068
3 Investment Income (including dividends, interest,
and other Similar amounts) ~
4 Income from Investment of tax-exempt bond proceeds ~
5 Royalties ~
(I) Real (II) Personal
6a Gross rents
b Less rental exps
c Rental me or (loss)
d Net rental Income or (loss) ~
7a Gross amount from (I) secunnes (II) Other
sales of assets
other than Inventof'l
b Less cost or other
bass & sales exps
c Gain or (loss)
d Net gain or (loss) ~
G) 8a GrossIncomefromfundraisingevents
::::J
I: (notIncluding$
G>
> of contnbuttonsreportedon line 1c)
..
G)
0::
SeePartIV,line 18 a
0-
G)
s: b Less: direct expenses b
c Net income or (loss) from fundraisin events
9a GrossIncomefromgamingactivities
~
SeePartIV,line 19 a
b Less: direct expenses b
c Net Income or (loss) from gaming activities ~
10a Gross sales of inventory, less
returns and allowances a
b Less: cost of goods sold b
c Net Income or (loss) from sales of Inventory ~
Miscellaneous Revenue Busn Code
11a Other 8,431 8,431

b Refunds 586 586
C Trainin!f 95 95
d All other revenue
e Total. Add lines 11a-11d ~ 9,112
12 Total revenue. See instructions. ~ 206,180 206,180 0 0
Form 990 (2012)
OM
203907/0212013907 AM
Fohn 990(2012) American College of Lifestyle Med 32-0208451 Page 10

Part IX Statementof Functional Expenses
Section 501(c)(3) and 501 (c)(4) orcarnzanons must complete all columns All other orcamzanons must complete column (A)
Check if Schedule 0 contains a response to any question in this Part IX
(A) (8) (C) (0)
rl
Do not inc!lude amounts reported on lines 6b, Managementand
Totalexpenses Programservice Fundralsmg
7b 8b 9b and 10b of Part VIII. expenses generalexpenses expenses
1 Grants and other assistance to governments and
organizations In the U S See Part IV, hne 21
2 Grants and other assistance to Individuals In
the U.S. See Part IV, line 22
3 Grants and other assistance to governments,
orqaruzanons. and individuals outside the
U.S. See Part IV, lines 15 and 16
4 Benefits paid to or for members
5 Compensation of current officers, directors,
trustees, and key employees
6 Compensation not Includedabove, to disquahfled
persons (as defined under secnon 4958(1)(1))and
persons descnbed in section 4958(c)(3)(8)
7 Other salanes and wages 46,381 46,381
8 Pension plan accruals and contnbunons (Include
section 401(k) and 403(b) employer contributions)
9 Other employee benefits
10 Payroll taxes
11 Fees for services (non-employees):
a Management
b Legal 818 818
c Accounting
d LobbYing
e Professional fundralsing services. See Part IV, hne 17
f Investment management fees
9 Other(Ifline119 amounlexceeds10% ofline25, column
(A) amount,listline119 expenses
onSchedule0)
12 Advertising and promotion
13 Office expenses 10,953 10,953
14 Information technology
15 Royalties
16 Occupancy 6,000 6,000
17 Travel
18 Payments of travel or entertainment expenses
for any federal, state, or local public officials
19 Conferences, conventions, and meetings 839 839
20 Interest
21 Payments to affiliates
22 Depreciation, depletion, and amortization
23 Insurance
24 Other expenses Itemize expenses not covered
above (List miscellaneous expenses In hne 24e If
hne24e amount exceeds 10% of hne25, column
(A) amount, hst line 24e expenses on Schedule 0 )
a Workshop 118,672 118,672
b Conference attendance 8,891 8,891
c Bank charges 6,322 6,322
d Administrative Asst 5,827 5,827
e All other expenses 5,323 5,323
25 expenses. Add lines1 through24e
Total functional 210,026 210,026 0 0
26 Joint costs. Complete thiS hneonly If the
organization reported in column (8) JOintcosts
from a combined educational campaign and
fundraismq sohcitaton Check here.... 0 if
followmo SOP 98-2 IASC 958-720)
OM Form 990 (2012)
203907/0212013907 AM

PartX BalanceSheet
Check If Schedule 0 contains a response to any question in this Part X I I
(A) (B)
Beginning of year End of year
1 Cash-rion-Interest bearing 13,345 1 9,499
2 Savings and temporary cash investments 2
3 Pledges and grants receivable, net 3
4 Accounts receivable, net 4
5 Loans and other receivables from current and former officers, directors,
trustees, key employees, and highest compensated employees.
Complete Part II of Schedule L 5
6 Loans and other receivables from other disqualified persons (as defined under section
4958(f)(1 », persons descnbed In section 4958(c)(3)(B), and contributing employers and
sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary
J!l organizations (see instructions). Complete Part II of Schedule L 6
II)
(I)
(I)
7 Notes and loans receivable, net 7
oCt 8 Inventories for sale or use 8
9 Prepaid expenses and deferred charges 9
10a Land, buildmqs, and equipment: cost or
other baSIS.Complete Part VI of Schedule D 10a
b Less: accumulated deprecation 10b 10c
11 Investments-publicly traded secuntles 11
12 Investments-other securities. See Part IV, line 11 12
13 Investments-program-related See Part IV, line 11 13
14 Intangible assets 14
15 Other assets. See Part IV, line 11 15
16 Total assets. Add lines 1 throuqh 15 (must equal line 34) 13,345 16 9,499
17 Accounts payable and accrued expenses 17
18 Grants payable 18
19 Deferred revenue 19
20 Tax-exempt bond liabilities 20
21 Escrow or custodial account liability. Complete Part IV of Schedule D 21
(I)
II)
22 Loans and other payables to current and former officers, directors,
~ trustees, key employees, highest compensated employees, and
:c
ca disqualified persons Complete Part II of Schedule L 22
:::i 23 Secured mortgages and notes payable to unrelated third parties 23
24 Unsecured notes and loans payable to unrelated third parties 24
25 Other liabilities (including federal income tax, payables to related third
parties, and other liabilities not Included on lines 17-24). Complete Part X
of Schedule D 25
26 Total liabilities. Add lines 17 throuch 25 0 26 0
(I)
Organizations that follow SFAS 117 (ASC 958), check here ~ D and
II)
U
complete lines 27 through 29, and lines 33 and 34.
I:
ca 27 Unrestricted net assets 27
iii
IX! 28 Temporarily restricted net assets 28
"C
I: 29 Permanently restncted net assets 29
::::I
...
II.. Organizations that do not follow SFAS 117 (ASC 958), check here ~ 00 and
-0
(I)
II)
II)
II)
complete lines 30 through 34.
30 Capital stock or trust pnncipal, or current funds 30
-
-e 31 Paid-in or capital surplus, or land, bUilding, or equipment fund
z
II) 32
33
Retained earnings, endowment, accumulated income, or other funds
Total net assets or fund balances
13,345
13,345
31
32
33
9,499
9,499
34 Total liabilities and net assets/fund balances 13,345 34 9,499
Form 990 (2012)
DM
203907/0212013907 AM
Form 990 (2012) American Collecre of Lifestyle Med 32-0208451 Page 12

Part XI Reconciliation of Net Assets
Check if Schedule 0 contains a response to any question in this Part XI n
1 Total revenue (must equal Part VIII, column (A), line 12) 1 206,180
2 Total e'Xpenses(must equal Part IX, column (A), line 25) 2 210,026
3 Revenue less expenses. Subtract line 2 from line 1 3 -3,846
4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A» 4 13,345
5 Net unrealized gains (losses) on investments 5
6 Donated services and use of facilities 6
7 Investment expenses 7
8 Prior period adjustments 8
9 Other changes In net assets or fund balances (explain in Schedule 0) 9
10 Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line
33, column (B)) 10 9,499
Part XU Financial Statementsand Reporting
Check if Schedule 0 contains a response to any question in this Part XII
Yes
o
No
1 Accounting method used to prepare the Fonn 990 ~ Cash 0 Accrual 0 Other _
If the organization changed Its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a Were the organization's financial statements compiled or reviewed by an Independent accountant? 2a x
If "Yes," check a box below to indicate whether the financial statements for the year were compiled or
reviewed on a separate baSIS,consolidated baSIS,or both
o Separate basis 0 Consolidated baSIS 0 Both consolidated and separate baSIS
x
b Were the organization's financial statements audited by an Independent accountant? 2b
If "Yes," check a box below to indicate whether the flnancral statements for the year were audited on a
separate baSIS,consolidated baSIS,or both:
o Separate baSIS 0 Consolidated baSIS 0 Both consolidated and separate basis
c If "Yes' to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight
of the audit, review, or compilation of ItSfinancial statements and selection of an independent accountant? 2c
If the organization changed either ItS oversight process or selection process dunng the tax year, explain In
Schedule O.
3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in
the Single Audit Act and OMB Circular A-133? 3a
b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the
recurred audit or audits, ~xplaln why in Schedule 0 and descnbe any steps taken to undem_osuch audits 3b
Form 990 (2012)
OM
203907/0212013907 AM
, .
OMS No 1545-0047
SCHEDULE 0 Supplemental Information to Form 990 or 990-EZ
(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.
2012
Department of th~ Treasury • Open to Public
Internal Revenue Service ~ Attach to Form 990 or 990-EZ. Ins lion
Name of the orqaruzauon Employer IdentificatIon number
American Colle e of Lifest 1e Med 32-0208451
Form 990, Part III, Line 4d - All Other Accomplishment
Provide workshops
Form 990, Part VI, Line 11b - Organization's Process to Review Form 990
No review was or will be conducted.
Form 990, Part VI, Line 19 - Governing Documents Disclosure Explanation
No documents available to the public
OM
1. 24PM
2039"OJ7I21f2014
Return of Organization Exempt From Income Tax OMBNo 1545-0047
Form 990 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 2013
Oepartmenl of!heTreasury ... Do not enter Social Security numbers on this form as it may be made public. Open to Public
Inlern.;lRevenueService ... Information about Form 990 and its instructions is at www irs. ovlform990. Ins ection
A For the 2013 calendar vear or tax year beainnina and end ina
Ifapplicable C Nameof orgaOlzallon
B Check 0 EmployerIdenllfieatlonnumber
~ Address
change American College of Lifestyle Med
DOingBUSiness
As 32-0208451
D
D
Name
change
lrnhal retum
Numberandstreel(orPObox ~ rnailrs not dehvered
10 slreeladdress) I Room/SUite E Telephone
number
PO Box 6432 314-398-7343
D Terminated C,lyor town, state orprovince.country,andZIPorforeignpostalcode
D Amended
return Chesterfield MO 63006 G Grossreceipts
$ 295,748
F Nameandaddressofpnncopal
officer
D Apphca~on
pending H(., IsthiSagroupreturnforsubordinates?
D Yes ~ No
H(b)AreallsubordinatesIncluded? Dyes D No
If"No,"altacha hsl (seeInstructions)
I Tax-exempt status I I 501(e)(31 IXI 501(el ( 6 ).....
(Insertno I r l4947(a)(1)or r l 527
J WebSite:... lifestylemedicine.orq H(e)GrOUD
exernonon number...
K Formof0!l!amza~on /XI
Coroora~on l Trust r r l Assocaaon r l Other'" IL Yearoffomna~on IM StateoflegaldomICile
Part I , Summary
1 Bnefly descnbe the organization's mission or most Significant acnvitres:
GI To offer quality education and certification of the practice in clinical
u
r: lifestyle medicine.
10
r:
L-
CD
o
>
0 2 Check this box'" 0
If the organization discontinued ItS operations or disposed of more than 25% of ItS net assets
05 3 Number of voting members of the governmg body (Part VI, line 1a) 3 0
rn 4 Number of Independent voting members of the governing body (Part VI, hne 1b) 4 0
GI
;;
's 5 Total number of mdividuals employed m calendar year 2013 (Part V, hne 2a) 5 0
;;
u 6 Total number of volunteers (estimate If necessary) 6 0
-c
7a Total unrelated busmess revenue from Part VIII, column (C), line 12 - i 7a 0
b Net unrelated business taxable income from Form 990-T tn;;; {-;L'(~~'~~-'I~r"lj
-' 7b 0
"
1 - - " - ~-~ ~
~----"-- ,
PriorYear CurrentYear
GI
8 Contnbutions and grants (Part YIII, hne 1h) '(i)' ;r/)~
,... _, 0
::l
r: 9 Program service revenue (Part YIII, line 2g) ~(!); AUl:i oM. A 2014 ;a::'! 197 068 295,748
>
CIJ
{i;:L,_.._ _J J 0
GI
fJ) a::
10 Investment mcome (Part VII', column (A), hnes 3, 4, and
11 Other revenue (Part YIII, column (A), lines 5, 6d, 8c, 9c, Oc,anO~DEN J ~
12 Total revenue - add lines B throuah 11 (must eaual Part l,u..column4A1":-hne+:h
UT 9,112
206.180
0
295 748
~ 13 Grants and Similar amounts paid (Part IX, column (A), hnes 1-3) 0
z
m 14 Benefits paid to or for members (Part IX, column (A), lme 4) 0
o rn 1S Salanes, other compensation, employee benefits (Part IX, column (A), hnes 5-10) 46,381 2 989
GI
rn
)::0' e
16a Professional fundraismq fees (Part IX, column (A), line 11e) 0
CIJ
c: Q. b Total fundralslng expenses (Part IX, column (D), line 25) ... 0
en )(
w 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) 163 645 244,589
~ 210.026 247,578
18 Total expenses Add hnes 13-17 (must equal Part IX, column (A), line 25)
c:>
~ ~ .. 19 Revenue less expenses Subtract line 18 from hne 12 -3 846
Be!llnnln~01CurrentYear
48,170
End01Year
c:>
~ ....
0"
!!g
"'i;
20 Total assets (Part X, line 16) 9 500 57_/
670
"co
~-g
21 Total habilltles (Part X, hne 26) 0 0
z:>
u.. 22 Net assets or fund balances Subtract line 21 from line 20 9 500 57,670
Part II Signature Block
Under penalties of penury, I declare that I have examined trns retum, includingaccompanying schedules and statements,and 10 the best of my knowledge and belief, It IS
true correct and complete Declarallon.,.-of preparer (other than officer) ISbased on all mtormanon of Whichpreparerhas any knowledge
"
Sign ~
A
Ignatureofofficer
BII -
d"
) 17-;l..!"'- l'f
Dale
Here Susan Benigas Executive Director
~Typeorprontname end uue
Paid
PnnVType
preparer's name
Theodore R. Ahre, CPA

Preparer's signature
Theodore R. Ahre, CPA

I, "' Dale
07/21/14
J Check DI
of PTIN
self-employed POO0640B2
Preparer Fum's nama ~ Theodore R. Ahre, CPA LLC Firm'sEIN~ 46-1648641
Use Only 576 Glatt Circle
Flmn'saddress ~ Woodburn, OR 97071-9675 Phoneno 503-982-5201
May the IRS diSCUSStms return With the preparer shown above? (see instructions) ilves nNo
For Paperwork Reduction Act Notice, see the separate Instructions. Form990 (2013)
OM
203907/2112014924 AM
, '
Fonn990(2013) American College of Lifestyle Med 32-0208451 Page 2

Part III 'Statement of Program Service Accomplishments
Check if Schedule 0 contains a response or note to any line in this Part III
1 Briefly describe the orqamzation's mission:
To offer quality education and certification of the practice. in clinical
lifestyle medicine.
2 Did the organizatJonundertake any significant program services dunng the year which were not listed on the
pnor Fonn 990 or 990-EZ? D Yes ~ No
If "Yes," descnbe these new services on Schedule O.
3 Did the orqaruzauoncease conductJng,or make significant changes In how It conducts, any program
services? D Yes ~ No
If "Yes." descnbe these changes on Schedule 0
4 Descnbe the organization's program service accomplishments for each of ItSthree largest program services, as measured by
expenses. SectJon501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others,
the total expenses, and revenue, if any, for each program service reported.
4a (Code: ) (Expenses $ 247 I 57 8 Including grants of $ ) (Revenue $

Provide workshops
4b (Code: ) (Expenses $ including grants of $ ) (Revenue $
4c (Code ) (Expenses $ including grants of $ ) (Revenue $
4d Other program services. (Describe in Schedule 0.)

(Expenses $ including grants of $ ) (Revenue $
4e Total program service expenses j- 247,578
OM Form 990 (2013)
203907/21/2014924 AM
, '
Form 990 (2013) American College of Li festy1e Med 32-0208451 Page 3

Part IV . Checklist of Reauired Schedules
Yes No
1 Is the organizallon descnbed in secuon 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes,"
complete Schedule A 1 X
2 Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? 2 X
3 Did the organization engage in direct or indirect political campaign acuvitres on behalf of or in opposmon to
candidates for public office? If "Yes," complete Schedule e, Part I 3 X
4 Section 501(c)(3) organizations. Did the organization engage In lobbying acuvitres, or have a section 501(h)
election in effect dunng the tax year? If "Yes," complete Schedule C, Part II 4
5 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,
assessments, or Similar amounts as defined In Revenue Procedure 98-19? If "Yes," complete Schedule c,
Part III 5 X
6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors
have the nght to provide advice on the drstnbution or Investment of amounts in such funds or accounts? If
"Yes," complete Schedule D, Part I 6 X
7 Did the organization receive or hold a conservation easement, Including easements to preserve open space,
the environment, histonc land areas, or histone structures? If "Yes," complete Schedule D, Part II 7 X
8 Did the organization maintain collections of works of art, histoncal treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III 8 X
9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a
custodian for amounts not listed In Part X; or provide credit counseling, debt management, credit repair, or
debt negotlallon services? If "Yes," complete Schedule D, Part IV 9 X
10 Did the organization, directly or through a related organization, hold assets in temporanly restncted
endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V 10 X
11 If the organizallon's answer to any of the following questions IS"Yes," then complete Schedule D, Parts VI,
VII, VIII, IX, or X as applicable.
a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes,"
complete Schedule D, Part VI 11a X
b Did the organization report an amount for investments-other secunues In Part X, line 12 that IS5% or more
of its total assets reported In Part X, line 16? If "Yes," complete Schedule D, Part VII 11b X
c Did the organization report an amount for investments-program related In Part X, line 13 that is 5% or more
of Its total assets reported In Part X, line 16? If "Yes," complete Schedule D, Part VIII 11c X
d Did the organization report an amount for other assets In Part X, line 15 that IS5% or more of its total assets
reported In Part X, line 16? If "Yes," complete Schedule D, Part IX 11d X
e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X 11e X
f Did the organization's separate or consolidated financal statements for the tax year include a footnote that addresses
the orqaruzanon's liability for uncertain tax positions under FIN 48 (ASe 740)? If "Yes," complete Schedule D, Part X 11f X
12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII 12a X
b Was the organization included In consolidated, Independent audited financral statements for the tax year? If "Yes," and If
the orqaruzauon answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional 12b X
13 Is the organization a school descnbed in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E 13 X
14a Did the organization maintain an office, employees, or agents outside of the United States? 14a X
b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaklng,
fundraising, business, investment, and program service activrnes outside the United States, or aggregate
foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV 14b X
15 Did the orqaruzation report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or
for any foreign organizallon? If "Yes," complete Schedule F, Parts" and IV 15 X
16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other
assistance to or for foreign Individuals? If "Yes," complete Schedule F, Parts III and IV 16 X
17 Did the orqaruzation report a total of more than $15,000 of expenses for professional fundraising services on
Part IX, column (A), lines 6 and 11e? If 'Yes," complete Schedule G, Part I (see instructions) 17 X
18 Did the organization report more than $15,000 total of fundraising event gross Income and contnbullons on
Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II 18 X
19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII,line 9a?
If "Yes," complete Schedule G, Part III 19 X
20a Did the organization operate one or more hospital faohues? If "Yes," complete Schedule H 20a X
b If "Yes" to line 20a, did the oroamzanon attach a copy of its audited financral statements to this retum? 20b
Fonn 990 (2013)
OM
.
203907/2112014924
'
AM
Form 990(2013) American College of Lifestyle Med 32-0208451 Paqe4

Part IV Checklist of Required Schedules (continued)
Yes No
21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or
government on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I and II 21 X
22 Did the organization report more than $5,000 of grants or other assistance to Individuals In the United States
on Part IX, column (A), line 2? If "Yes," complete Schedule I, Parts I and III 22 X
23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the
organization's current and former officers, directors, trustees, key employees, and highest compensated
employees? If "Yes," complete Schedule J 23 X
24a Did the organization have a tax-exempt bond Issue Withan outstanding pnncipal amount of more than
$100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b
through 24d and complete Schedule K. If "No," go to line 25a 24a X
b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? 24b
c Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? 24c
d Did the organization act as an "on behalf of issuer for bonds outstanding at any time dunnq the year? 24d
25a Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage In an excess benefit transaction
with a disqualified person dunnq the year? If "Yes," complete Schedule L, Part I 25a
b Is the organization aware that It engaged In an excess benefit transaction Witha disqualified person In a pnor
year, and that the transaction has not been reported on any of the organization's pnor Forms 990 or 990-EZ?
If "Yes," complete Schedule L, Part I 25b
26 Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any
current or former officers, directors, trustees, key employees, highest compensated employees, or
disqualified persons? If so, complete Schedule L, Part II 26 X
27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee,
substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled
entity or family member of any of these persons? If "Yes," complete Schedule L, Part III 27 X
28 Was the organization a party to a business transaction Withone of the follOWingparties (see Schedule L,
Part IV Instructions for applicable filing thresholds, conditions, and exceptions)
a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV 28a X
b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete
Schedule L, Part IV 28b X
c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)
was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV 28c X
29 Did the organization receive more than $25,000 In non-cash contnbunons? If 'Yes," complete Schedule M 29 X
30 Did the organization receive contnbunons of art, historical treasures, or other Similar assets, or qualified
conservation contnbunons? If "Yes," complete Schedule M 30 X
31 Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I 31 X
32 Did the organization sell, exchange, dispose of, or transfer more than 25% of ItS net assets? If "Yes,"
complete Schedule N, Part II 32 X
33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301 7701-2 and 301.7701-3? If ·Yes," complete Schedule R, Part I ·. 33 X
34 Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Parts II, III,
or IV, and Part V, line 1 34 X
b If "Yes" to line 35a, did the organization receive any payment from or engage In any transaction with a
controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ·. 35b
36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-chantable
related organization? If "Yes," complete Schedule R, Part V, line 2 36
37 Did the organization conduct more than 5% of ItSactivities through an entity that ISnot a related organization
and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R,
Part VI ·. 37 X
38 Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11b and
19? Note. All Form 990 filers are required to complete Schedule 0 38 X
Form 990 (2013)
OM
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Fonn990(2013) American College of Lifestyle Med 32-0208451 Page 5

Part V Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule 0 contains a response or note to any line In this Part V
Yes
o
No
1a Enter the number reported in Box 3 of Fonn 1096. Enter -0- If not applicable I 1a I
b Enter the number of Fonns W-2G included In line 1a. Enter -0- if not applicable 1b
c Did the organization comply with backup withholding rules for reportable payments to vendors and
reportable gaming (gambling) winnings to pnze winners? 1c x
2a Enter the number of employees reported on Fonn W-3, Transmittal of Wage and Tax
Statements, filed for the calendar year ending with or within the year covered by this return
b If at least one is reported on line 2a, did the organization file all required federal employment tax returns? 2b
Note. If the sum of lines 1a and 2a ISgreater than 250, you may be required to e-file (see Instructions)
3a Did the organization have unrelated busmess gross Income of $1,000 or more dunng the year? 3a x
b If ·Yes," has it filed a Fonn 990-T for trus year? If "No" to line 3b, provide an explanation in Schedule 0 3b
4a At any time dunng the calendar year, did the organization have an Interest in, or a signature or other authonty
over, a financial account In a foreign country (such as a bank account. securities account, or other financial
account)? 4a x
b If "Yes," enter the name of the foreign country. ~
See Instructions for filing requirements for Fonn TD F 90-22.1, Report of Foreign Bank and Fmancial Accounts
5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? 5a x
b Did any taxable party notify the organization that It was or ISa party to a prohibited tax shelter transaction? 5b x
c If ·Yes" to line 5a or 5b, did the organization file Fonn 8886-T? 5c
6a Does the organization have annual gross receipts that are nonnally greater than $100,000, and did the
organization sohcrt any contnbutlons that were not tax deductible as charitable contributions? 6a x
b If "Yes," did the organization include with every sohotanon an express statement that such contnbuuons or
gifts were not tax deductible? 6b
7 Organizations that may receive deductible contributions under section 170(c).
a Did the organization receive a payment In excess of $75 made partly as a contribution and partly for goods
and services provided to the payor? 7a
b If "Yes," did the organization notify the donor of the value of the goods or services provided? 7b
c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which It was
required to file Fonn 8282? 7c
d If 'Yes." indicate the number of Fonns 8282 filed dunng the year
e Did the organization receive any funds, directly or Indirectly, to pay premiums on a personal benefit contract? 7e
f Did the organization, dunng the year, pay premiums, directly or Indirectly, on a personal benefit contract? 7f
g If the organization received a contnbunon of quahfied Intellectual property, did the organization file Fonn 8899 as required? 7g
h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Fonn 1098-C? 7h
8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting
organizations. Did the supporting organization, or a donor advised fund maintained by a sponsonng
organization, have excess business holdings at any time dunng the year? 8
9 Sponsoring organizations maintaining donor advised funds.
a Did the organization make any taxable drstnbutions under section 4966? 9a
b Did the organization make a distnbution to a donor, donor advisor, or related person? 9b
a Initiation fees and capital contributions included on Part VIII, line 12 110a 1
b Gross receipts, included on Fonn 990, Part VIII, hne 12, for pubhc use of club facihties 10b
a Gross income from members or shareholders 11a
b Gross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them.) L.-:.1..:.1b::..L. --1
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization fihng Fonn 990 in heu of Fonn 1041? 1-1.:..:2::=a=+-_-+-
__
b If "Yes," enter the amount of tax-exempt interest received or accrued dunng the year 1L.-:.1:2b::.I.l-I -I
13 Section 501(c)(29) qualified nonprofit health insurance issuers.
a Is the organization licensed to issue quahfied health plans In more than one state? 1-'-13;;.;a,,+_--+
__
Note. See the instructions for additional infonnation the orqaruzauon must report on Schedule O.
b Enter the amount of reserves the organization is required to maintain by the states in which
the organization ISlicensed to issue quahfied health plans Ir1.::.3b:.t-I -I
c Enter the amount of reserves on hand 13c
~~--------------~r_~--_+~-
14a Did the organization receive any payments for indoor tanning services dunng the tax year? 14a X
b If "Yes • has it filed a Fonn 720 to report these payments? If "No," provide an explanation in Schedule 0 14b
OM Form 990 (2013)
--------------------------------------------------------------------- --- -----
203907/2112014924 AM

Part Vl Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No"
response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule 0 contains a response or note to any line in this Part VI [L
Section A Governing Bodv and Management
Yes No
1a Enter the number of voting members of the governing body at the end of the tax year 1a
If there are matenal differences In votmg nghts among members of the governing body, or
if the governing body delegated broad authonty to an executive committee or Similar
committee, explain in Schedule 0
b Enter the number of voting members included In line 1a, above, who are Independent 1b
2 Old any officer, director, trustee, or key employee have a family relationship or a business relationship With
any other officer, director, trustee, or key employee? 2 X
3 Old the organization delegate control over management duties customarily performed by or under the direct
supervision of officers, directors, or trustees, or key employees to a management company or other person? 3 X
4 Did the organization make any Significantchanges to ItSgoverning documents since the prior Form 990 was filed? 4 X
5 Old the organization become aware dunng the year of a Significant diversion of the organization's assets? 5 X
6 Did the organization have members or stockholders? 6 X
7a Old the organization have members, stockholders, or other persons who had the power to elect or appoint
one or more members of the governing body? 7a X
b Are any governance decisions of the organization reserved to (or subject to approval by) members,
stockholders, or persons other than the governing body? 7b X
8 Old the organization contemporaneously document the meetings held or written actions undertaken dunng the year by the follOWing:
a The governing body? 8a X
b Each committee with authority to act on behalf of the governing body? 8b X
9 Is there any officer, director, trustee, or key employee listed In Part VII, Section A, who cannot be reached at
the organization's mailing address? If "Yes," prOVidethe names and addresses in Schedule 0 9 X
Section B. Policies (This Section B requests information about coheres not required by the Internal Revenue Code.)
Yes No
10a Old the organization have local chapters, branches, or affiliates? 10a X
b If "Yes," did the organization have written policies and procedures governing the acuvities of such chapters,
affiliates, and branches to ensure their operations are consistent With the organization's exempt purposes? 10b
11a Has the organization provided a complete copy of this Form 990 to all members of Its governing body before filing the form? 11a X
b Describe in Schedule 0 the process, If any, used by the organization to review thiS Form 990.
12a Old the organization have a written conflict of Interest policy? If "No," go to line 13 12a X
b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? 12b
c Did the organization regularly and consistently monitor and enforce compliance Withthe policy? If "Yes,"
descnbe in Schedule 0 how ttus was done 12c
13 Old the organization have a wntten wtllstleblower policy? 13 X
14 Old the organization have a written document retention and destruction policy? 14 X
15 Did the process for determining compensation of the following persons Include a review and approval by
Independent persons, comparability data, and contemporaneous substantiation of the deliberation and decrslon?
a The organization's CEO, Executive Director, or top management official 15a X
b Other officers or key employees of the organization 15b X
If "Yes" to line 15a or 15b, descnbe the process in Schedule 0 (see instructions)
16a Old the organization invest in, contnbute assets to, or participate in a jomt venture or Similar arrangement
Witha taxable entity dunng the year? 16a X
b If "Yes," did the organization follow a wntten policy or procedure requmnq the organization to evaluate its
paruopanon in joint venture arrangements under applicable federal tax law, and take steps to safeguard the
organization's exempt status Withresp_ectto such arrangements? 16b
Section C. Disclosure
17 List the states Withwhich a copy of this Form 990 ISrequired to be filed.... None
18 Section 6104 requires an organization to make ItS Forms 1023 (or 1024 If applicable), 990, and 990-T (Section 501(c)(3)s only)
available for public inspection. Indicate how you made these available Check all that apply.
o Own website 0 Another's website 0 Upon request 0Other (explain in Schedule 0)
19 Describe in Schedule 0 whether (and if so, how) the organization made ItSgoverning documents, conflict of interest policy, and
financial statements available to the public dunng the tax year.
20 State the name, physical address, and telephone number of the person who possesses the books and records of the
organization·.... Susan Benigas PO Box 6432
Chesterfield MO 63006
OM Form 990 (2013)
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Form990(2013) American College of Lifestyle Med 32-0208451 Page 7

Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and
Independent Contractors
Check if Schedule 0 contains a response or note to any line in this Part VII 0
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed Report compensation for the calendar year ending Withor Within the
organization's tax year
• List all of the organization's current officers, directors, trustees (whether Individuals or organizations), regardless of amount of
compensation Enter -0- in columns (0), (E), and (F) If no compensation was paid.
• List all of the organization's current key employees, If any. See instructions for definition of "key employee"
• List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.
• List all of the organization's former officers, key employees, and highest compensated employees who received more than
$100,000 of reportable compensation from the organization and any related organizations.
• List all of the organization's former directors or trustees that received, In the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.
List persons In the follOWingorder: individual trustees or directors, institutional trustees; officers, key employees; highest
compensated employees; and former such persons
[!] Check this box If neither the organization nor any related organizations compensated any current officer, director, or trustee
(A) (8) (C) (0) (E) (F)
Name and TItle Average Position Reportable Reportable Esbmated
hours per (do not check more than one compensation compensation from amount of
week box, unless person IS both an from related other
(hst any officer and a director/trustee) the orqamzauons compensabon
hours for 'T1
organization (W·2Jl0GG·MISCj from the
related
0
3i
"!!l
'"
CD
'<
"':':
3<5
'0 =r
0
3
(W-2Jl099-MISC) organlzabon
orqamzauons CD
~~ !!l and related
below dotted
3
"!2.
0
-c
mg orqaruzauons
hne) 3
CD '0
CD
~
II>
10
Co.
(1)David Katz
4.00
President 0.00 X 0 0 0
(2) George Guthrie
4.00
President Elect 0.00 X 0 0 0
(3) Ingrid Edshteyn
4.00
secretary 0.00 X 0 0 0
(4) Wayne Dysinger
4.00
Treasurer 0.00 X 0 0 0
(5)
(6)
(7)
(8)
(9)
(10)
(11)
OM Form 990 (2013)

203907/21/2014924AM
Form 990 ~2013) American College of Lifestyle Med 32 - 0208451 Page 8
Part vn Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A) (8) (C) (0) (E) (F)
NameandbUe Average Posruon Reportable Reportable Esbmated
hoursper (donotcheck morethanone compensabon compensabon from amountof
week box,unlesspersonIS bothan from retated other
(listany officeranda director/trustee) the orqaruzaucne compensabon
hoursfor organlzabon (W-211099-MtSC) fromthe
g 0 '":1: "T'I
related "'-
3; '"
e 3<i5 0
-c
(W-211099-MISC) orgamzabon
o~ 3!!l
"0::.-
orgamzabons ~ "
g CD andrelated
belowdolled a
g
3
"0
i8 orgaOlzabons
c- 3
line) -c
.. 1il
a
'"
(12)
'"
C1.
(13)
(14)
(15)
(16)
(17)
(18)
(19)
1b Sub-total ....
c Total from continuation sheets to Part VII, Section A ....
d Total (add lines 1b and 1cl ....
2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 In
reporta bIe compensation fr am th e organization .... 0
Yes No
3 Old the organization list any former officer, director, or trustee, key employee, or highest compensated
employee on line ta? If "Yes," complete Schedule J for such mdividual 3 X
4 For any Individual listed on line 1a, IS the sum of reportable compensation and other compensation from the
organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual .. 4 X
5 Old any person listed on line 1a receive or accrue compensation from any unrelated organization or Individual
for services rendered to the organization? If "Yes," complete Schedule J for such person 5 X
Section B. Independent Contractors
1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of
compensation fr am the orqanlzation.
. . Report compensation ~or the ca Ien dar year en dmowith
Ing Wit or Within th e organization
.. s tax year.
(A) (8) (C)
Name andbusiness address Descnpbon of services Comliensabon
2 Total number of independent contractors (including but not limited to those listed above) who
received more than $100,000 of compensation from the orqarnzanon .... 0
OM Form 990 (2013)
203907/21/2014924 AM
Form990(2013) American College of Lifestyle Med 32-0208451 Page 9

Part VIII . Statement of Revenue
Check if Schedule 0 contains a response or note to any line in this Part VIII D
(A) (B) (C) (0)
Total revenue Related or Unrelated Revenue
exempt business exduded from tax
function revenue under sections
....
(1)(1)
Cc 1a Federated campaigns
111:::1
1a
revenue 512·514
"0 b Membership dues 1b

~E c Fundratsmq events 1c
~~ 1d
.- III d Related organizations
CI=
uiE e Governmentgrants (contnbulJons) 1e
c-
oCl)
.-
"QI
..
:::I.e
f All other contnbubons,giftS,grants,
and similar amounts not Includedabove 1f
.0 ..
:sO
C-c 9 NoncashcontnbubonsIncludedIn lines la-It $
Oc
0111
CI>
h Total. Add lines 1a-11 ...
:::3 Busn. Code
I:
CI>
2a Membership fees 211,210 211,210
i;
0:: b Conference Sponsorship 85,716 85,716
CI>
.~
u
C Refunds -1,178 -1,178
CI>
en d
E e
I!!
m f All other program service revenue
~
0.. 9 Total. Add lines 2a-2f ... 295,748
3 Investment income (Including dividends, Interest,
and other similar amounts) ...
4 Income from investment of tax-exempt bond proceeds ...
5 Royalties ...
(I) Real (II) Personal
6a Gross rents
b Less rental exps
C Rental me or (loss)
d Net rental Income or (loss)
7a Gross amountfrom
...
(I) Secunbes (II) Other
sales of assets
other than Inventor.
b Less cost or other
basrs & sales exps
C Gain or (loss)
d Net gain or (loss) ...
QI 8a GrossIncomefromfundraisingevents
:::I
c (notincluding$
GI
> of contnbuttonsreportedon line1c)
..
GI
0::
GI
s:
SeePartIV,line18 a
b Less: direct expenses b
0 c Net income or (loss) from fundraisin events ...
9a GrossIncomefromgamingacnvmes,
SeePartIV,line19 a
b Less. direct expenses b
c Net Income or (loss) from gaming activities ...
10a Gross sales of inventory, less
returns and allowances a
b Less' cost of goods sold b
c Net income or (loss) from sales of Inventory ...
Miscellaneous Revenue Busn. Code
11a
b
c
d All other revenue
e Total. Add lines 11a-11d ...
12 Total revenue. See Instructions. ... 295,748 295,748 0 0
Form 990 (2013)
OM
2039 07/2112014 9 24 AM

Part IX . Statement of Functional Expenses
Section 501(c)(3) and 501 (c)(4) organizations must complete all columns All other organizations must complete column (A)
Check If Schedule 0 contains a response or note to any line in this Part IX
(A) (8) (C) (0)
r1
Do not include amounts reported on lines 6b,
T otal expenses Programservice Management and Fundralsong
7b, 8b, 9b, and 10b of Part VIII. expenses generalexpenses expenses
1 Grants and other assistance to govemments and
organizations In the U S See Part IV, line 21
2 Grants and other assistance to indiViduals In
the U.S See Part IV, line 22

3 Grants and other assistance to govemments,
organizations, and Individuals outside the
US See Part IV, lines 15 and 16
4 Benefits paid to or for members
5 Compensation of current officers, directors,
trustees, and key employees
6 Compensationnot Included above, to disqualified
persons (as defined under section 4958(n(1)) and
persons descnbed In section 4958(c)(3)(B)
7 Other salanes and wages 2,989 2,989
8 Pension plan accruals and contnbutlons (Include
section 401(k) and 403(b) employer contnbutlons)
9 Other employee benefits
10 Payroll taxes
11 Fees for services (non-employees)
a Management
b Legal
c Accounting 1,147 1,147
d Lobbying
e Professionalfundraising services See Part IV, line 17
f Investment management fees
9 Other(Ifhne119 amountexceeds10% ofhne25, column
(A) amount hsthne119 expensesonSchedule0)
12 Advertismq and promotion
13 Office expenses 12,945 12,945
14 Information technology
15 Royalties
16 Occupancy 2,000 2,000
17 Travel
18 Payments of travel or entertainment expenses
for any federal, state, or local public officials
19 Conferences, conventions, and meetings
20 Interest
21 Payments to affiliates
22 Depreciation, depletion, and amortization
23 Insurance
24 Other expenses. Itemize expenses not covered
above (List miscellaneous expenses In line 24e If
line 24e amount exceeds 10% of line 25, column
(A) amount, list line 24e expenses on Schedule0.)
a Workshop 212,984 212,984
b B~k charges 12,103 12,103
c Newsletter 735 735
d Telephone 666 666
e All other expenses 2,009 2,009
25 Totalfunctionalexpenses.Add hnes1 through24e 247,578 247,578 0 0
26 Joint costs. Complete this line only if the
organization reported in column (B) joint costs
from a combined educational campaign and
fundralslng sonctaaon Check here ~ 0 if
following SOP 98-2 (ASC 958-720)
OM Fcnn 990 (2013)
2039 07/2112014 9 24 AM

Pari X . Balance Sheet
Check if Schedule 0 contains a response or note to any line in this Part X f 1
(A) (B)
Beginning of year End of year
1 Cash--non-Interest bearing 9,500 1 57,670
2 Savings and temporary cash investments 2
3 Pledges and grants receivable, net 3
4 Accounts receivable, net 4
5 Loans and other receivables from current and former officers, directors,
trustees, key employees, and highest compensated employees
Complete Part II of Schedule L 5
6 Loans and other receivables from other disqualified persons (as defined under section
4958(f)(1)), persons descnbed in section 4958(c)(3)(8), and contnbutmq employers and
sponsonng organizations of section 501(c)(9) voluntary employees' beneficiary
J!l organizations (see instructions). Complete Part II of Schedule L 6
G)
VI
VI
7
Notes and loans receivable, net 7
< 8
Inventones for sale or use 8
9
Prepaid expenses and deferred charges 9
10a
Land, buildmqs, and equipment: cost or
other basis. Complete Part VI of Schedule D 10a
b Less: accumulated depreciation 10b 10c
11 Investments-publicly traded secunnes 11
12 Investments-other secunnes. See Part IV, line 11 12
13 Investments-program-related See Part IV, line 11 13
14 Intangible assets 14
15 Other assets See Part IV, line 11 15
16 Total assets. Add lines 1 throuqh 15 (must equal line 34) 9,500 16 57,670
17 Accounts payable and accrued expenses 17
18 Grants payable 18
19 Deferred revenue 19
20 Tax-exempt bond liabilities 20
21 Escrow or custodial account liability. Complete Part IV of Schedule D 21
VI
G)
22 Loans and other payables to current and former officers, directors,
~ trustees, key employees, highest compensated employees, and
:E disqualified persons. Complete Part II of Schedule L 22
ftI
:::i 23 Secured mortgages and notes payable to unrelated third parties 23
24 Unsecured notes and loans payable to unrelated third parties 24
25 Other liabilities (including federal Income tax, payables to related third
parties, and other liabilities not Included on lines 17-24). Complete Part X
of Schedule D 25
26 Total liabilities. Add lines 17 tnrouoh 25 0 26 0
VI
Organizations that follow SFAS 117 (ASC 958). check here ~ o
and
G)
o complete lines 27 through 29. and lines 33 and 34.
c:: 27
ftI 27 Unrestncted net assets
iii 28
III 28 Temporanly restncted net assets
"tI Permanently restricted net assets 29
c:: 29
..
::::I
u,
0
Organizations that do not follow SFAS 117 (ASC 958). check here ~
complete lines 30 through 34.
~ and
VI
GiVI 30 Capital stock or trust princtpal, or current funds 30
<
z
..
VI
G)
31
32
Paid-in or capital surplus, or land, buildmq, or equipment fund
Retained eamings, endowment, accumulated Income, or other funds 9,500
31
32 57,670
33 Total net assets or fund balances 9,500 33 57,670
34 Total liabilities and net assets/fund balances 9,500 34 57,670
Form 990 (2013)
OM
203907/2112014924 AM

Part Xl . Reconciliation of Net Assets
1
Check if Schedule 0 contains a response or note to any line in this Part XI
Total revenue (must equal Part VIII, column (A), line 12) 1 295,748
n
2 Total expenses (must equal Part IX, column (A), line 25) 2 247,578
3 Revenue less expenses. Subtract line 2 from line 1 3 48,170
4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) 4 9,500
5 Net unrealized gains (losses) on Investments 5
6 Donated services and use of facilitJes 6
7 Investment expenses 7
8 Pnor period adjustments 8
9 Other changes In net assets or fund balances (explain In Schedule 0) 9
10 Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line
33, column (B» 10 57,670
Part XU Flnancial Statements and Reportmg
Check If Schedule 0 contains a response or note to any line In this Part XII
Yes
o
No
1 AccountJngmethod used to prepare the Form 990 ~ Cash D Accrual 0 Other _
If the organization changed Its method of accounting from a pnor year or checked "Other," explain in
Schedule O.
2a Were the organization's financial statements compiled or reviewed by an Independent accountant? 2a x
If "Yes," check a box below to indicate whether the financral statements for the year were compiled or
reviewed on a separate basis, consolidated basis, or both:
o Separate basis D Consolidated basis D Both consolidated and separate basts
b Were the organization's financial statements audited by an independent accountant? 2b x
If "Yes." check a box below to indicate whether the financial statements for the year were audited on a
separate basis, consolidated basis, or both.
o Separate basis D Consolidated basis D Both consolidated and separate basis .
c If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight
of the audit, review, or compilation of ItSfinancial statements and selection of an independent accountant? 2c
If the organization changed either ItSoversight process or selection process dunng the tax year, explain in
Schedule O.
3a As a result of a federal award, was the orqaruzation required to undergo an audit or audits as set forth In
the Single Audit Act and OMB Circular A-133? 3a x
b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the
required audit or audits, explain why in Schedule 0 and describe any steps taken to undergo such audits 3b
Form 990 (2013)
OM
.. .
2039 07/2112014924 AM
OMS No 1545-004 7
SCHEDUL£ 0 Supplemental Information to Form 990 or 990·EZ
(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. 2013
Department of the Treasury ... Attach to Form 990 or 990-EZ. Open to Pubnc
tntemal Revenue Service ... Information about Schedule 0 (Form 990 or 990-EZ) and its instructions Is at www.irs.gov/form990. Inspection
Name of the orqaruzauon Employer Identification number
American Colle e of Lifest 1e Med 32-0208451
Form 990, Part III, Line 4d - All Other Accomplishment
Provide workshops
~orm 990, Part VI, Line 11b - Organization's Process to Review Form 990
No review was or will be conducted.
~orm 990, Part VI, Line 19 - Governing Documents Disclosure Explanation
No documents available to the public
DM
----------------------------------------------------------------------------------------
.,
20390511312014900 AM
,.
Form 8868 Application for Extension of Time To File an

Exempt Organization Return OMB No 1545-1709
(Rev. January 2014)
.... File a separate application for each return.
Department of the Treasury
Intemal Revenue ServIce
....Information about Form 8868 and its Instructions is at www.irs.gov/form8868.
• If you are filing for an Automatic 3-Month Extension, complete only Part I and check thrs box .... X
• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II (on page 2 of this form)
Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form 8868.
Electronic filing (e-file). You can electronically file Form 8868 If you need a 3-month automatic extension of time to file (6 months for
a corporation required to file Form 990-T), or an additional (not automatic) 3-month extension of time You can electronically file Form
8868 to request an extension of time to file any of the forms listed In Part I or Part II with the exception of Form 8870, Information
Return for Transfers ASSOCiated With Certain Personal Benefit Contracts, whtch must be sent to the IRS In paper format (see
mstrucnons) For more details on the electromc filing of tms form, VISitwww.lrs gov/efile and dick on e-file for Chanties & Nonprofits
Part I Automatic 3-MonthExtension of Time. Only submit anginal (no copies needed).
A corporation required to file Form 990-T and requesting an automatic 6-month extension - check thrs box and complete
Part I only
All other corporations (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of time
to file income tax returns
Enter filer's identifying number see instructions
Type or Name of exempt orqaruzation or other filer, see instructions Employer Identification number (EIN) or
print
American Colleqe of Lifestvle Med 32-0208451
FIle by the Number, street, and room or suite no If a PObox, see mstrucnons Social secunty number (SSN)
due dale lor 612 Glatt Circle
filing your
relum See
City, town or post office, state, and ZIP code For a foreign address, see instructions
Instructions Woodburn OR 97071
Enter the Return code for the return that thrs application ISfor (file a separate application for each return)
Application Return Application Return

Is For Code Is For Code
Form 990 or Form 990-EZ 01 Form 990-T (corporation) 07
Form 990-BL 02 Form 1041-A 08
Form 4720 (IndiVidual) 03 Form 4720 (other than individual) 09
Form 990-PF 04 Form 5227 10
Form 990-T (sec 401(a) or 408(a) trust) 05 Form 6069 11
Form 990-T (trust other than above) 06 Form 8870 12
Marc Braman
612 Glatt Circle
• Thebooksaremthecareof ....Woodburn OR 97071
Telephone No .... 971-983-5383 FAX No ....

• If the organization does not have an office or place of business In the United States, check ttus box
• If ttus ISfor a Group Return, enter the organization's four digit Group Exemption Number (GEN) If thrs IS
for the whole group, check ttus box .... 0
If It ISfor part of the group, check thrs box .... 0 and attach
a list Withthe names and EINs of all members the extension ISfor
1 I request an automatic 3-month (6 months for a corporation required to file Form 990-T) extension of time
until 08/15/14 ,to file the exempt orqaruzatron return for the organization named above The extension IS
for the organtzation's return for
.... ~ calendar year 2013 or
....
0 tax year beginning , and ending
2 If the tax year entered In line 1 ISfor less than 12 months, check reason 0 lrutral return 0 Final return
n chance In accounnnq penod
3a If tms apphcanon ISfor Forms 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits See instructions 3a $ 0
b If tlus apphcauon ISfor Forms 990-PF, 990-T, 4720, or 6069, enter any refundable credits and
esltmated tax payments made. Include any pnor year overpayment allowed as a credit 3b $ 0
c Balance due. Subtract line 3b from nne 3a Include your payment Withttus form, If required, by usmq
EFTPS (Electronic Federal Tax Payment System). See instructions 3c $ 0
Caution. If youaregomgto makeanelectronicfundswithdrawal(directdebrt)WiththiSFonn8868,seeFonn8453-EOandFonn8879·EOforpaymentinstructions
For Privacy Act and Paperwork Reduction Act Notice, see Instructions. Fonn 8868 (Rev 1-2014)
OM

American College of Lifestyle Medicine, IRS 990s 2008 + 2011-Present

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American College of Lifestyle Medicine, IRS 990s 2008 + 2011-Present

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OMB No 1545-1150

reCheck Do- 0 if not

L -22 Cash , savings , and investments . . . . . . . . . . . . . . . 4664 22 20485

Form 990 EZ (2ooe)

statement requirements in the instructions for Part VI

Total number of other employees paid over $100,000 ^

------------ ------------------------------------------------------------------------------- ----

------------ ------------------------------------------------------------------------------- --------

------------ ------------------------------------------------------------------------------- --------

------------ ------------------------------------------------------------------------------- --------

------------ ------------------------------------------------------------------------------- --------

Total number of other independent contractors each receiving over $ 100,000 . . ^

From: Kathy Cater [kcater@fifestylemedicine.org]

Dear Mr. Corsi,

467 Misty Lane

1475 Mt. Hood Ave

24785 Stewart Street. EH 101

401 Taylor Blvd

11538 Anderson Street

43183 Corte Cabrera

Bragg Health Foundation

8700 Mason Montgomery Rd

25231 La Mar Rd Apt C

From : Kathy Cater [kcater@lifestylemedicine.org]

Here is one more board member's estimate of hours spent.

Begin forwarded message:

From : Greg Steinke <greg_steinke@gmail com>

I estimate 2 hours per month so far.

' k „_ e;c^•, •: i •..,

Log% ^ ^n^,•. ^.A

Baard of P.d V11^L5 I ors-2Lett4L5

American College of Lifestyle Medicine

• SIYXIDM RE OIHER FMS:

I 1 fees, serums:( 1080

riaa.irg, gr hics 1048

Various fees, aaypal, lark etc 312

Office sullies, voice nail 563

total casts 5403

Fonn 990-EZ Return of Organization Exempt From Income Tax

a Gross Income from gaming (attach Schedule G if greater than Y, }

b Less' cost of goods sold I 7b I

22 Cash, savings, and investments 9,040 22 13,345

31 Other program services (describe in Schedule 0)

Form 990-EZ (2011)

f Total number of other employees paid over $100,000 . . . . ... _

• 'Fo~ 990 Return of Organization Exempt From Income Tax

ti,e 12) 206,180

medthis retum, includingaccompanyingschedulesand statements,and to the best of my knowledgeand belief,It IS

Form 990(2012) American College of Lifestyle Med 32-0208451 Page 2

4a (Code: ) (Expenses $ 210 ,026 Including grants of $ ) (Revenue $

4b (Code. ) (Expenses $ including grants of $ ) (Revenue $

4c (Code: ) (Expenses $ including grants of $ ) (Revenue $

4d Other program services. (Descnbe in Schedule 0.)

Form 990 (2012) American College of Lifestyle Med 32-0208451 Page 3

Form 990 (2012) American College of Li festyle Med 32-0208451 Paqe 4

Fdrm990(2012) American College of Lifestyle Med 32-0208451 Page 6

Form 990(2012) American College of Lifestyle Med 32-0208451 Page 7

DAA Fonm 990 (2012)

Foim 990 (~!o12) American College of Lifestyle Med 32 - 0208451 Page 9

11a Other 8,431 8,431

Fohn 990(2012) American College of Lifestyle Med 32-0208451 Page 10

Form 990 (2012) American College of Lifestyle Med 32-0208451 Page 11