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8 <br />rtr4lit-~QI~Q KLI~~[}~R°~1M~Ll~'I hfh~[FlY1~~tW~°v ~I tli ~~ ~4~ ~€~~c ]$~ ~v ',it~i ~i~5 'a~p~.~ h~`~""n,kF Sir ~F~tl <br />Has yotar organization attended a Blue Cross and Blue Shield of North Carolina Foundation Healthy <br />Community Institute for Nan-Profit Excellence? <br />^ Yes ® No <br />(If no, please visit our Website at www.bcbsnc.com/foundation for additional information ) <br />Are any Blue Cross and Blue Shield of North Carolina employees involved with your organization as <br />volunteers/board members/committee members, etc.? <br />^ Yes ® No <br />If Yes, please explain: <br />Have you previously received funding from the BCBSNC Foundation? <br />^ Yes ® No <br />How many members are on your board of directors? Board of Commissioners- 5 <br />How many board members made a personal financial contribtation to your organization within the <br />past 12 months? t.Jnknown, however they all pay Orange County property and sales tax <br />Is there any pending litigation against your organization? <br />^ Yes ®No <br />If Yes, please explain: <br />Has your organization had to pay any cotart-ordered judgments in the past three years? <br />^ Yes ® No <br />If Yes, for what and how much? <br />Have any of the principals of your organization or principals of any of your afFiliates been convicted of <br />a felony within the last 10 years? <br />^ Yes ® No <br />