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        <Identifier>Travel for Companions</Identifier>
        <ReturnReference>Schedule J, Part I, Line 1a</ReturnReference>
        <Explanation>Per IRS regulations, travel for companions is a taxable benefit. Therefore, if the executive director or CFO approves as an exception reimbursement of these expenses, it will be included as taxable compensation to the employee. In 2012, there were no recipients of companion travel.</Explanation>
      </Form990ScheduleJPartIII>
    </IRS990ScheduleJ>
    <IRS990ScheduleM documentId="IRS990ScheduleM">
      <WorksOfArt />
      <ArtHistoricalTreasures />
      <ArtFractionalInterest />
      <BooksAndPublications />
      <ClothingAndHouseholdGoods />
      <CarsAndOtherVehicles />
      <BoatsAndPlanes />
      <IntellectualProperty />
      <SecuritiesPubliclyTraded>
        <NonCashCheckbox>X</NonCashCheckbox>
        <NumberOfContributions>2</NumberOfContributions>
        <NoncashContribsRptdF990>52857</NoncashContribsRptdF990>
        <MethodOfDeterminingRevenues>Fair Market Value</MethodOfDeterminingRevenues>
      </SecuritiesPubliclyTraded>
      <SecuritiesCloselyHeldStock />
      <SecuritiesPrtnrshpTrustIntrsts />
      <SecuritiesMiscellaneous />
      <QualifiedContribHistStruct />
      <QualifiedContribOther />
      <RealEstateResidential />
      <RealEstateCommercial />
      <RealEstateOther />
      <Collectibles />
      <FoodInventory />
      <DrugsAndMedicalSupplies />
      <Taxidermy />
      <HistoricalArtifacts />
      <ScientificSpecimens />
      <ArchaeologicalArtifacts />
      <NumberOf8283Received>2</NumberOf8283Received>
      <AnyPropertyThatMustBeHeld>false</AnyPropertyThatMustBeHeld>
      <ReviewProcessUnusualNCGifts>true</ReviewProcessUnusualNCGifts>
      <ThirdPartiesUsed>false</ThirdPartiesUsed>
      <Form990ScheduleMPartII>
        <Identifier>Number of Contributions or Items Contributed</Identifier>
        <ReturnReference>Schedule M, Part I, Column (b)</ReturnReference>
        <Explanation>The College is reporting the number of contributions received.</Explanation>
      </Form990ScheduleMPartII>
    </IRS990ScheduleM>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <GeneralExplanation>
        <Identifier>Other Program Services</Identifier>
        <ReturnReference>Form 990, Part III, Line 4d</ReturnReference>
        <Explanation>The College has an Integrated Communications and Member Services division among others. Through Member Services, the College continues to remain a major professional association, with over 77,000 members, for all surgical specialists that meets the needs of member surgeons with programs and services that help them adapt to a changing health care environment. The Division evaluates all applications for Fellowship based upon defined fellowship, Associate Fellow, and Resident/Medical Student requirements. The Division also staffs the International Relations Committee, Scholarship Committee, and the 12 Surgical Specialty Advisory Councils. Scholarships are awarded to various medical students and Residents and are administered within this area. This Division also acts as the staff liaison for the 216 elected Board of Governors. The Board of Governors advise and council the Board of Regents. The Division also heads the activities of our 103 domestic and international chapters. Expenses: $12,443,539. Grants: $ 386,977. Revenue: $ 2,422,901.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Material Differences in Voting Rights</Identifier>
        <ReturnReference>Form 990, Part VI, Line 1a</ReturnReference>
        <Explanation>According to Article V, Section 2, subparagraph (a) of the bylaws, it states, "During the intervals between meetings of the Board of Regents, the Executive Committee shall exercise the powers of the Board of Regents in the management and direction of the business and the conduct of the affairs of the college, except that it shall not have power to elect fellows; amend the byalws; or regulate fees, dues, or assessments. It shall keep a record of its proceedings and shall, after each meeting, report the same to the regents for approval at the next succeesing meeting of the Board of Regents."</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Form 990 Review Process</Identifier>
        <ReturnReference>Form 990, Part VI, Line 11b</ReturnReference>
        <Explanation>After the 990 forms were completed by the ACS Accounting Department and reviewed by outside tax professionals, copies of the 990 forms were sent to the ACS Finance Committee for review (ACS Board of Regents delegated this responsibility to the ACS Finance Committee). The ACS Finance Committee was given ample time to review the documents and address any concerns to the Chief Financial Officer. Once the ACS Finance Committee's concerns were addressed, the ACS Accounting department revised the 990 forms (if necessary), emailed a copy to the full Board of Regents, and filed them with the IRS.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Conflict of Interest Policy Monitoring &amp; Enforcement</Identifier>
        <ReturnReference>Form 990, Part VI, Line 12c</ReturnReference>
        <Explanation>The College has conflicts of interest policies for employees, consultants and board members. All employees, consultants and board members are required to sign a disclosure statement each year, which are collected and disseminated by the Chief Financial Officer's office. There is also an ACS Conflicts of Interest Committee that meets periodically as the need arises to discuss issues that relate to conflicts of interest. The committee accounts for the receipt of disclosure statements and follows up on any issues. This information is then reported to the ACS Finance Committee of the Board of Regents. If the ACS Finance Committee feels there are conflicts that are questionable in nature, they are reported to the ACS Board of Regents Chair and Treasurer for action. The Board of Regents Executive Committee shall take action on any presumed or potential violation of this policy by a member of leadership to ensure that a conflict of interest does not arise or does not continue. In addition to any legal penalties, such action may include, but shall not be limited to, oral admonishment, written reprimand, resignation, and restitution. A member who disagrees with the findings or recommendations of the Finance Committee or the action of the Board of Regents Executive Committee may appeal the decision to the Board of Regents.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Process for Determining Compensation</Identifier>
        <ReturnReference>Form 990, Part VI, Line 15a and 15b</ReturnReference>
        <Explanation>The College has policies and procedures concerning compensation increases, performance evaluations, and job evaluations. In addition, merit increases are included as a budget parameter for review by the finance committee as is the addition of any new employee or human resource benefit proposal. The College has an executive compensation committee as a subcommittee to the finance committee. The committee is comprised of the Board of Regents Chair, Board of Regents Treasurer, Board of Governors Secretary, and a member of the finance committee. The executive compensation committee's purpose is as follows: to establish procedures to create a "rebuttable presumption of reasonableness" in connection with IRS intermediate sanctions regulations. Responsibilities are to ensure that compensation for each "disqualified person" is reasonable. Human Resources provides comparability data to the committee in the form of surveys, other similar organizations, geographical comparisons, and actual written offers from similar institutions for the services of a disqualified person. The committee documents the basis for all compensation determinations.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Documents Made Available to Public</Identifier>
        <ReturnReference>Form 990, Part VI, Line 19</ReturnReference>
        <Explanation>The Bylaws are available on our website.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>Other Changes in Net Assets or Fund Balances</Identifier>
        <ReturnReference>Form 990, Part XI, Line 9</ReturnReference>
        <Explanation>Pension Adjustment: 4,476,699. Change in Value of Annuities: -9,923. Book/Tax Difference of Investment in Partnerships: -35,313. Tenant Lease Buyout -404,387. Change in Funds Held for Others: -3,305,518. ------------- Total: 721,558.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:COMPUTER/STATISTICAL CONSULT. TOTAL FEES:2772541</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:PUBLIC RELATIONS CONSULT. TOTAL FEES:2462530</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:HONORARIA TOTAL FEES:2373090</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:OTHER CONSULT. TOTAL FEES:1756847</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:FACILITIES CONSULT. TOTAL FEES:975000</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:PERFORMANCE IMPROVE CONSULT. TOTAL FEES:818291</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:EDITORIAL CONSULT. TOTAL FEES:338759</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:EMPLOYMENT AGENCY FEES TOTAL FEES:273450</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:WEBSITE CONSULT. TOTAL FEES:200866</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:HR BENCHMARKING CONSULT. TOTAL FEES:174711</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:DATA PROCESSING SERVICES TOTAL FEES:163704</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:PAYROLL SERVICES TOTAL FEES:20414</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER FEES FOR SERVICES FOR NON-EMPLOYEES</Identifier>
        <ReturnReference>FORM 990 PART IX LINE 11G</ReturnReference>
        <Explanation>DESCRIPTION:ONLINE &amp; DATABASE RESEARCH TOTAL FEES:2319</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="IRS990ScheduleR">
      <Form990ScheduleRPartI>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>Surgeons Asset Management</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>633 N Saint Clair Street</AddressLine1>
          <City>Chicago</City>
          <State>IL</State>
          <ZIPCode>60611</ZIPCode>
        </AddressUS>
        <EIN>203761195</EIN>
        <PrimaryActivities>Invst Advisor</PrimaryActivities>
        <LegalDomicileState>IL</LegalDomicileState>
        <TotalIncome>0</TotalIncome>
        <EOYAssets>0</EOYAssets>
        <DirectControllingEntityName>
          <BusinessNameLine1>ACS</BusinessNameLine1>
        </DirectControllingEntityName>
      </Form990ScheduleRPartI>
      <Form990ScheduleRPartI>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>ACS East Ontario LLC</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>633 N Saint Clair Street</AddressLine1>
          <City>Chicago</City>
          <State>IL</State>
          <ZIPCode>60611</ZIPCode>
        </AddressUS>
        <EIN>362192800</EIN>
        <PrimaryActivities>Re Investment</PrimaryActivities>
        <LegalDomicileState>IL</LegalDomicileState>
        <TotalIncome>-6833</TotalIncome>
        <EOYAssets>2825334</EOYAssets>
        <DirectControllingEntityName>
          <BusinessNameLine1>ACS</BusinessNameLine1>
        </DirectControllingEntityName>
      </Form990ScheduleRPartI>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>American College of Surgeons Prof Assoc</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>633 N Saint Clair Street</AddressLine1>
          <City>Chicago</City>
          <State>IL</State>
          <ZIPCode>60611</ZIPCode>
        </AddressUS>
        <EIN>300079883</EIN>
        <PrimaryActivities>Ed in Surgery</PrimaryActivities>
        <LegalDomicileState>IL</LegalDomicileState>
        <ExemptCodeSection>501(c)(6)</ExemptCodeSection>
        <DirectControllingEntityName>
          <BusinessNameLine1>ACS</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrg>true</ControlledOrg>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>ACSPA Surgeons PAC</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>633 N Saint Clair Street</AddressLine1>
          <City>Chicago</City>
          <State>IL</State>
          <ZIPCode>60611</ZIPCode>
        </AddressUS>
        <EIN>141849039</EIN>
        <PrimaryActivities>Political Act</PrimaryActivities>
        <LegalDomicileState>IL</LegalDomicileState>
        <ExemptCodeSection>527</ExemptCodeSection>
        <DirectControllingEntityName>
          <BusinessNameLine1>ACSPA</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrg>true</ControlledOrg>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>American College of Surgeons Foundation</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>633 N Saint Clair Street</AddressLine1>
          <City>Chicago</City>
          <State>IL</State>
          <ZIPCode>60611</ZIPCode>
        </AddressUS>
        <EIN>300305504</EIN>
        <PrimaryActivities>Granting</PrimaryActivities>
        <LegalDomicileState>IL</LegalDomicileState>
        <ExemptCodeSection>501(c)(3)</ExemptCodeSection>
        <PublicCharityStatus>7</PublicCharityStatus>
        <DirectControllingEntityName>
          <BusinessNameLine1>ACS</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrg>true</ControlledOrg>
      </Form990ScheduleRPartII>
      <ReceiptOfIntAnnRentsRoyalties>false</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>false</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>true</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>false</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>false</LoansOrGuaranteesFromOtherOrg>
      <SaleOfAssetsToOtherOrg>false</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>false</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>false</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>false</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>false</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>false</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>true</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>false</SharingOfFacilities>
      <SharingOfPaidEmployees>true</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>false</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>true</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>false</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>false</OtherTransferFromOtherOrg>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>American College of Surgeons Prof Assoc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>c</TransactionType>
        <AmountInvolved>16366957</AmountInvolved>
        <MethodOfAmtDetermination>Cost</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>American College of Surgeons Prof Assoc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>m</TransactionType>
        <AmountInvolved>1403495</AmountInvolved>
        <MethodOfAmtDetermination>Cost</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>American College of Surgeons Prof Assoc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>o</TransactionType>
        <AmountInvolved>114492</AmountInvolved>
        <MethodOfAmtDetermination>Cost</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>American College of Surgeons Prof Assoc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>q</TransactionType>
        <AmountInvolved>498845</AmountInvolved>
        <MethodOfAmtDetermination>Cost</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>American College of Surgeons Foundation</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>c</TransactionType>
        <AmountInvolved>1046343</AmountInvolved>
        <MethodOfAmtDetermination>Cost</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>American College of Surgeons Foundation</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>o</TransactionType>
        <AmountInvolved>674939</AmountInvolved>
        <MethodOfAmtDetermination>Cost</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
    </IRS990ScheduleR>
  </ReturnData>
</Return>