Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MEMORIAL BLOOD CENTERS INC
Employer identification number
41-0693869
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
363,186
400,532
525,531
465,428
462,287
2,216,964
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
39,088,748
44,734,432
48,526,003
48,520,947
47,857,318
228,727,448
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
39,451,934
45,134,964
49,051,534
48,986,375
48,319,605
230,944,412
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
9,015
8,861
16,801
11,839
13,570
60,086
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
22,058,012
22,306,781
25,428,275
24,382,504
25,028,021
119,203,593
c
Add lines 7a and 7b..
22,067,027
22,315,642
25,445,076
24,394,343
25,041,591
119,263,679
8
Public Support (Subtract line 7c from line 6.)
111,680,733
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
39,451,934
45,134,964
49,051,534
48,986,375
48,319,605
230,944,412
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
557,213
68,999
24,280
3,124
12,692
666,308
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
557,213
68,999
24,280
3,124
12,692
666,308
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
45,303
146,330
23,475
630,054
656,016
1,501,178
13
Total support (Add lines 9, 10c, 11 and 12.).
40,054,450
45,350,293
49,099,289
49,619,553
48,988,313
233,111,898
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
47.910 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
47.170 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.290 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.440 %
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME ASSET IMPAIRMENT LOSS
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MEMORIAL BLOOD CENTERS INC
Employer identification number
41-0693869
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 1
THE EXECUTIVE COMMITTEE IS COMPOSED OF THE CHAIR, VICE CHAIR, SECRETARY AND OTHER DIRECTOR(S) DESIGNATED BY THE BOARD OF DIRECTORS TO SERVE ON THE COMMITTEE. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE BUSINESS OF THE ORGANIZATION BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, BUT IS SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 11
THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED AND APPROVED THE 990. THE FORM 990 WAS THEN SENT TO THE FULL BOARD OF DIRECTORS BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C
DIRECTORS AND OFFICERS MUST DISCLOSE ALL CONFLICTS OF INTEREST AND MUST ANNUALLY COMPLETE AND RETURN TO THE NOMINATING AND GOVERNANCE COMMITTEE THE QUESTIONNAIRE WHICH IS A PART OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. WHENEVER IN THE COURSE OF EVENTS A DIRECTOR'S OR OFFICER'S CIRCUMSTANCES CHANGE, SO THAT HE OR SHE KNOWS OR HAS REASON TO KNOW THAT AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST MAY ARISE, SUCH DIRECTOR OR OFFICER SHALL PROMPTLY DISCLOSE THE POTENTIAL CONFLICT TO THE NOMINATING AND GOVERNANCE COMMITTEE. THE DIRECTOR OR OFFICER SHALL NOT PARTICIPATE IN, TAKE ANY ACTION UPON, OR VOTE UPON SUCH MATTERS UNTIL THE QUESTION OF THE EXISTENCE OF THE CONFLICT OF INTEREST HAS BEEN DETERMINED BY THE NOMINATING AND GOVERNANCE COMMITTEE. WHEN A CONFLICT OF INTEREST DOES IN FACT EXIST UNDER THE DEFINITION SET FORTH ABOVE, THE PERSON WITH THE CONFLICT OF INTEREST SHALL NOT BE COUNTED FOR DETERMINING THE PRESENCE OF A QUORUM, EVEN WHEN PERMITTED BY LAW AND SHALL NOT PARTICIPATE IN ANY WAY IN, OR BE PRESENT DURING, THE DELIBERATIONS AND DECISION-MAKING VOTE WITH RESPECT TO THE MATTER. NEVERTHELESS, THE INTERESTED PARTY SHALL HAVE AN OPPORTUNITY TO PROVIDE FACTUAL INFORMATION ABOUT THE MATTER. THE MINUTES OF THE MEETING SHOULD REFLECT THAT THE DIRECTOR OR OFFICER HAVING A CONFLICT DISCLOSED SUCH INTEREST AND ABSTAINED VOTING ON THE MATTER AND THAT A QUORUM WAS PRESENT FOR SUCH ACTION.
FORM 990, PART VI, SECTION B, LINE 15
THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS, COMPOSED ENTIRELY OF INDEPENDENT PERSONS, OVERSEES EXECUTIVE COMPENSATION AND, IN DOING SO, RETAINS AN EXTERNAL PARTY TO CONDUCT AN INDEPENDENT MARKET SURVEY ON A REGULAR BASIS (EVERY 2 - 3 YEARS). THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2008 FOR THE CEO, D. BERGLUND; CFO, J. BUSKE, VP OF HR AND ORGANIZATIONAL DEVELOPMENT, R. CLAXTON; VP OF MEDICAL & QUALITY AFFAIRS, J. GORLIN; VP OF TECHNOLOGY OPERATIONS, J. PETERSEN; VP OF RECRUITMENT, COLLECTION & PRODUCTION PLANNING, K. KIEFFER; AND ASSOCIATE MEDICAL DIRECTOR, E. PERRY.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS OPEN TO THE PUBLIC.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED LOSSES ON INVESTMENTS: -3,799. PENSION LIABILITY ADJUSTMENT 458,340. LOSS ON IMPAIRMENT OF FIXED ASSETS -109,872. TOTAL TO FORM 990, PART XI, LINE 5: 344,669.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.