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
THE BLOOD CENTER OF IOWA
Employer identification number
42-0864127
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.") .
27,708
27,590
24,563
211,857
99,698
391,416
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......
20,389,157
23,787,586
25,889,984
28,399,158
27,011,927
125,477,812
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.
20,416,865
23,815,176
25,914,547
28,611,015
27,111,625
125,869,228
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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.
0
c
Add lines 7a and 7b..
0
8
Public Support (Subtract line 7c from line 6.)
125,869,228
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...
20,416,865
23,815,176
25,914,547
28,611,015
27,111,625
125,869,228
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
86,339
87,439
59,414
18,090
19,652
270,934
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
86,339
87,439
59,414
18,090
19,652
270,934
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.)
16,549
18,549
16,277
20,927
8,942
81,244
13
Total support (Add lines 9, 10c, 11 and 12.).
20,519,753
23,921,164
25,990,238
28,650,032
27,140,219
126,221,406
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
99.720 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.600 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.210 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.290 %
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 (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
THE BLOOD CENTER OF IOWA
Employer identification number
42-0864127
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
THE MANAGEMENT DUTIES ARE PROVIDED BY LIFESERVE BLOOD CENTER. PLEASE SEE THE EXPLANATION BELOW FOR PART VI, LINE 4.
FORM 990, PART VI, SECTION A, LINE 4
DURING THE YEAR, THE BLOOD CENTER OF IOWA (BCI) AGREED TO A PLAN OF MERGER WITH LIFESERVE BLOOD CENTER (LIFESERVE), AND SIOUXLAND COMMUNITY BLOOD BANK (SCBB). LIFESERVE WAS FORMED TO FACILITATE A MERGER BETWEEN BCI AND SCBB. BOTH BCI AND SCBB ARE NONPROFIT CORPORATIONS EXEMPT UNDER IRC SECTION 501(C)(3). DURING 2010, LIFESERVE SUBMITTED AN APPLICATION FOR FDA LICENSURE OF ITS BLOOD RELATED ACTIVITIES. WHEN THE APPLICATION IS APPROVED AND ALL OTHER REQUIRED STEPS TO COMPLETE THE MERGER ARE ACCOMPLISHED, BOTH BCI AND SCBB WILL HAVE THEIR CURRENT FDA LICENSES REVOKED, AND WILL MERGE INTO LIFESERVE. AFTER THE PLAN OF MERGER WAS APPROVED, BOTH BCI AND SCBB IMPLEMENTED A TRANSFER OF ALL ADMINISTRATION, HUMAN RESOURCES, INFORMATION TECHNOLOGY, AND QUALITY ASSURANCE ASSETS AND RELATED EXPENSES TO LIFESERVE. BCI AND SCBB DECIDED TO MERGE BECAUSE OF A VARIETY OF HEALTHCARE OPPORTUNITIES THAT EXIST BECAUSE OF THE ORGANIZATIONS PROXIMITY TO EACH OTHER. THEIR COMBINATION ALLOWS THE OPPORTUNITY TO ADD VALUE-ADDED SERVICES TO ALL HOSPITALS, WHICH INCLUDES INCREASED TECHNOLOGY TO THE HOSPITALS, BETTER TRANSFUSION DATA FOR PHYSICIANS AND ADMINISTRATORS, AND INCREASED INVENTORY LEVELS OF AVAILABLE BLOOD PRODUCTS. THE MERGER WILL ALLOW THE ORGANIZATION TO CONTROL COSTS AND TO DECREASE THE COST OF BLOOD PRODUCTS TO THE 89 HOSPITALS SERVED. BEGINNING APRIL 1, 2010, AND UNTIL THE MERGER IS FINALIZED, THE ELEVEN MEMBERS OF LIFESERVE'S BOARD OF DIRECTORS WILL ALSO SERVE AS THE BOARD MEMBERS OF SCBB AND BCI. ADDITIONALLY, ALL THREE ENTITIES WILL OPERATE IN A COORDINATED FASHION BY VIRTUE OF THEIR COMMON BOARD MEMBERS AND EMPLOYEES. ONCE THE MERGER IS FINALIZED, ALL ASSETS AND OPERATIONS WILL BE TRANSFERRED TO LIFESERVE, AND THE SCBB AND BCI WILL CEASE TO EXIST. AS OF DECEMBER 31, 2010, THE MERGER HAD NOT BEEN COMPLETED.
FORM 990, PART VI, SECTION B, LINE 11
THE FINANCE COMMITTEE OF THE BOARD WILL REVIEW THE COMPLETED FORM 990 VIA EMAIL BEFORE IT IS FILED. ANY QUESTIONS OR COMMENTS RELATED TO ITS PREPARATION WILL BE DOCUMENTED BY ACCOUNTING STAFF AND FORWARDED TO THE CPA FIRM PREPARING THE RETURN FOR REVISION AND RECONCILIATION.
FORM 990, PART VI, SECTION B, LINE 12C
MANAGEMENT AND THE BOARD OF DIRECTORS ARE AWARE OF THE POLICY. BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE CONFLICT OF INTEREST POLICY. ALL SIGNIFICANT TRANSACTIONS ARE REVIEWED BY MANAGEMENT, OR THE BOARD IF APPROPRIATE, TO ENSURE COMPLIANCE.
FORM 990, PART VI, SECTION B, LINE 15
THE HUMAN RESOURCES DEPARTMENT GATHERS MARKET RESEARCH TO COMPARE POSITIONS AND COMPENSATION WITH OTHER HEALTH CARE PROVIDERS AND BLOOD CENTERS THROUGHOUT THE U.S. TO DETERMINE APPROPRIATE COMPENSATION. WHEN NECESSARY, RECOMMENDATIONS ARE THEN MADE TO THE BOARD FOR THEIR APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
PRIOR PERIOD ADJUSTMENTS: 181,336.
FORM 990, PART XII, LINE 2C
THE FINANCE COMMITTEE WHICH ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS HAS NOT CHANGED ITS PROCESS FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.