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
DONOR NETWORK OF ARIZONA
Employer identification number
86-0707697
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.") .
448,349
299,986
477,730
392,123
324,208
1,942,396
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......
20,079,552
23,661,206
26,595,679
28,122,189
31,125,261
129,583,887
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.
20,527,901
23,961,192
27,073,409
28,514,312
31,449,469
131,526,283
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
131,526,283
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...
20,527,901
23,961,192
27,073,409
28,514,312
31,449,469
131,526,283
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
141,132
173,064
54,629
24,650
142,801
536,276
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
141,132
173,064
54,629
24,650
142,801
536,276
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.)
1,450
0
0
0
0
1,450
13
Total support (Add lines 9, 10c, 11 and 12.).
20,670,483
24,134,256
27,128,038
28,538,962
31,592,270
132,064,009
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
99.593 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.619 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.406 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.380 %
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
DONOR NETWORK OF ARIZONA
Employer identification number
86-0707697
Identifier
Return Reference
Explanation
PROGRAM DESCRIPTIONS
Form 990, Part III
4A ORGAN RECOVERY & PLACEMENT SERVICES 23 people received transplantable pancreata, 1 person received a transplantable lung, 24 people received transplantable lungs en bloc, and 2 people received transplantable small intestines. The organization facilitated the importation of 180 transplantable organs from other geographical areas. 4B Tissue & Ocular Recovery & Placement Services These donors also donated sclera for transplantation purposes. 4D Donor Program Development - Hospital & Community Services - The hospital donor program development department is responsible for maximizing the total number of donors recovered for transplant in Arizona through the implementation of individualized donor programs based on comprehensive hospital assessment, analysis of the donor potential in Arizona, the implementation of ongoing quality process improvement and initiation and fostering of effective relationships within the professional community. Currently this department has 12 full-time coordinators and one manager who, in addition to the Director, provide education and services to over 120 hospitals throughout Arizona. In addition the department has one Data Coordinator who is responsible for medical record review and other quality monitors for the department and a professional education coordinator who is responsible for internal and external training. Donor Network of Arizona continues to utilize the best practices as defined by the U.S. Department of Health and Human Services' Breakthrough Collaboratives for organ donation and transplantation. This includes active participation in regional and national improvement efforts. These efforts continue to help us maximize conversion rates, donors and the number of organs transplanted per donor in Arizona. Donor Network of Arizona continues to work with the Arizona Hospital and Healthcare Association to spread the collaborative methodologies and improvements to all Arizona hospitals. Through this effort Donor Network of Arizona held champion training events at several Arizona as well as a monthly webinar education series. DNA continued implementation of our In-House Coordinator in two of our seven Level 1 Trauma Centers. The In-House Coordinator is based upon a Best Practice as identified through the Breakthrough Collaborative. While these coordinators are Organ Recovery Staff and respond to organ donation referrals, they also act as the Donor Program Coordinators for their assigned hospitals. The Hospital Donor Program Development Department conducts 400 - 600 professional education offerings each year and has provided designated requestor training to over 4,000 healthcare workers throughout the state. In addition, the hospital donor program development staff at Donor Network of Arizona coordinates special education events and projects and develops and maintains educational materials. 4D -- Donor Program Development - Community Development/Public Relations The focus of our community development / public relations department is to increase organ and tissue donor registration in Arizona by creating and expanding public outreach programs, distributing information and developing and expanding community partnerships. Some key public education highlights for 2010 included: - More than 240,000 people registered their decision to be a donor on the DonateLife AZ Registry. - DNA continued the Live It, Give It, Check It campaign with the Arizona Department of Transportation including promotional materials at all offices, newsletter articles, web promotion and more. - Volunteers contributed over 3600 hours of their time for outreach efforts and our internal projects. - There were 262 stories in Arizona that included the Donor Network of Arizona website and / or phone number. - Donor Network of Arizona also increased our presence in Social Media and ended the year with 4,161 likes on our Facebook page, 475 followers on Twitter and 1,844 views of our YouTube videos. - Meredith McCall rode on the Donate Life Float in the annual Rose Parade in Pasadena, CA as Arizona's representative. Meredith is a kidney pancreas recipient. Her brother was an organ donor several years ago. James McCall's image was also on the float as a Florograph. - More than 200 Public Speaking Engagements and Events. - Continued to use multiple portals to allow Arizonans to register including kiosks, forms, and mail. - University of Arizona won the Donate Life Campus Challenge in a competition during April to increase donation on college campuses in AZ. - Finalized the final year of a $1+million dollar grant from U.S. Department of Health and Human Services to reach out to the Hispanic community via swap meets in Tucson and Phoenix.
GOVERNANCE, MANAGEMENT & DISCLOSURE
PART VI
SECTION B LINE 11: THE 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND, Upon completion, a draft is emailed to all members of the Board of Directors for their review and comment. After their review is complete, the firm is provided with any comments or changes and/or instructed to file the return. SECTION B LINE 12C: Internal Reporting All members of the DNA Board of Directors will be required to complete a conflict of interest disclosure statement upon affiliation with DNA or hiring and to update the statement at least annually. The Chief Executive Director shall prepare a report for the DNA Board of Directors' annual meeting listing all transactions between DNA and DNA Board of Directors. The report will include: - A description of the transaction and its date. - The amount of the transaction and its impact on DNA. - The name of the DNA Board of Director member involved and the name of the other entity, if any, and a description of the nature of the DNA Board of Director's interest in the transaction. If a conflict of interest cannot be avoided, the Board member who has a conflict of interest shall not vote on, participate in or attempt to influence any DNA decision affected by the conflict of interest, except to provide information as specifically requested by deciding committee or body. SECTION B LINES 15A&B: Procedure: Compensation Philosophy and Strategy The objectives of DNA's executive compensation program are to provide a competitive Executive total compensation program compared to other organizations of similar size and type, particularly healthcare organizations. DNA's philosophy is to: Strongly link pay with performance. Retain the talented senior management team and show that DNA values them. Ensure reasonable compensation as compared to peers. It is the committee's intent to use peer data from similar positions in similar organizations under similar circumstances. Position base salary competitively at least at the median labor market as compared to peers. Ensure that DNA's total compensation, including total cash compensation and employee and executive benefits, is positioned at competitive practice overall when DNA meets its key goals. - DNA provides an Executive compensation program that integrates all elements of compensation and benefits. - Base salary is market-based and reflects an individual's performance. Annually an individual's performance is evaluated relative to their position accountabilities and performance criteria as well as organizational accountabilities. - The Organizational Incentive Plan, DNA's annual incentive, rewards achievement on key organizational goals that represent success measures for organ procurement, eye and tissue organizations. Incentive goals strongly align with DNA's mission. The Plan rewards organization-wide performance to reinforce teamwork. A threshold of financial performance is necessary for the Plan to be affordable. Procedure: Compensation Committee Responsibilities and Duties The Compensation Committee will meet regularly as scheduled in conjunction with board meetings. The Compensation Committee will be responsible to contract an outside consultant to review and trend current market data and total executive compensation to ensure executives are reasonably compensated. This will be done at a minimum of two to three years or as needed. The Committee will oversee and supervise the consultant's work product. All compensation agreements and decisions made by the Committee will be made independently and with due diligence. All compensation agreements and decisions will be thoroughly documented in the Finance/Compensation Committee minutes or the Executive session board minutes as appropriate. Guidelines for documentation are as follows and will include: - Identification of attendees - Verification and statement that no member has a conflict of interest. - Documentation that those who have a conflict will be excused. - Identification of source and collection of compensation data Detailed documentation of the terms of the compensation being approved If compensation value differs from comparability data, the basis for determination will be stated. With each decision regarding executive compensation, the committee will be responsible to establish a "rebuttable presumption of reasonableness". In doing so, the Committee will: - Ensure participants are independent - Make decisions based on appropriate comparability data. - Ensure minutes reflect a written record of the committee's work. The Compensation Committee will report all decisions regarding executive compensation to the full Board. ALL REVIEWS WERE PERFORMED IN JANUARY 2011 OR ON DATE OF HIRE IF HIRED AFTER JANUARY 2011. SECTION C LINE 19: The organization's articles of incorporation, by-laws, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. RECONCILIATION OF NET ASSETS PART XI LINE 5: UNREALIZED GAIN ON INVESTMENTS: $180,139
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.