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
2012
Open to Public Inspection
Name of the organization
CARDIOVASCULAR OUTCOMES INC
Employer identification number
37-1419769
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
ST LUKES HOSPITAL,
,
KANSAS CITY,
MO
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
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......
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.
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.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012
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
2012
Open to Public Inspection
Name of the organization
CARDIOVASCULAR OUTCOMES INC
Employer identification number
37-1419769
Identifier
Return Reference
Explanation
ALL OTHER ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
THE RIGHTS TO SUBLICENSE SEVERAL DISEASE-SPECIFIC HEALTH STATUS INSTRUMENTS ARE HELD BY CVO. THE SEATTLE ANGINA QUESTIONNAIRE (SAQ), THE KANSAS CITY CARDIOMYOPATHY QUESTIONNAIRE (KCCQ), AND THE PERIPHERAL ARTERIAL QUESTIONNAIRE (PAQ) ARE LICENSED TO RESEARCHERS THROUGH CVO. DURING 2012, >25 LICENSES WERE AWARDED TO ACADEMIC AND NOT-FOR-PROFIT RESEARCHERS INTERESTED IN PATIENT CENTERED, DISEASE-SPECIFIC HEALTH STATUS FOR CARDIOVASCULAR ILLNESSES. PUBLISHING FROM THE PREMIER REGISTRY (PROSPECTIVE REGISTRY EVALUATING OUTCOMES AFTER MYOCARDIAL INFARCTION: EVENTS AND RECOVERY) REMAINS A LARGE PART OF CVO'S ACCOMPLISHMENTS. THE EXTENSIVE DATABASE WAS USED BY MULTIPLE INVESTIGATORS, PHYSICIANS AND NURSES ALIKE, FOR PUBLICATION IN EIGHT SCIENTIFIC ABSTRACTS AND MANUSCRIPTS THIS YEAR.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
IN ACCORDANCE WITH ITS REVIEW FUNCTION, THE BOARD OF DIRECTORS SHALL TAKE THE FOLLOWING ACTIONS: "SELECT THE FORM 990 PREPARER. "CONDUCT A DETAILED REVIEW OF THE FORM 990 AND CONSIDER THE ISSUES PRESENTED. "ENSURE THAT THE MISSION STATEMENT STATED IN THE FORM 990 HAS BEEN APPROVED BY THE BOARD OF DIRECTORS. "CAREFULLY MONITOR THE DESCRIPTION OF THE CORPORATION'S PURPOSES AND ACTIVITIES REPORTED ON THE FORM 990 TO ENSURE ACCURACY AND COMPLIANCE WITH SECTION 501(C)(3). "APPROVE AND DISTRIBUTE THE ANNUAL DISCLOSURE STATEMENT TO OFFICERS, DIRECTORS AND KEY EMPLOYEES TO ACQUIRE INFORMATION ON THEIR RESPECTIVE FAMILY AND BUSINESS RELATIONSHIPS, TRANSACTIONS WITH THE CORPORATION, POTENTIAL CONFLICTS OF INTEREST, AND OTHER INFORMATION NEEDED TO ANSWER VARIOUS FORM 990 QUESTIONS AND COMPLY WITH THE CORPORATION'S CONFLICTS OF INTEREST POLICY. "CONSULT DIRECTLY WITH THE FORM 990 PREPARER AND LEGAL COUNSEL RELATIVE TO ANY ISSUES PRESENTED ON THE FORM.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
EACH COVERED PERSON WILL ANNUALLY SIGN A STATEMENT THAT AFFIRMS SUCH PERSON: "HAS RECEIVED A COPY OF THIS POLICY; "HAS READ AND UNDERSTANDS THE POLICY; "HAS AGREED TO COMPLY WITH THE POLICY; AND "UNDERSTANDS THE CORPORATION IS EXEMPT FROM FEDERAL INCOME TAX AND TO MAINTAIN ITS FEDERAL TAX EXEMPTION THE CORPORATION MUST ENGAGE PRIMARILY IN ACTIVITIES THAT ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN ADDITION, EACH COVERED PERSON WILL ANNUALLY COMPLETE, SIGN AND PROMPTLY RETURN TO THE BOARD OR THE EXECUTIVE COMMITTEE A QUESTIONNAIRE AND DISCLOSURE STATEMENT SUBSTANTIALLY IN THE FORM ATTACHED HERETO. A COVERED PERSON NEED NOT DISCLOSE COMPENSATION PAID TO THE COVERED PERSON BY CORPORATION PURSUANT TO A RESOLUTION OF THE BOARD. PERIODIC REVIEWS TO ENSURE THAT THE CORPORATION OPERATES IN A MANNER CONSISTENT WITH ITS TAX-EXEMPT PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX, THE BOARD OR THE EXECUTIVE COMMITTEE WILL CONDUCT PERIODIC REVIEWS. THE PERIODIC REVIEWS WILL, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: "IF THE CORPORATION PAYS COMPENSATION, WHETHER THE CORPORATION COMPENSATION ARRANGEMENTS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND ARE THE RESULT OF ARM'S-LENGTH BARGAINING; AND "WHETHER TRANSACTIONS AND ARRANGEMENTS WITH OTHER ENTITIES AND INDIVIDUALS CONFORM TO THE CORPORATION'S POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER THE CORPORATION'S TAX-EXEMPT PURPOSES AND DO NOT RESULT IN PRIVATE INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT, OR IN AN EXCESS BENEFIT TRANSACTION. USE OF OUTSIDE EXPERTS WHEN CONDUCTING THE PERIODIC REVIEWS PROVIDED FOR ABOVE, THE BOARD OR THE EXECUTIVE COMMITTEE SHOULD RELY ON APPROPRIATE OUTSIDE EXPERTS WHEN APPROPRIATE SUCH AS ATTORNEYS, APPRAISERS, OR COMPENSATION OR OTHER CONSULTANTS.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
THE ORGANIZATION DOES NOT COMPENSATE ITS TOP OFFICER'S.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
1. SERVICES TO BE PROVIDED MUST BE SPECIFIED AND APPROVED BY A BOARD MEMBER, INCLUDING A MAXIMUM REIMBURSEMENT AMOUNT. 2. ONCE SERVICES ARE APPROVED, A SUMMARY OF WORK PROVIDED, DIRECT EXPENSES AND ANY CONSULTATION FEES MUST ACCOMPANY AN INVOICE PRIOR TO ANY PAYMENT BEING ISSUED. CONSULTATION FEES WILL REQUIRE DOCUMENTATION OF HOURS SPENT OR SERVICES PERFORMED AND WILL BE PROVIDED AT THE CONSULTANT'S USUAL AND CUSTOMARY FEE. THESE WILL BE APPROVED BY A BOARD MEMBER AS BEING REASONABLE FOR THE SERVICES PROVIDED. 3. IF SERVICES ARE PROVIDED WITHOUT A FORMAL, SIGNED AGREEMENT, THEN PAYMENT AMOUNT WILL BE DETERMINED BY THE OFFICER OR BOARD MEMBER, AS IF THE REQUEST HAD BEEN MADE PRIOR TO THE COMPLETION OF THE WORK. IF APPROVAL IS NOT PROVIDED, THEN NO PAYMENTS WILL BE MADE. AN INVOICE IS REQUIRED PRIOR TO ANY PAYMENT BEING ISSUED.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
ON THE COMPANY'S WEBSITE "WWW.CVOUTCOMES.ORG" THERE IS A STATEMENT STATING "POLICIES RELATED TO THE GOVERANCE OF CV OUTCOMES, INC. ARE AVAILABLE UPON REQUEST." WHEN YOU CLICK ON THE STATEMENT, IT WILL LINK TO AN E-MAIL ADDRESS WERE PEOPLE CAN REQUEST THE INFORMATION THEY WANT.
OTHER CHANGES IN NET ASSETS EXPLANATION
FORM 990, PART XI, LINE 9
UNREALIZED GAIN ON SECURITY 13,521
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.