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
BloodCenter of Wisconsin Inc
Employer identification number
39-0807235
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 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.") ....
15,904,094
17,382,980
16,558,435
19,116,752
16,594,248
85,556,509
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
15,904,094
17,382,980
16,558,435
19,116,752
16,594,248
85,556,509
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)..
16,866,817
6
Public support. Subtract line 5 from line 4.
68,689,692
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..
15,904,094
17,382,980
16,558,435
19,116,752
16,594,248
85,556,509
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
1,292,659
622,621
797,970
773,398
769,884
4,256,532
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
14,660
0
0
0
0
14,660
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
42,752
59,245
4,893
100,000
0
206,890
11
Total support (Add lines 7 through 10).
90,034,591
12
Gross receipts from related activities, etc. (see instructions)
..................
12
593,844,095
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
76.293 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
78.530 %
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
BloodCenter of Wisconsin Inc
Employer identification number
39-0807235
Identifier
Return Reference
Explanation
Other Program Services
Part III, Line 4d
BloodCenter of Wisconsin, Inc. fulfills its tax-exempt purpose in three ways: A. Blood research institute conducts research in vascular biology, immunobiology, transfusion medicine, hemostasis and stem cell biology. B. Organ and Tissue Donation combines procurement services and education to enhance the lives of patients and provides guidance to the families of potential donors. C. Medical Sciences Institute provides medical services including consultation with hospitals we serve, special patient services for patients with unique blood disorders including providing community education programs for medical professionals through routine lecture series and the specialist in blood banking programs.
Business Relationship
PART VI, LINE 2
Dale Kent and Peter Ziegler have a business relationship. John Raymond and Dr. Gleason have a business relationship.
FORM 990 REVIEW
PART VI - LINE 11B
BloodCenter of Wisconsin utilizes Grant Thornton LLP to complete the IRS Form 990 and related schedules. Following completion they are reviewed by the Controller, Sr. Vice President and CFO and the President and CEO. The draft forms are then reviewed by the Compliance and Audit Committee prior to submission to the IRS. The full board is provided a copy of the Form 990 prior to filing.
WRITTEN CONFLICT OF INTEREST POLICY
PART VI B - LINE 12
BLOODCENTER OF WISCONSIN MAINTAINS A WRITTEN CONFLICT OF INTEREST POLICY. ON AN ANNUAL BASIS CURRENT DIRECTORS AND OFFICERS ARE ASKED TO COMPLETE A DISCLOSURE FORM BASED ON IRS REQUIREMENTS THAT INCLUDES THE FOLLOWING: WHETHER THEY HAVE ANY DIRECT OR INDIRECT RELATIONSHIP EITHER THROUGH BUSINESS OR FAMILY MEMBER WITH BLOODCENTER OF WISCONSIN. WHETHER THEY RECEIVED COMPENSATION FROM ANY ORGANIZATION THAT SHARES COMMON OWNERSHIP OR CONTROL WITH BLOODCENTER OF WISCONSIN. WHETHER THEY HAVE SERVED AS AN OFFICER, DIRECTOR, KEY EMPLOYEE, PARTNER OR MEMBER OF AN ENTITY (OR SHAREHOLDER OF A PROFESSIONAL CORPORATION) DOING BUSINESS WITH BLOODCENTER OF WISCONSIN. THESE ANSWERS ARE ACCUMULATED, SUMMARIZED AND EVALUATED BY MANAGEMENT TO DETERMINE IF ANY CONFLICTS EXIST. IDENTIFIED CONFLICTS ARE ADDRESSED IN ACCORDANCE WITH THE WRITTEN POLICY.
Compensation
Part VI, Line 15a and b
The Executive Committee of the BloodCenter of Wisconsin (BCW) Board of Directors, acting in its capacity as the Compensation Committee, sets and monitors the compensation philosophy for the organization. Other than the BCW President & Chief Executive Officer, the Executive/Compensation Committee does not include members of management and is comprised entirely of individuals who do not have a conflict of interest with respect to BCW compensation arrangements. The BCW President & Chief Executive Officer recuses her/himself from all discussions and approvals related to her/his compensation. Executive compensation arrangements are reviewed for reasonableness and approved by the Executive/Compensation Committee annually. The Executive/Compensation Committee assesses the reasonableness of executive compensation arrangements after it obtains and reviews appropriate data for comparability from the Human Resource Department and an independent compensation consultant. The Executive/Compensation Committee engages a qualified independent compensation consultant annually. The independent consultant performs an analysis of compensation levels at regional and national organizations of comparable size, scope and structure and provides the Committee with comprehensive data on the availability of similar services within the geographic area, compensation surveys, written offers from similar institutions, and other information relevant to comparability of compensation. The Executive/Compensation Committee's review, recommendations and approvals are documented concurrently in the Committee minutes, which are subsequently reviewed and approved by the Executive/Compensation Committee as reasonable, accurate and complete. BloodCenter of Wisconsin has an incentive program for Executives, Directors, Management, Investigators and Staff described in detailed written policies approved by the Executive/Compensation Committee annually. Evaluation and Compensation Review -CEO - Each year, the Executive/Compensation Committee evaluates the CEO's performance against established objectives, determines incentive payment and merit increase based upon performance and market data provided by the third party compensation consultant, and works with the CEO to establish objectives for the next year. -Executives - Each year, the Executive/Compensation reviews the performance of each Executive and their individual goals, reviews and approves recommended compensation ranges, and approves final salary and incentive payments. Executives are positioned within the appropriate salary range based on the: -Executive's knowledge, competencies, and experience, -Performance of the Executive's areas of responsibility, -The Executive's contribution to overall BloodCenter of Wisconsin performance, -The importance of retaining the Executive, -Internal equity considerations, -The financial resources available -Executive base salary increases provided in the competitive market
ORGANIZATION'S DOCUMENTS OPEN TO THE PUBLIC
Part VI - LINE 19
The organization makes its governing documents, conflict of interest policy, and financial statements available upon request to the public. Viewing is done on the organization's premises.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES
PART XI, LINE 5
Pension Adjustment (3,311,905)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.