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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
INLAND NORTHWEST BLOOD CENTER
Employer identification number
91-0499130
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
407,042
428,684
444,554
344,395
378,941
2,003,616
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......
20,670,189
21,939,177
22,824,300
23,126,300
22,923,082
111,483,048
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
21,077,231
22,367,861
23,268,854
23,470,695
23,302,023
113,486,664
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
41,000
0
0
0
0
41,000
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..
41,000
0
0
0
0
41,000
8
Public support (Subtract line 7c from line 6.)
113,445,664
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
21,077,231
22,367,861
23,268,854
23,470,695
23,302,023
113,486,664
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
188,702
122,716
214,528
183,153
213,279
922,378
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
188,702
122,716
214,528
183,153
213,279
922,378
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
21,265,933
22,490,577
23,483,382
23,653,848
23,515,302
114,409,042
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
99.158 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.733 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.806 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.835 %
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
INLAND NORTHWEST BLOOD CENTER
Employer identification number
91-0499130
Return Reference
Explanation
FORM 990, PART III, LINES 4D
OTHER PROGRAM SERVICES CONSIST OF SALES OF DERIVATIVES AND OTHER PROGRAM ACTIVITIES.
FORM 990, PART VI, LINES 6 AND 7A
LINE 6 - BLOOD SYSTEMS, INC. (BSI) IS THE SOLE CORPORATE MEMBER OF INLAND NORTHWEST BLOOD CENTER (INBC). LINE 7A - BSI, AS THE SOLE CORPORATE MEMBER OF INBC, MAY RECOMMEND ELECTION OF A MEMBER TO THE INBC BOARD OF DIRECTORS. INBC MUST MAKE ONE SEAT ON THE BOARD OF DIRECTORS AVAILABLE TO BSI.
FORM 990, PART VI, LINE 7B
BSI, AS THE SOLE CORPORATE MEMBER OF INBC, HAS THE FOLLOWING RESERVED RIGHTS: A) BSI RESERVES THE RIGHT OF FINAL APPROVAL OF THE FOLLOWING ACTIONS, BUT THE INBC BOARD WILL HAVE PRIMARY RESPONSIBILITY FOR THE FOLLOWING AREAS: 1) NOMINATION OF MEMBERS OF THE INBC BOARD. 2) ESTABLISHMENT OF GOALS AND MONITORING AND EVALUATING THE PERFORMANCE OF THE INBC PRESIDENT AND CEO. 3) DEVELOPMENT OF THE INBC STRATEGIC PLAN. 4) PREPARATION AND ADOPTION OF THE ANNUAL INBC OPERATING AND CAPITAL BUDGET. B) BSI RESERVES THE RIGHT OF FINAL APPROVAL OF THE FOLLOWING ACTIONS AND INBC WILL GIVE ADVANCE NOTICE PRIOR TO TAKING ANY OF THE FOLLOWING ACTIONS: 1) CHANGES TO THE INBC MISSION STATEMENT. 2) CHANGES TO THE INBC ARTICLES OF INCORPORATION. 3) CHANGES TO THE INBC BYLAWS. 4) ESTABLISHMENT OF ANY JOINT VENTURES, MERGERS, PARTNERSHIPS, SUBSIDIARIES AND AFFILIATIONS BETWEEN INBC AND ANY OTHER ORGANIZATION. 5) DECISIONS RELATED TO THE HIRING AND TERMINATION OF THE INBC PRESIDENT AND CEO. 6) APPROVING THE INCURRENCE OR REFINANCING OF DEBT OF INBC IN EXCESS OF $100,000 IN THE AGGREGATE, OTHER THAN IN THE ORDINARY COURSE OF BUSINESS. 7) APPROVING ANY SALE OF INBC ASSETS IN EXCESS OF $100,000 IN THE AGGREGATE, OTHER THAN IN THE ORDINARY COURSE OF BUSINESS. C) BSI RESERVES THE RIGHT TO SELECT THE INBC INDEPENDENT AUDITORS (EXTERNAL AND INTERNAL).
FORM 990, PART VI, LINE 11B
THE DRAFT 990, INCLUDING SCHEDULES, IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BOARD FINANCE COMMITTEE. COMMITTEE MEMBERS HAVE THE OPPORTUNITY TO ASK QUESTIONS OR REQUEST ANY ADDITIONAL INFORMATION PRIOR TO FILING. THE CFO AND PRESIDENT/CEO EACH REVIEW THE DRAFT 990, AND ALL SCHEDULES, PRIOR TO SUBMISSION. THE FINAL DRAFT 990 IS DISTRIBUTED TO ALL MEMBERS OF THE GOVERNING BOARD IN ELECTRONIC FORMAT, WITH PAPER COPIES PROVIDED TO THOSE REQUESTING THEM, PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, LINE 12C
DIRECTORS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY REVIEW AND SIGN OFF ON THE CONFLICT OF INTEREST POLICY AND COMPLETE A FORM DESCRIBING ANY SITUATIONS THAT COULD RESULT IN A CONFLICT OF INTEREST. THE BOARD CHAIR REVIEWS ALL THE CONFLICT OF INTEREST STATEMENTS AND THESE ARE MAINTAINED WITH THE BOARD RECORDS.
FORM 990, PART VI, LINES 15A AND 15B
THE COMPENSATION AND BENEFITS OF INBC'S TWO TOP EMPLOYEES, THE PRESIDENT & CEO AND THE MEDICAL DIRECTOR, ARE DEVELOPED BY THE PERSONNEL AND EXECUTIVE COMMITTEE OF THE INBC BOARD OF DIRECTORS FOLLOWING INBC'S EXECUTIVE COMPENSATION AND BENEFITS PHILOSOPHY AND ARE APPROVED BY THE FULL BOARD OF DIRECTORS. THE PROGRAM IS DESIGNED TO BE COMPETITIVE WITH OTHER HIGH-QUALITY BLOOD CENTERS OF SIMILAR SIZE AND COMPLEXITY FROM ACROSS THE COUNTRY, INCLUDING THE NORTHWEST REGION OF THE UNITED STATES, AND TO REFLECT THE MEDIAN (50%) OF THE PEER GROUP. TOTAL COMPENSATION COMPONENTS INCLUDE BASE SALARIES, VARIABLE INCENTIVE PAY AND BENEFITS POSITIONED AT THE MEDIAN OF THE PEER GROUP. BASE SALARIES ARE REVIEWED AND APPROVED ANNUALLY BY THE BOARD OF DIRECTORS. SALARY RANGE ADJUSTMENTS ARE BASED ON THE VALUE EACH POSITION CONTRIBUTES TO INBC AND RECOGNITION OF THE LEVEL OF ACCOUNTABILITY, CONTRIBUTION AND EXPERIENCE REQUIRED FOR EACH POSITION.
FORM 990, PART VI, LINE 19
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.