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
MIDWEST TRANSPLANT NETWORK INC
Employer identification number
43-1016328
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.") .
387,582
9,945
12,724
14,282
29,200
453,733
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......
29,233,997
28,871,510
34,055,810
35,574,630
38,888,727
166,624,674
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.
29,621,579
28,881,455
34,068,534
35,588,912
38,917,927
167,078,407
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
0
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
0
0
0
0
0
c
Add lines 7a and 7b..
0
0
0
0
0
0
8
Public support (Subtract line 7c from line 6.)
167,078,407
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...
29,621,579
28,881,455
34,068,534
35,588,912
38,917,927
167,078,407
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,381,260
1,414,792
1,524,259
1,665,984
1,761,922
7,748,217
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
1,381,260
1,414,792
1,524,259
1,665,984
1,761,922
7,748,217
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
0
0
0
0
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
460
27,420
6,382
873
35,135
13
Total support. (Add lines 9, 10c, 11, and 12.)..
31,002,839
30,296,707
35,620,213
37,261,278
40,680,722
174,861,759
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
95.549 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
95.471 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
4.431 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
4.500 %
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
MIDWEST TRANSPLANT NETWORK INC
Employer identification number
43-1016328
Return Reference
Explanation
FORM 990, PART III, LINES 1, 4A, 4B & 4C
Midwest Transplant Network (MTN) first began operation as Midwest Organ Bank in 1973. Initially incorporated as a not-for-profit, community-based tissue typing laboratory and kidney recovery program by physicians dedicated to the care and treatment of end state renal disease patients, we became one of the nation's first independent organ procurement organizations (OPO). After the passage of the 1984 National Organ Transplant Act, the Health Care Finance Administration (HCFA) certified our organization as an OPO and designated an exclusive service area that included the state of Kansas and more than 60 counties in central and western Missouri. Within our Donation Service Area (DSA), we serve a population of 5.2 million and have service contracts with approximately 2,430 hospitals. Five of those hospitals are transplant centers and include The Children's Mercy Hospital, Research Medical Center, Saint Luke's Hospital, University Hospital, and the University of Kansas Hospital. At the urging of hospitals in our area, we expanded the scope of services to include tissue and eye recovery and in 1999 changed our name to Midwest Transplant Network to better describe the expanded nature of the services provided. MTN is a member of the United Network for Organ Sharing (UNOS) and participates in the Organ Procurement and Transplant Network (OPTN) that is overseen by the U. S. Department of Health and Human Services Health Resources Services Administration (HRSA). Governance of the organization is provided by a Governing Board which is comprised of business leaders, physicians, and members of the community. An Advisory Board of individuals with experience and expertise in donation, transplantation, healthcare and other disciplines provides advice to the Governing Board for specific areas of policy development. General responsibility for the organization is delegated to the Chief Executive Officer. MTN's primary purpose is to facilitate the organ and tissue donation process when a person dies at a hospital within the service area. In accordance with legal and regulatory requirements, MTN's highly trained staff work with physicians to evaluate the potential for donation of organs, tissues and eyes to determine if they are suitable for transplantation, research or medical study. Appropriate consents or authorizations are obtained and the process to complete the recovery of donated gifts is initiated. After death is pronounced, the potential donor is treated to ensure that organ function is maintained prior to recovery. In accordance with UNOS policy, organs are allocated, the surgical recovery is completed, and organs are distributed to the transplant programs. Vital organs for transplant include heart, lung, liver, kidney, pancreas, and small bowel. MTN works under contract with several tissue processors, eye banks and research organizations to recover tissues, research tissues and organs. Tissues for transplant include skin, bone, connective tissue, blood vessels, heart valves, cornea, and eyes. Research organs and tissues may include those listed or others specified by the researcher. The tissue banks we contract with give priority access to tissue from our donors to hospitals located in our service area. These organizations include Musculoskeletal Transplant Foundation, RTI Donor Services, Cryolife, Lifenet, IIAM and National Disease Research Interchange. MTN works collaboratively with SAving sight and the Kansas Eye Bank and Research Center to maximize the gift of eye and cornea donation. Public education and awareness about the critical need for donation and transplantation is an important goal of our organization. MTN staff work throughout the year to provide public education programs and utilize our trained group of "Ambassadors" to reach out to the community. We also collaborate and partner with Government agencies, eye banks, hospitals, and other non-profit organizations to bring the message of lifesaving donation to a broader multicultural audience. Examples include the Missouri Department of Health & Senior Services which operates the state's donor registry, National Kidney Foundation, Donate Life America, American Liver Foundation, Gift of Life, and the Tournament of Roses Parade. Other services provided by the organization in support of the primary mission include: - Hospital services to include policy development, process improvement - Medical and hospital staff education/training - Consultation to increase compliance with federal and state regulations - Donor family support services - Infectious disease laboratory testing for organ donors - Histocompatibility laboratory testing services for organ and bone marrow transplant programs to match donors and recipients MTN strives to continually improve operations through a formal quality improvement program. The mission of the organization is fulfilled in each day's activity by continually striving to achieve excellence in service to the community. MTN's vision is "Leading organ and tissue donation through excellence, quality, and partnerships." The result of 40 plus years of lifesaving work is seen every day in the region's hospitals, in communities MTN serves, and in the recipients whose lives have been enriched because of the generosity of someone else.
FORM 990, PART VI, SECTION A, LINE 2
Dr. Steve Reintjes, Vice-Chair of the Governing Board, is a brother of Dr. Mark Reintjes, a key employee of Midwest Transplant Network and the Medical Director.
FORM 990, PART VI, SECTION B, LINE 11b
AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ANY CHANGES REQUESTED ARE MADE BY THE ACCOUNTING FIRM. A COPY OF THE 990 IS THEN PROVIDED TO ALL GOVERNING BOARD MEMBERS ALONG WITH A RESPONSE TIME FOR QUESTIONS AND COMMENTS. ALL ISSUES ARE RESOLVED AND THE 990 IS FILED.
FORM 990, PART VI, SECTION B, LINE 12C
ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO COMPLETE ANNUAL CORPORATE COMPLIANCE TRAINING, WHICH INCLUDES THE CONFLICT OF INTEREST POLICY AND A WRITTEN TEST. THE CORPORATE COMPLIANCE PROGRAM IS AUDITED ANNUALLY. ANY CONFLICTS OF INTEREST ARE DETERMINED AND REVIEWED BY THE BOARD CHAIR AND OUTSIDE LEGAL COUNSEL. IF IT IS DETERMINED THAT A BOARD MEMBER HAS A CONFLICT OF INTEREST, THE BOARD MEMBER MUST ABSTAIN FROM VOTING ON ANY ISSUE RELATED TO THE CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15A & LINE 15B
Midwest Transplant Network engages an independent firm to survey executive and key employee compensation every three years. In addition, the organization uses a salary survey provided by the Association for Organ Procurement Organizations every two years. This information is provided to the Compensation Committee for their annual review of executive and key employee compensation, pay increases and benefits on an annual basis. During 2013, the Compensation Committee met on January 30, 2013 for this review.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC.
FORM 990 PART IX LINE 11G
DESCRIPTION:SURGEON & OTHER MEDICAL FEES TOTAL FEES:5097650
FORM 990 PART IX LINE 11G
DESCRIPTION:NON-DSA ORGAN RECOVERY FEES TOTAL FEES:1492870
FORM 990 PART IX LINE 11G
DESCRIPTION:LABORATORY FEES TOTAL FEES:1561432
FORM 990 PART IX LINE 11G
DESCRIPTION:REGISTRY FEES TOTAL FEES:399389
FORM 990 PART IX LINE 11G
DESCRIPTION:OTHER CONTRACT SERVICES TOTAL FEES:955706
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.