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
THE GLOBAL CENTER FOR MEDICAL INNOVATION INC
Employer identification number
26-4723391
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.") ....
216,100
542,994
2,169,732
528,572
3,457,398
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..
144,644
179,759
258,617
356,027
939,047
4
Total. Add lines 1 through 3
216,100
144,644
722,753
2,428,349
884,599
4,396,445
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.
4,396,445
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..
216,100
144,644
722,753
2,428,349
884,599
4,396,445
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
375
794
298
412
194
2,073
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).
4,398,518
12
Gross receipts from related activities, etc. (see instructions)
..................
12
281,483
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
99.950 %
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.") .
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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
THE GLOBAL CENTER FOR MEDICAL INNOVATION INC
Employer identification number
26-4723391
Return Reference
Explanation
FORM 990, PAGE 6, PART VI, LINE 2
MARK ALLEN JAY YADOV DIRECTOR DIRECTOR BUSINESS RELATIONSHIP
FORM 990, PAGE 6, PART VI, LINE 4
SINCE THE FILING OF ITS LAST FORM 990 FOR THE CALENDAR YEAR ENDED DECEMBER 31,2012, GCMI HAS AMENDED ITS ORGANIZATIONAL DOCUMENTS; SPECIFICALLY THE ARTICLES OF INCORPORATION AND THE BYLAWS. THE AMENDMENTS ADDRESS THE RESTRUCTURING OF THE ORGANIZATION FROM A MEMBERSHIP ORGANIZATION TO A NON- MEMBERSHIP ORGANIZATION. IN ADDITION, THE AMENDMENTS ADDRESS GCMI'S NEW RELATIONSHIP AS AN ORGANIZATION FORMALLY AFFILIATED WITH THE GEORGIA INSTITUTE OF TECHNOLOGY (THE "INSTITUTE"). EFFECTIVE JULY 1, 2013, THE ORIGINAL MEMBERS OF THE ORGANIZATION AND THEIR RESPECTIVE REPRESENTATIVES ON GCMI'S BOARD RESIGNED AND CEDED ANY AND ALL CLAIMS TO THEIR INITIAL MEMBERSHIP CONTRIBUTIONS AND ANY ADDITIONAL CONTRIBUTIONS MADE TO THE ORGANIZATION. ACCORDINGLY, THE AMENDED ORGANIZATIONAL DOCUMENTS ELIMINATE ANY AND ALL RIGHTS OF THE FORMER MEMBERS, INCLUDING THE RIGHT TO BE REPRESENTED ON THE BOARD. THE FOLLOWING ARE THE SPECIFIC ADDITIONAL CHANGES MADE TO THE ORGANIZATIONAL DOCUMENTS: THE ARTICLES OF THE INCORPORATION: THE ARTICLES WERE AMENDED AND RESTATED TO REFLECT THAT THE ORGANIZATION HAS NO MEMBERS. THE PURPOSE OF THE ORGANIZATION AS DESCRIBED IN THE ARTICLES REMAIN UNCHANGED. BYLAWS: THE BYLAWS WERE ALSO AMENDED AND RESTATED TO REFLECT THAT THE ORGANIZATION HAS NO MEMBERS. IN ADDITION, THE PURPOSE AND POWERS WERE EXTENDED TO INCLUDE GCMI'S RELATIONSHIP WITH THE INSTITUTE; THAT IN FURTHERANCE OF ITS GENERAL PURPOSES THE ENTITY WILL ALSO OPERATE FOR THE BENEFIT OF THE INSTITUTE TO FOSTER EDUCATION, SCIENTIFIC RESEARCH AND ECONOMIC DEVELOPMENT BY FACILITATING MEDICAL DEVICE INNOVATION AND COMMERCIALIZATION. IN ADDITION, THE CORPORATION SHALL COORDINATE THE MEDICAL DEVICE COMMUNITY IN THE STATE OF GEORGIA AND THE SOUTHEAST, INCLUDING UNIVERSITIES; RESEARCH CENTERS; CLINICIANS; ESTABLISHED DEVICE AND DRUG COMPANIES AS WELL AS EARLY STAGE COMPANIES IN FURTHERANCE OF ITS PURPOSE THE AMENDED AND RESTATED BYLAWS ALSO REFLECT CHANGES RELATED TO THE NUMBER, QUALIFICATION AND COMPOSITION OF THE ENTITY'S BOARD OF DIRECTORS. SPECIFICALLY, THE BOARD WILL NOW BE COMPRISED OF FIVE (5) - TEN (10) MEMBERS, WHO ARE RECOMMENDED TO THE PRESIDENT OF THE INSTITUTE FOR APPOINTMENT BY THE THEN EXISTING BOARD. IN ADDITION, THE MAJORITY OF THE APPOINTED BOARD MEMBERS SHALL BE INDIVIDUALS WHO ARE NOT EMPLOYED BY THE INSTITUTE OR THE UNIVERSITY SYSTEM OF GEORGIA. THE BOARD APPOINTS THE ORGANIZATION'S EXECUTIVE DIRECTOR WHILE THE PRESIDENT OF THE INSTITUTE APPOINTS THE CHAIR OF THE BOARD. WITH RESPECT TO THE DISTRIBUTION OF CORPORATE ASSETS UPON DISSOLUTION, THE AMENDED AND RESTATED BYLAWS PROVIDE THAT THE ENTITY MUST FIRST PAY OR MAKE PROVISIONS FOR THE PAYMENT OF ANY OF THE ENTITIES' KNOWN LIABILITIES. NEXT, ANY RESIDUAL ASSETS MUST BE DISTRIBUTED TO AN ORGANIZATION DESCRIBED IN SECTION 501(C)3 AND 170(C)2 OF THE INTERNAL REVENUE CODE OF 1986, WHICH ALSO OPERATES FOR THE SUPPORT OF THE INSTITUTE AT THE TIME OF DISSOLUTION, AS DETERMINED BY AN AFFIRMATIVE VOTE OF THE MAJORITY OF THE THEN CURRENT BOARD. TO THE EXTENT THAT THE BOARD HAS NOT SELECTED AN ORGANIZATION FOR THE DISTRIBUTION OF RESIDUAL ASSETS, SAID ASSETS SHALL VEST IN AND BE TRANSFERRED ,WITHOUT CONSIDERATION, TO THE BOARD OF REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA; OR, IN THE EVENT THAT THE BOR IS NOT AT THAT TIME AN INSTRUMENTALITY OF THE STATE OF GEORGIA, THEN THE RESIDUAL ASSETS SHALL BE TRANSFERRED TO ONE OR MORE EXEMPT ORGANIZATIONS DESCRIBED IN SECTION 501(C)3 AND 170(C)2 OF THE INTERNAL REVENUE CODE OF 1986.
FORM 990, PAGE 6, PART VI, LINE 7A
BOARD MEMBERS ARE APPOINTED BY THE PRESIDENT OF THE GEORGIA INSTITUTE OF TECHNOLOGY.
FORM 990, PAGE 6, PART VI, LINE 11B
THE SECRETARY OF THE CORPORATION EMAILS A DRAFT OF THE FORM 990 TO THE FULL BOARD OF DIRECTORS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. IF THE REVIEW RESULTS IN ANY CHANGES, THE REVISED FORM 990 IS DISTRIBUTED TO THE BOARD PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 12C
CONFLICT OF INTEREST POLICY APPLIES TO EACH MEMBER OF THE BOARD OF DIRECTORS AND TO ALL OFFICERS OF THE ORGANIZATION. THE POLICY ALSO SERVES AS GUIDANCE FOR ALL PERSONS EMPLOYED BY THE GEORGIA INSTITUTE OF TECHNOLOGY WHO HAVE SIGNIFICANT RESPONSIBILITIES FOR THE ACTIVITIES OF THE ORGANIZATION. THE POLICY REQUIRES EACH DIRECTOR AND OFFICER ANNUALLY TO (1) REVIEW THE POLICY (2)DISCLOSE ANY POSSIBLE PERSONAL, FAMILIAL OR BUSINESS RELATIONSHIPS THAT REASONABLY COULD GIVE RISE TO A CONFLICT OF INTEREST INVOLVING THE ORGANIZATION AND (3)ACKNOWLEDGE BY HIS OR HER SIGNATURE THAT THEY ARE IN ACCORDANCE WITH THE LETTER AND SPIRIT OF THE POLICY. DISCLOSURE FORMS ARE DISTRIBUTED AND COLLECTED BY THE EXECUTIVE DIRECTOR OF THE ORGANIZATION WHO PROVIDES ANY POSITITIVE RESPONSES TO THE BOARD OF DIRECTORS IN EXECUTIVE SESSION AS APPROPRIATE. DIRECTORS AND OFFICERS ARE REQUESTED TO DISCLOSE SUBSTANTIVE RELATIONSHIPS THEY OR MEMBERS OF THEIR FAMILY MAINTAIN WITH ORGANIZATIONS THAT DO BUSINESS WITH THE ORGANIZATION OR WHICH OTHERWISE COULD BE CONSTRUED TO POTENTIALLY AFFECT THEIR INDEPENDENT, UNBIASED JUDGEMENT IN LIGHT OF THEIR DECISION-MAKING AUTHORITY OR RESPONSIBILITY. DIRECTORS OR OFFICERS WHO HAVE DECLARED OR HAVE BEEN FOUND TO HAVE A CONFLICT OF INTEREST REFRAIN FROM CONSIDERATION OF PROPOSED TRANSACTIONS UNLESS FOR SPECIAL REASONS THE BOARD REQUESTS INFORMATION OR INTERPRETATION. PERSONS WITH THE CONFLICTS DO NOT VOTE, PARTICIPATE IN THE DISCUSSION OR ATTEND THE MEETING DURING VOTE. ANY PROPOSED TRANSACTION IN WHICH A CONFLICT OF INTEREST HAS BEEN DECLARED OR FOUND TO EXIST MUST BE APPROVED BY A MAJORITY OF THE DISINTERESTED MEMBERS OF THE BOARD OR THE APPROPRIATE COMMITTEE OF THE BOARD AFTER DISCLOSURE OF THE CONFLICT OF INTEREST.
FORM 990, PAGE 6, PART VI, LINE 19
PROVIDED UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.