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
Mid-America Transplant Services
Employer identification number
23-7426306
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.") .
121,667
117,689
1,311,704
1,342,144
1,367,472
4,260,676
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......
36,954,813
37,272,855
36,718,748
37,320,625
36,670,006
184,937,047
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.
37,076,480
37,390,544
38,030,452
38,662,769
38,037,478
189,197,723
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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
c
Add lines 7a and 7b..
0
8
Public support (Subtract line 7c from line 6.)
189,197,723
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...
37,076,480
37,390,544
38,030,452
38,662,769
38,037,478
189,197,723
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
625,485
976,437
928,695
1,944,619
10,365
4,485,601
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
625,485
976,437
928,695
1,944,619
10,365
4,485,601
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
32,918
25,035
65,907
54,792
-204,490
-25,838
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
64,529
64,529
13
Total support. (Add lines 9, 10c, 11, and 12.)..
37,799,412
38,392,016
39,025,054
40,662,180
37,843,353
193,722,015
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
97.660 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
97.090 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
2.320 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
2.740 %
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
Mid-America Transplant Services
Employer identification number
23-7426306
Return Reference
Explanation
Form 990, Part III, Line 4a, Program Service Accomplishments Cont'd
IN ADDITION TO ITS ONGOING COMMUNITY EDUCATION PROGRAMS, THE MTS BOARD DEVELOPED MULTIPLE PROJECTS TO SUPPORT AND BENEFIT THE COMMUNITY. THE MTS RECIPIENT FUND WAS ESTABLISHED TO ASSIST PRE-AND POST-TRANSPLANT PATIENTS AT FOUR ST. LOUIS HOSPITALS WITH FUNDS TOWARD HOUSING, MEDICAL AND DENTAL EXPENSES. IN 2013, 104 APPLICATIONS WERE APPROVED TO HELP PATIENTS AND THEIR FAMILIES. ADDITIONALLY, THE MTS FAMILY HOUSE WAS OPENED IN 2013, WHICH PROVIDES LODGING ASSISTANCE TO PATIENTS WHO MUST RESIDE CLOSE TO THE TRANSPLANT CENTER WHILE AWAITING A TRANSPLANT OR RECEIVING CARE POST-TRANSPLANT SURGERY. THE MTS FAMILY HOUSE CONTINUALLY REMAINS AT CAPACITY OF 10 PATIENTS. THE MTS DONOR MEMORIAL MONUMENT AND PARK HONORS DONORS AND THEIR FAMILIES FROM THE COMMUNITIES IT SERVES AND CONTINUES TO PROVIDE A COMMUNITY SPACE FOR FAMILIES TO VISIT AND HONOR THEIR LOVED ONES.
Form 990, Part VI, Section A, line 2
BOARD MEMBERS ROBERT VIETH AND MARY VIETH ARE SPOUSES.
Form 990, Part VI, Section B, line 11
THE 990 WILL BE AVAILABLE TO ALL BOARD MEMBERS PRIOR TO FILING ON THE BOARD MEMBER INTERNET PORTAL. THE FORM 990 IS PREPARED BY THE INDEPENDENT CPA FIRM THAT ALSO CONDUCTS THE ANNUAL AUDIT. THE CEO AND COO PERFORM AN INDEPTH REVIEW OF THE 990 AS WELL AS RESPOND TO ALL QUESTIONS AND COMMENTS REGARDING THE 990 BY THE BOARD.
Form 990, Part VI, Section B, line 12c
ALL OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY AND MUST ANNUALLY REVIEW THE CONFLICT OF INTEREST POLICY AND DISCLOSE ANY CONFLICTS OF INTEREST. THE CONFLICT OF INTEREST POLICY CONTAINS PROCEDURES FOR DETERMINATION OF WHETHER A CONFLICT EXISTS, FOR ADDRESSING OF CONFLICTS AND FOR DEALING WITH POTENTIAL VIOLATIONS OF THE POLICY. COMPLIANCE WITH THE POLICY IS MONITORED BY MANAGEMENT.
Form 990, Part VI, Section B, line 15
A POLICY IS IN PLACE THAT INCLUDES ANNUAL REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF MTS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDIVIDUALS WITHOUT CONFLICTS OF INTEREST WITH RESPECT TO COMPENSATION REVIEW AND APPROVAL. AN INDEPENDENT EXTERNAL FIRM PROVIDES MARKET COMPETITIVE COMPENSATION DATA FROM COMPARABLE, TAX EXEMPT ORGANIZATIONS AND PUBLISHED SURVEYS AND CONDUCTS A COMPETITIVENESS ASSESSMENT OF MTS OFFICERS AND KEY EMPLOYEES TO THE MARKET. THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS.
Form 990, Part VI, Section C, line 19
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST.
Form 990, Part IX, line 24e
Flight Expenses: Program service expenses 1,031,201. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,031,201. Operating Room: Program service expenses 657,370. Management and general expenses 0. Fundraising expenses 0. Total expenses 657,370. Surgeon Fees: Program service expenses 473,300. Management and general expenses 0. Fundraising expenses 0. Total expenses 473,300. Special Procedures: Program service expenses 414,516. Management and general expenses 0. Fundraising expenses 0. Total expenses 414,516. Evaluation Costs: Program service expenses 343,299. Management and general expenses 0. Fundraising expenses 0. Total expenses 343,299. Education: Program service expenses 270,228. Management and general expenses 43,915. Fundraising expenses 0. Total expenses 314,143. Instruments: Program service expenses 262,893. Management and general expenses 0. Fundraising expenses 0. Total expenses 262,893. Hospital Laboratory: Program service expenses 259,608. Management and general expenses 0. Fundraising expenses 0. Total expenses 259,608. Intensive Care Unit: Program service expenses 168,072. Management and general expenses 0. Fundraising expenses 0. Total expenses 168,072. Donations: Program service expenses 40,385. Management and general expenses 110,630. Fundraising expenses 0. Total expenses 151,015. Community Education: Program service expenses 143,346. Management and general expenses 7,500. Fundraising expenses 0. Total expenses 150,846. Tissue Typing: Program service expenses 146,450. Management and general expenses 0. Fundraising expenses 0. Total expenses 146,450. Restoration Tissue: Program service expenses 139,533. Management and general expenses 0. Fundraising expenses 0. Total expenses 139,533. Repair and Maintenance: Program service expenses 42,153. Management and general expenses 95,218. Fundraising expenses 0. Total expenses 137,371. Professional Dues: Program service expenses 114,587. Management and general expenses 19,124. Fundraising expenses 0. Total expenses 133,711. Consults: Program service expenses 99,845. Management and general expenses 0. Fundraising expenses 0. Total expenses 99,845. Respiratory Therapy: Program service expenses 58,393. Management and general expenses 0. Fundraising expenses 0. Total expenses 58,393. Other Acquisition Costs: Program service expenses 25,237. Management and general expenses 0. Fundraising expenses 0. Total expenses 25,237. Anesthesiology: Program service expenses 17,433. Management and general expenses 0. Fundraising expenses 0. Total expenses 17,433. INTERCOMPANY EXPENSE: Program service expenses -1,436,151. Management and general expenses 0. Fundraising expenses 0. Total expenses -1,436,151.
Form 990, Part XI, line 9:
TRANSFERS OUT TO DONATE LIFE FOUNDATION -26,163,421.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.