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
PUGET SOUND BLOOD CENTER AND PROGRAM
Employer identification number
91-1019655
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.") .
6,242,609
7,189,946
6,913,549
1,609,433
1,670,472
23,626,009
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......
144,542,592
148,393,694
150,260,881
147,588,876
158,851,257
749,637,300
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
478,187
599,351
1,077,538
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.
150,785,201
155,583,640
157,174,430
149,676,496
161,121,080
774,340,847
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
37,867
21,762
39,465
54,169
72,760
226,023
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..
37,867
21,762
39,465
54,169
72,760
226,023
8
Public support (Subtract line 7c from line 6.)
774,114,824
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...
150,785,201
155,583,640
157,174,430
149,676,496
161,121,080
774,340,847
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
783,090
1,037,671
1,399,319
2,574,831
3,162,201
8,957,112
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
783,090
1,037,671
1,399,319
2,574,831
3,162,201
8,957,112
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.)..
151,568,291
156,621,311
158,573,749
152,251,327
164,283,281
783,297,959
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
98.830 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.180 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
1.140 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.790 %
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
PUGET SOUND BLOOD CENTER AND PROGRAM
Employer identification number
91-1019655
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 4
THE BYLAWS WERE AMENDED. THE AMENDMENTS WERE ADOPTED ON JUNE 13, 2014 AFTER A VOTE BY THE BOARD OF TRUSTEES. UPDATES WERE MADE TO THE TRUSTEES SECTION TO CLARIFY THE PROCESS TO OCCUR SHOULD THERE BE BOARD VACANCIES. ADDITIONALLY, SECTIONS WERE ADDED RELATED TO ONE VOTING AND ONE NON-VOTING SEAT ON THE BOARD FOR MEMBERS OF THE OREGON ADVISORY COUNCIL. CLARIFICATIONS WERE MADE RELATED TO WHEN ELECTED TERMS BEGIN FOR BOARD MEMBERS AS WELL AS THE NUMBER OF DAYS BY WHICH WRITTEN NOTICE NEEDS TO BE GIVEN FOR MEETINGS. A QUALITY ADVOCACY COMMITTEE WAS ADDED TO THE BOARD COMMITTEES SECTION. ADDITIONALLY, CHANGES WERE MADE TO THE NUMBER OF DAYS BY WHICH MAIL VOTES NEED TO BE RECEIVED FOR APPROVAL OF AMENDMENTS AND CLARIFICATION WAS MADE RELATED TO WHEN THE PRESIDENT/CEO MUST PRESENT THE AUDITED FINANCIAL STATEMENTS TO THE BOARD.
FORM 990, PART VI, SECTION B, LINE 11
INTERNALLY, DATA FOR THE FORM 990 IS PREPARED BY THE ACCOUNTING REPORTING MANAGER AND REVIEWED BY THE CONTROLLER AND THE CHIEF FINANCIAL OFFICER. THE FORM 990 IS THEN PREPARED BY OUR CPA FIRM. EXTERNAL REVIEW CONSISTS OF THE FORM 990 BEING POSTED TO THE BOARD OF TRUSTEE WEBSITE, AND THE BOARD MEMBERS ARE EMAILED A LINK TO THIS PASSWORD PROTECTED SITE SO THAT THE FORM 990 CAN BE REVIEWED.
FORM 990, PART VI, SECTION B, LINE 12C
PSBC HAS ALL HUMAN RESOURCE POLICIES (INCLUDING CONFLICT OF INTEREST) ONLINE AND ACCESSIBLE. ANY CHANGES ARE HIGHLIGHTED AND SENT TO ALL EMPLOYEES. UPON HIRE AND UPON MAJOR POLICY CHANGES, EMPLOYEE SIGNS ACKNOWLEDGEMENT FORM TO EVIDENCE THAT SHE/HE IS RESPONSIBLE TO READ AND BECOME ACQUAINTED WITH THE POLICIES. ANNUALLY BOARD MEMBERS MUST SIGN A FORM AND DISCLOSE CONFLICTS OF INTEREST. THESE ARE REVIEWED BY THE BOARD CHAIR AND PRESIDENT.
FORM 990, PART VI, SECTION B, LINE 15
THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS AND APPROVES THE PRESIDENT'S COMPENSATION BASED ON RESEARCH OF OTHER COMPARABLE ORGANIZATIONS AND INDUSTRY STANDARDS PERFORMED BY A COMPENSATION CONSULTING FIRM. IN 2014 AN OUTSIDE CONSULTING FIRM PROVIDED TRENDS IN BOTH PERFORMANCE INCREASES AND BONUSES FOR CEOS. THE BOARD USED THIS INFORMAITON IN THE PRESIDENT'S COMPENSATION REVIEW. KEY EMPLOYEES' AND OFFICERS' SALARIES ARE REVIEWED AGAINST MARKET DATA WITH CONSIDERATION OF INTERNAL EQUITY. MARKET DATA INCLUDES ANNUAL SURVEY FROM INDUSTRY ASSOCIATION AND COMPARISON TO ADDITIONAL REGIONAL AND NATIONAL MARKET DATA APPROXIMATELY EVERY TWO TO THREE YEARS. IN ADDITION, MEDICAL STAFF SALARIES ARE REVIEWED AGAINST UNIVERSITY RANGES FOR PHYSICIANS OF LIKE SPECIALTIES.
FORM 990, PART VI, SECTION C, LINE 19
GOVERNING DOCUMENTS AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:
JOINT VENTURE LOSS 12,314.
FORM 990, PART XII, LINE 2C
THERE HAS BEEN NO CHANGE TO HOW THE COMMITTEE REVIEWS THE FINANCIAL STATEMENTS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.