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
MISSISSIPPI VALLEY REGIONAL BLOOD CENTER
Employer identification number
42-0859501
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.") .
7,966
8,367
12,955
30,374
2,013,956
2,073,618
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......
41,373,396
49,370,203
61,081,762
65,046,130
61,023,592
277,895,083
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.
41,381,362
49,378,570
61,094,717
65,076,504
63,037,548
279,968,701
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.
19,654,035
23,283,513
29,500,875
29,202,364
26,932,957
128,573,744
c
Add lines 7a and 7b..
19,654,035
23,283,513
29,500,875
29,202,364
26,932,957
128,573,744
8
Public support (Subtract line 7c from line 6.)
151,394,957
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...
41,381,362
49,378,570
61,094,717
65,076,504
63,037,548
279,968,701
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
3,427
22,417
26,402
20,668
53,378
126,292
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
3,427
22,417
26,402
20,668
53,378
126,292
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.)..
41,384,789
49,400,987
61,121,119
65,097,172
63,090,926
280,094,993
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
54.050 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
52.900 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.050 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.030 %
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
MISSISSIPPI VALLEY REGIONAL BLOOD CENTER
Employer identification number
42-0859501
Return Reference
Explanation
FORM 990, PART III, LINE 4A: PROGRAM SERVICE ACCOMPLISHMENTS
THE MISSISSIPPI VALLEY REGIONAL BLOOD CENTER (MVRBC) IS THE PRIMARY PROVIDER OF BLOOD PRODUCTS AND SERVICES TO 90 HOSPITALS IN ILLINOIS, IOWA, MISSOURI AND WISCONSIN. THE BLOOD CENTER WORKS TOGETHER WITH GENEROUS BLOOD DONORS THROUGHOUT THE MVRBC SERVICE REGION TO FULFILL ITS MISSION OF PROVIDING WORLD CLASS BLOOD PRODUCTS TO PATIENTS IN NEED. MVRBC'S HEADQUARTERS IS IN DAVENPORT, IOWA, WHERE ITS TESTING, PROCESSING AND PRIMARY DISTRIBUTION CENTER HANDLES MORE THAN 250,000 BLOOD COMPONENTS EACH YEAR. SINCE ITS FOUNDING IN 1974, MVRBC HAS COLLECTED MORE THAN 3.4-MILLION UNITS OF BLOOD FROM VOLUNTEER DONORS AND HAS SERVED MILLIONS OF PATIENTS THROUGHOUT OUR REGION AND THROUGH NATIONAL RESOURCE SHARING PROGRAMS. IN 2013, VOLUNTEER BLOOD DONORS PROVIDED MORE THAN 180,000 DONATIONS TO MVRBC. THESE DONATIONS WERE COLLECTED AT THE BLOOD CENTER'S 19 FIXED SITE DONOR CENTERS AND AT MORE THAN 3,500 MOBILE BLOOD DRIVES HELD THROUGH THE SERVICE REGION. MVRBC HAS PROVIDED LIFE-SAVING BLOOD PRODUCTS AND SERVICES TO HOSPITALS IN THE QUAD CITIES AND SURROUNDING REGION FOR NEARLY 40 YEARS. IN 2013, THE MVRBC SERVICE REGION INCLUDED HOSPITALS IN SOUTHWESTERN WISCONSIN, WESTERN, CENTRAL AND NORTHWESTERN ILLINOIS, EASTERN AND SOUTHEASTERN IOWA AND IN EASTERN AND CENTRAL MISSOURI. REPRESENTATIVES FROM MVRBC ALSO PROVIDE EDUCATIONAL PROGRAMS ON BLOOD DONATION AND BLOOD TRANSFUSIONS FOR SCHOOL GROUPS AND THE GENERAL PUBLIC. ANNUALLY, THE BLOOD CENTER'S YOUTH EDUCATION PROGRAM REACHES MORE THAN 60 SCHOOLS AND APPROXIMATELY 9,000 STUDENTS IN MVRBC'S SERVICE REGION. THIS SERVICE PROVIDES FREE EDUCATION ON THE MEDICAL SCIENCE BEHIND BLOOD DONATION, TESTING, PROCESSING AND TRANSFUSIONS AND INCLUDES THE OPPORTUNITY FOR STUDENTS TO LEARN THEIR BLOOD TYPE IF THEY SO DESIRE. BEYOND THIS FORMAL OUTREACH PROGRAM, MVRBC'S DONOR RESOURCE CONSULTANTS AND PUBLIC RELATIONS STAFF ROUTINELY LEAD TOURS OF THE BLOOD CENTER AND PROVIDE INFORMAL PROGRAMS ON BLOOD AND BLOOD DONATION THROUGHOUT MVRBC'S SERVICE REGION.
FORM 990, PART VI, SECTION B, LINE 11
PRIOR TO FILING THE FORM 990 WITH THE IRS, THE FORM 990 IS PROVIDED ELECTRONICALLY TO THE ORGANIZATION'S BOARD MEMBERS. IN ADDITION, MCGLADREY, LLP, THE ACCOUNTING FIRM THAT PREPARES MISSISSIPPI VALLEY REGIONAL BLOOD CENTER'S RETURN, MEETS WITH THE AUDIT AND BUSINESS SUPPORT COMMITTEE TO REVIEW THE FORM 990 PRIOR TO FILING THE TAX RETURN.
FORM 990, PART VI, SECTION B, LINE 12C
THE BOARD OF DIRECTORS SIGN A CONFIDENTIALITY AND CONFLICT DISCLOSURE STATEMENT ANNUALLY FOLLOWING THE ANNUAL MEETING. THE BOARD APPROVED THE CONFLICT POLICY THAT DEFINES CONFLICTS AND THE POLICY IS REVIEWED ANNUALLY. THE DIRECTOR WHO BELIEVES THEY HAVE A CONFLICT REPORTS THAT ON THE FORM AND IS RESPONSIBLE FOR SELF-IDENTIFYING IF A VOTE IS TAKEN WHERE THEY SHOULD ABSTAIN OR DECLARE A CONFLICT. ANY OTHER BOARD DIRECTOR CAN RAISE CONCERN ABOUT SOMEONE ELSE HAVING A CONFLICT. THIS PROCESS IS INCLUDED IN THE NEW BOARD DIRECTOR ORIENTATION CLASS. CONFLICTS USUALLY LIMIT VOTING RIGHTS BUT ALSO MAY RESULT IN THE DIRECTOR BEING ASKED TO LEAVE THE BOARD ROOM DURING CONVERSATIONS RELATED TO THE ISSUE WHERE THERE IS A CONFLICT. BOARD MINUTES REFLECT ANY DECLARED CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15A
THE EXECUTIVE COMMITTEE SERVES AS THE COMPENSATION COMMITTEE FOR THE BOARD OF DIRECTORS IN DETERMINING THE COMPENSATION OF THE CEO. THE EXECUTIVE COMMITTEE IS PROVIDED THE ABC NATIONAL SURVEY OF CEO, MEDICAL DIRECTOR, AND COO EACH YEAR TO REVIEW FOR SETTING COMPENSATION. THE SURVEY INCLUDES ALL INDEPENDENT BLOOD CENTERS IN THE UNITED STATES. IN LATE 2012, THE BOARD ALSO COMMISSIONED AN OUTSIDE COMPENSATION CONSULTANT WHO CONDUCTED EXTENSIVE SURVEYS OF SIMILAR OPERATIONS FOR ALL JOB CATEGORIES WITHIN MISSISSIPPI VALLEY BLOOD CENTER, INCLUDING THE CEO POSITION. THE EXECUTIVE COMMITTEE PRESENTS THE RECOMMENDATION FOR COMPENSATION TO THE FULL BOARD IN EXECUTIVE SESSION. THE FULL BOARD VOTES ON THE CEO'S COMPENSATION EACH YEAR. THE COMPENSATION AS REPORTED WAS DETERMINED ON DECEMBER 12, 2012.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:
CHANGE IN FAIR VALUE OF INTEREST SWAP AGREEMENT 110,030. BOOK/TAX DIFFERENCES IN PARTNERSHIP INCOME 12,470. RCE INVESTMENT INCOME -2,822.
FORM 990, PART XII, LINE 2C:
A COMMITTEE, WHICH MEETS ON A QUARTERLY BASIS, ENGAGES THE INDEPENDENT ACCOUNTANTS TO PERFORM THE AUDIT. IN ADDITION, THEY MEET WITH THE AUDITORS TO GO OVER THE AUDIT REPORT AND MANAGEMENT LETTER. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR REPORTING YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.