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.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
CENTRAL INDIANA REGIONAL BLOOD CENTER
Employer identification number
35-0991629
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
561,367
546,726
269,710
69,969
85,941
1,533,713
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......
64,478,093
60,263,270
59,925,574
63,865,634
63,098,734
311,631,305
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.
65,039,460
60,809,996
60,195,284
63,935,603
63,184,675
313,165,018
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.)
313,165,018
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
65,039,460
60,809,996
60,195,284
63,935,603
63,184,675
313,165,018
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
187,581
137,353
174,031
269,099
340,997
1,109,061
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
187,581
137,353
174,031
269,099
340,997
1,109,061
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
52,745
210,285
0
0
0
263,030
13
Total support. (Add lines 9, 10c, 11, and 12.)..
65,279,786
61,157,634
60,369,315
64,204,702
63,525,672
314,537,109
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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
99.564 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
99.572 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0.353 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
0.325 %
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to 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) 2012
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.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
CENTRAL INDIANA REGIONAL BLOOD CENTER
Employer identification number
35-0991629
Identifier
Return Reference
Explanation
PROCESS TO REVIEW THE FORM 990
FORM 990, PART VI, QUESTION 11B
A FINAL VERSION OF THE 990 TAX RETURN IS REVIEWED BY THE CEO, DIRECTOR OF ACCOUNTING, AND AN INDEPENDENT CPA FIRM. THE RETURN IS EMAILED TO EACH INDIVIDUAL BOARD MEMBER OR POSTED TO A SECURE WEBSITE TO ALLOW EACH BOARD MEMBER ACCESS TO THE DOCUMENTS. THE BOARD MEMBERS ARE GIVEN THE OPPORTUNITY TO REVIEW THE ENTIRE DRAFT RETURN AND ASK QUESTIONS REGARDING THE RETURN. AFTER ALL QUESTIONS ARE SATISFACTORILY ANSWERED, BOARD MEMBERS ARE REQUESTED TO AFFIRM THEIR INDIVIDUAL REVIEW IS COMPLETE AND THE RETURN MAY BE FILED WITH THE IRS. AFFIRMATIVE NOTICES FROM ALL BOARD MEMBERS ARE RECEIVED PRIOR TO THE FILING OF THE RETURN.
PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY
FORM 990, PART VI, QUESTION 12C
ANNUAL CONFLICT OF INTEREST LETTERS ARE SENT BY CORPORATE COUNSEL TO THE BOARD OF DIRECTORS AND KEY EMPLOYEES. ANSWERS ARE RECEIVED AND REVIEWED BY CORPORATE COUNSEL AND A SUMMARIZED RESPONSE IS SENT TO THE AUDIT COMMITTEE AND CEO FOR REVIEW. ANY BOARD MEMBER WHO HAS A CONFLICT OF INTEREST ABSTAINS FROM VOTING ON THE RELATED ISSUE.
REVIEW OF CEO OR TOP MGMT OFFICIAL COMPENSATION
FORM 990, PART VI, QUESTIONS 15A & 15B
THE COMPENSATION COMMITTEE REVIEWS COMPARATIVE DATA FROM TWO DIFFERENT OUTSIDE CONSULTANTS AND RECOMMENDS THE CEO'S COMPENSATION. THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES COMPENSATION OF OFFICERS AND KEY EMPLOYEES. THE COMPENSATION POLICY IS THEN SUBMITTED AS A RECOMMENDATION BY THE COMPENSATION COMMITTEE TO THE BOARD FOR APPROVAL. COMPENSATION WAS LAST REVIEWED AND APPROVED BY THE BOARD IN MAY 2013.
JOINT VENTURE
FORM 990, PART VI, LINE 16a & 16b
THE COMMUNITY BLOOD CENTERS' EXCHANGE RRG: ADVENT OF THE HUMAN IMMUNODEFICIENCY VIRUS (HIV), WHICH CAUSES ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS), IN THE LATE 1980'S, THE INSURANCE INDUSTRY BECAME VERY RELUCTANT TO INSURE BLOOD CENTERS AGAINST RISKS ASSOCIATED WITH TAINTED BLOOD. IF INSURANCE COULD BE FOUND, THE PRICING BECAME EXTREMELY PROHIBITIVE EVEN WITH THE IMPLEMENTATION OF TESTS REQUIRED BY THE FOOD AND DRUG ADMINISTRATION. INDEPENDENT BLOOD CENTERS SUCH AS THE INDIANA BLOOD CENTER (IBC), WHICH SUPPLY ABOUT ONE-HALF OF THE BLOOD IN THE UNITED STATES, WERE FEARFUL OF CONDUCTING BUSINESS WITHOUT PROFESSIONAL LIABILITY INSURANCE COVERAGE DUE TO COST OR LACK OF AVAILABILITY AND ORGANIZED A RISK RETENTION GROUP TO SELF INSURE BLOOD CENTERS. IBC IS ONE OF THE ORIGINAL ORGANIZERS AND OWNERS OF THE COMMUNITY BLOOD CENTER'S EXCHANGE RRG (BCX). AS A HEALTH CARE PROVIDER AS DEFINED BY INDIANA LAW, IBC ACQUIRES ITS PROFESSIONAL LIABILITY INSURANCE FROM BCX. BCX IS A FOR-PROFIT CORPORATION DOMICILED IN THE STATE OF INDIANA. IN ASSESSING AN ANNUAL PREMIUM, BCX ALSO COLLECTS THE SURCHARGE WHICH IBC MUST PAY INTO THE INDIANA PATIENT COMPENSATION FUND. MARGINS FOR BCX REMAIN IN THE CORPORATION AS RESERVE FUNDS FOR PAYMENT OF CLAIMS. THE INSURANCE COMMISSION OF THE STATE OF INDIANA HAS TO APPROVE RELEASE OF FUNDS (SURPLUS) BY BCX TO ITS OWNERS FOR ANY DISTRIBUTION TO BE MADE. GROUP SERVICES FOR AMERICA'S BLOOD CENTERS (GSABC): IS A MEMBER OF AMERICAS BLOOD CENTERS (ABC), A TRADE ORGANIZATION DEDICATED TO THE MEDICAL, SCIENTIFIC, AND EDUCATIONAL INTERESTS OF INDEPENDENT BLOOD CENTERS THROUGHOUT THE UNITED STATES. THOSE INDEPENDENT BLOOD CENTERS PROVIDE ABOUT ONE-HALF OF THE SUPPLY OF BLOOD AND BLOOD PRODUCTS NEEDED BY PATIENTS IN THE U.S. ABC FORMED GROUP SERVICES FOR AMERICAS' BLOOD CENTERS AS A SUBCHAPTER T FOR-PROFIT COOPERATIVE ORGANIZED UNDER THE LAWS OF DELAWARE IN ORDER TO NEGOTIATE WITH VENDORS ON BEHALF OF ITS MEMBERS TO ACHIEVE VOLUME PRICING FOR THE PURCHASE OF FOOD AND DRUG ADMINISTRATION (FDA) REQUIRED TESTING REAGENTS, AND RELATED BLOOD BANKING MEDICAL SUPPLIES, MEDICAL EQUIPMENT, ETC. THIS ASSISTS IBC TO KEEP THE COSTS OF PROVIDING BLOOD AND BLOOD TO PATIENTS AT THE LOWEST LEVEL REASONABLY POSSIBLE.
AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & F/S
FORM 990, PART VI, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.