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
NATIONAL HEMOPHILIA FOUNDATION
Employer identification number
31-0928221
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.") .
136,984
84,427
136,629
108,833
143,567
610,440
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......
23,110
29,327
919
2,625
2,643
58,624
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
2,554
20,055
9,704
9,125
41,438
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.
160,094
116,308
157,603
121,162
155,335
710,502
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
42,530
35,507
52,493
130,530
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.
39,400
17,000
56,400
c
Add lines 7a and 7b..
39,400
17,000
42,530
35,507
52,493
186,930
8
Public support (Subtract line 7c from line 6.)
523,572
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...
160,094
116,308
157,603
121,162
155,335
710,502
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,273
1,334
1,255
1,250
1,293
6,405
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
1,273
1,334
1,255
1,250
1,293
6,405
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
2,809
2,809
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.)..
161,367
120,451
158,858
122,412
156,628
719,716
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
72.750 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
77.120 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
1.000 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
1.000 %
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
NATIONAL HEMOPHILIA FOUNDATION
Employer identification number
31-0928221
Return Reference
Explanation
FORM 990-EZ, PART I, LINE 8
REFUNDS 18 TOTAL 18
FORM 990-EZ, PART I, LINE 16
SCAVENGER HUNT OFFICE 22 INFORMATION TECHNOLOGY 32 CONFERENCES/MEETINGS 27 STAFF TRAINING TRAVEL 28 DUES & SUBSCRIPTIONS 4 CREDIT CARD FEES 20 MEN'S EVENT OFFICE 148 INFORMATION TECHNOLOGY 219 BOARD COMMITTEE MTGS. 183 AUTO EXPENSE 80 DUES & SUBSCRIPTIONS 29 STAFF TRAINING TRAVEL 190 PT. CONF TRAVEL 49 CREDIT CARD FEES 138 GIFT CARD SALES OFFICE 22 INFORMATION TECHNOLOGY 32 DUES & SUBSCRIPTIONS 4 AUTO EXPENSE 12 BOARD COMMITTE MTG EXP 27 STAFF CONF TRAVEL FEES 28 CREDIT CARD FEES 20 CAMP JOY OFFICE 61 COMPUTER EXPENSE 90 VENUE EXPENSE 21,490 BOARD COMMITTE MTG EXP 76 CREDIT CARD FEES 57 DUES & SUBSCRIPTIONS 12 AUTO EXPENSE 153 STAFF CONF TRAVEL FEES 78 ANNL MTING/EDUCATION EVENTS 178 INFORMATION TECHNOLOGY 219 COMMITTEE MEETING EXPENSE 184 PATIENT CONF TRAVEL FEES 190 STAFF CONF FEES 49 CREDIT CARD FEES 138 VENUE EXPENSE 2,757 DUES & SUBSCRIPTIONS 29 AUTO EXPENSE 86 NEWSLETTER 223 INFORMATION TECHNOLOGY 219 SUPPLIES 38 AUTO EXPENSE 80 BOARD COMMITTE MTG EXP 183 STAFF CONF TRAVEL FEES 190 PATIENT CONF TRAVEL FEES 49 DUES & SUBSCRIPTIONS 29 CREDIT CARD FEES 138 PATIENT ASSISTANCE OFFICE EXPENSE 122 COMPUTER EXPENSE 180 AUTO MILEAGE 66 STAFF TRAVE 157 COMMITTEE MEETING EXPENSE 151 PATIENT ID BRACELETS 2,058 CREDIT CARD FEES 114 PATIENT CHILD CARE 145 PATIENT SCHOLARSHIPS 1,500 PATIENTMEDICAL ASSISTANCE 137 PATIENT GROCERIES 274 PATIENT RENT & SHELTER 2,303 PATIENT UTILITIES 1,243 PATIENT POSTAGE 120 PATIENT TRANS. ASSISTANCE 2,075 PATIENT CONF.&TRAVEL FEES 7,463 DUES & SUBSCRIPTIONS 24 WOMEN'S EVENT OFFICE 149 INFORMATION TECHNOLOGY 217 AUTO EXPENSE 80 BRD COMM.MTG. EXP 183 STAFF CONF TRAVEL FEES 190 PATIENT CONF TRAVEL FEES 49 DUES & SUBSCRIPTIONS 29 CREDIT CARD FEES 138 FIRST STEPS OFFICE 148 INFORMATION TECHNOLOGY 219 AUTO EXPENSE 80 STAFF TRAINING TRAVEL 239 FOOD/BEVERAGE 380 CHILDCARE EXPENSE 110 DUES & SUBSCRIPTIONS 29 CREDIT CARD FEES 138 BRD & COMMITTEE MTGS. 183 RUSTY BALL OFFICE 22 INFORMATION TECHNOLOGY 32 AUTO EXP. 12 STAFF TRAINING TRAVEL 28 BD COMMITTE MTG. EXP 27 EVENT SUPPLIES 128 DUES & SUBSCRIPTIONS 4 CREDIT CARD FEES 20 SUMMER EVENT OFFICE 148 INFORMATION TECHNOLOGY 218 VENUE EXPENSE 3,798 AUTO EXPENSE 80 BOARD COMMITTE MTG EXP 183 STAFF CONF TRAVEL FEES 190 PATIENT CONF TRAVEL FEES 49 DUES & SUBSCRIPTIONS 29 CREDIT CARD FEES 138 KROGER COMMUNITY RELATIONS OFFICE 22 INFORMATION TECHNOLOGY 32 AUTO EXPENSE 12 BOARD COMMITTE MTG EXP 27 STAFF CONF TRAVEL FEES 28 DUES & SUBSCRIPTIONS 4 CREDIT CARD FEES 20 WINTER EVENT 148 INFORMATION TECHNOLOGY 219 AUTO EXPENSE 80 BOARD COMMITTE MTG EXP 183 DUES & SUBSCRIPTIONS 29 CREDIT CARD FEES 138 STAFF CONF TRAVEL FEES 190 PATIENT CONF TRAVEL FEES 49 VENUE EXPENSE 825 CHILDCARE EXPENSE 30 EXPENSES OFFICE EXPENSE 123 COMPUTER EXP. 191 AUTO MILEAGE REIMBURSEMENT 70 COMMITTEE MEETING EXPENSE 160 STAFF TRAVEL FOR TRAINING 166 INSURANCE DIRECTOR'S & OFFICE 1,648 OHIO CHARITABLE TRUST ACT 50 BANK SERVICES CHARGES 169 DUES, SUBSCRIP.®ISTRAT 26 CREDIT CARD FEES 120 INVESTMENT EXP. 95 MISC EXP 13 NON-INVESTMENT DEPRECIATION 679 TOTAL 59,655
EDUCATION,RESEARCH & SPECIFIC HELP FOR INDIVIDUALS WITH BLEEDING DISORDERS
FORM 990-EZ, PART III, LINE 28
TRI-STATE BLEEDING DISORDERS PROVIDES DIRECT CLIENT ASSISTANCE IN THE FOLLOWING AREAS: SCHOLARSHIPS (2 INDIVIDUALS), TRANSPORTATION (10 FAMILIES), MEDICAL ID BRACELETS (50 INDIVIDUALS), MEDICAL & DENTAL COSTS, FOOD, RENT, SHELTER, FURNISHINGS, & UTILITES (15 FAMILIES)
FORM 990-EZ, PART III, LINE 30
TRI STATE BLEEDING DISORDERS FOUNDATION PROVIDES EDUCATIONAL OPPORTUNITIES TO INDIVIDUALS WITH THESE DISORDERS, THEIR FAMILIES, AND INTERESTED COMMUNITY MEMBERS. THE EDUCATIONAL EVENTS HELD THIS YEAR SERVED 170 INDIVIDUALS. A NEWSLETTER IS PUBLISHED TWICE A YEAR AND SENT TO APPROXIMATELY 750 INDIVIDUALS PROVIDING INFORMATION ON BLOOD DISEASES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.