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
THE INSTITUTE FOR TRANSFUSION MEDICINE
Employer identification number
25-1562714
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)
No
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(A)
CENTRAL BLOOD BANK
251055312
09
Yes
Yes
Yes
0
(B)
LIFESOURCE BLOOD SERVICES
363492969
09
Yes
Yes
Yes
0
(C)
VIRGINIA BLOOD SERVICES
540959121
09
Yes
Yes
Yes
0
(D)
ITXM CLINICAL SERVICES
251839168
09
Yes
Yes
Yes
0
(E)
ITXM DIAGNOSTICS
030497690
09
Yes
Yes
Yes
0
(F)
BLOOD SCIENCE FOUNDATION
251562715
0
Yes
Yes
Yes
0
(G)
HEMOPHILIA CENTER OF WESTERN PENNSYLVANIA
251562716
03
Yes
Yes
Yes
0
Total
0
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.") .
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......
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.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
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...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.)..
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
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
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
THE INSTITUTE FOR TRANSFUSION MEDICINE
Employer identification number
25-1562714
Identifier
Return Reference
Explanation
PART VI, SECTION A, LINE 4
EFFECTIVE DECEMBER 7, 2012, THE INSTITUTE FOR TRANSFUSION MEDICINE, VIRGINIA BLOOD SERVICES AND THE VBS GROUP (NOW KNOWN AS VIRGINIA BLOOD FOUNDATION) ENTERED INTO A TRANSACTION WHERE THE INSTITUTE FOR TRANSFUSION MEDICINE BECAME THE SOLE CORPORATE MEMBER OF VIRGINIA BLOOD SERVICES, THEREBY ACQUIRING ALL CORPORATE MEMBERSHIP RIGHTS, TITLE AND INTEREST. THE BYLAWS OF ITXM WERE AMENDED AND RESTATED TO INCLUDE THAT FOR THE NEXT THREE YEARS, TWO REPRESENTATIVES FROM THE COMMUNITY SERVICED BY VBS WILL BE INCLUDED ON THE ITXM BOARD OF DIRECTORS. THESE TWO INDIVIDUALS SHALL BE NOMINATED BY THE VB FOUNDATION AND APPROVED BY THE BOARD OF DIRECTORS OF ITXM. SUCH INDIVIDUALS MUST MEET THE SAME QUALIFICATIONS AS OTHER BOARD MEMBERS AS DETERMINED BY THE GOVERNANCE AND NOMINATING COMMITTEE, AND SHALL BE SUBJECT TO ALL NOMINATIONS, ELECTION OR APPOINTMENT, APPLICABLE TERM LENGTH, REMOVAL PROVISIONS AND COMMITTEE ELIGIBILITY REQUIREMENTS OF THE ARTICLES OF INCORPORATION AND THESE BYLAWS NOT INCONSISTENT WITH THIS SECTION. PART VI, SECTION B, LINE 11 THE 990 IS COMPLETED BY MANAGEMENT AND IS REVIEWED BY AN EXTERNAL, INDEPENDENT ACCOUNTING FIRM. THE AUDIT AND FINANCE COMMITTEE, WITH THE ASSISTANCE OF MANAGMENT, REVIEWS THE 990 IN DETAIL AND THEN IT IS SENT TO THE FULL BOARD FOR THEIR REVIEW PRIOR TO FILING. PART VI, SECTION B, LINE 12C ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO SUBMIT A FORM ANNUALLY DISCLOSING ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST. THE FORMS ARE REVIEWED BY THE GOVERNANCE COMMITTEE WHICH THEN DETERMINES WHETHER A CONFILCT EXISTS. ANY PERSON DEEMED TO HAVE A CONFLICT DURING THE YEAR IS PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND DECISIONS REGARDING CONFLICTED TRANSACTIONS. PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS RETAINS AN INDEPENDENT, THIRD-PARTY COMPENSATION CONSULTANT TO ANNUALLY REVIEW AND ANALYZE THE MARKET COMPETITIVENESS, REASONABLENESS AND APPROPRIATENESS OF EXECUTIVE PAY AT ITXM. THIS ANALYSIS INCLUDES EXECUTIVES REPORTING DIRECTLY TO THE CEO AND EMPLOYEES WHOSE BASE SALARIES EXCEED THE LOWEST PAID DIRECT REPORT TO THE CEO. AT THE REQUEST OF THE COMPENSATION COMMITTEE, THE COMPENSATION CONSULTANT CONDUCTS AN ANNUAL COMPETITIVE ANALYSIS THAT FOCUSES ON BASE PAY, SHORT-TERM INCENTIVE PAY AND LONG-TERM INCENTIVE PAY AND CONDUCTS A TOTAL COMPENSATION ANALYSIS INCLUSIVE OF INDIRECT COMPENSATION AND OTHER NON-CASH COMPENSATION ELEMENTS EVERY THREE TO FIVE YEARS DEPENDING ON REGULATORY, LEGISLATIVE AND EXTERNAL ACTIONS AND TRENDS. THE COMPETITIVE ANALYSES ARE CONDUCTED ACCORDING TO A BOARD-APPROVED EXECUTIVE COMPENSATION STRATEGY AND MARKET ANALYSIS METHODOLOGY. THIS PROCESS WAS COMPLETED IN 2013. PART VI, SECTION C LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PART XI, LINE 8 THE PRIOR PERIOD ADJUSTMENT RELATES TO CONSOLIDATING THE INTERCOMPANY RECEIVABLE OR INTERCOMPANY PAYABLE BALANCES OF THE SUBSIDIARIES OF THE INSTITUTE FOR TRANSFUSION MEDICINE (ITXM), WHICH ARE ALL SECTION 501(C)(3) TAX EXEMPT ORGANIZATIONS, INTO THE ITXM FUND BALANCE. PART XI, LINE 9 PURCHASE OF VIRGINIA BLOOD SERVICES ($15,327,839) PENSION LIABILITY ADJUSTMENT 5,235,890 TOTAL PART XI, LINE 9 ($10,091,949)
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:MEDICAL TECHNICAL TOTAL FEES:1912
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:CONSULTING TOTAL FEES:1520137
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:TEMPORARY HELP TOTAL FEES:119555
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:OTHER TOTAL FEES:314035
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.