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
RENAL SUPPORT NETWORK
Employer identification number
95-4672679
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.") ....
904,992
548,476
642,829
690,350
665,771
3,452,418
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
904,992
548,476
642,829
690,350
665,771
3,452,418
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)..
2,208,115
6
Public support. Subtract line 5 from line 4.
1,244,303
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..
904,992
548,476
642,829
690,350
665,771
3,452,418
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
62,024
48,321
48,139
42,984
38,208
239,676
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
0
11
Total support (Add lines 7 through 10).
3,692,094
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
33.700 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
35.630 %
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.") .
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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:
13000170
Software Version:
2013v3.1
-
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
RENAL SUPPORT NETWORK
Employer identification number
95-4672679
Return Reference
Explanation
Client Note 1
Client Note 1 - RENAL SUPPORT NETWORK2009 FORM 99095-4672679QUALIFYING AS PUBLICLY SUPPORTEDRenal Support Network(RSN) is a nonprofit, patient-focused, patient-run organization established in 1993 to provide non-medical services to those affected by chronic kidney disease(CKD). RSN strives to help patients develop their personal coping skills, special talents, and employability by educating and empowering them (and their family members) to take control of the course and management of the disease.Contributions are not required to become a member of RSN. Over 200 individual and corporate contributors support the funding of the many programs available to CKD patients. The RSN board members consist of 8 kidney patients and 6 renal care professionals who are experts in the field of chronic kidney disease and related areas.RSN currently has the following programs and services:Live & Give Newsletter(16 page newsletter)is written by people with kidney disease, healthcare professionals and care givers.Over 31,000 copies are distributed bi-annually at medical facilities and sent to individuals. The Wellness & Education Kidney Advocacy Network (weKAN)This program consists of 'patient activists' from across the country whose common goal is to ensure that people with CKD receive quality care. Patient activists also work to educate people about the risks of chronic kidney disease.KidneyTalkAn online radio talk show hosted by Lori Hartwell and Stephen Furst, covering a wide variety of kidney-related topics(go to rsnhope.org) to inspire kidney patients to lead the fullest life possible. This show is being recognized worldwide.14th Annual Renal Teen Prom(over 400 people attended from across the country)A free event for teenagers and young adults with kidney disease.Set in the style of a senior prom, this gala draws "kidney teens", their guests, and volunteers for a night of fun, entertainment and camaraderie. Hopeline-This program is a toll free call-in line offering patient to patient encouragement and support from operators who live successfully with chronic kidney disease. Regional Patient Lifestyle Meetings (1700 people attended). This program offers day-long seminars on topics having real-life relevance. 15 meetings were held in various locations throughout the nation.RSN holds an Annual Essay Contest which provides people who have CKD with a forum where they can share their experiences, strength, and hope, as well as inspire others. Every year we have a different theme and the top three essays win prizes and have their essay published in our Live & Give Newsletter as well as on our website. Kidneyspace.com is our new online bulletin board that serves as a forum for over 1,100 members and hundreds of thousands of posts.Visit www.RSN hope.org for more informationDONATIONS ARE ENCOURAGED ON THE RSN WEBSITE AND ARE ACCEPTED BY PHONE, CHECK OR ON-LINE.
Form 990, Part III, Line 4d: Other Program Services Description
OTHER PROGRAM SERVICES 4: The Annual Renal Teen Prom has over 400 in attendance from California and other states. The goal is to let young people know they are not alone as they continue their lifetime journey with kidney disease. Young people with CKD ages 14 to 24 come to enjoy a night of glamour. OTHER PROGRAM SERVICES 5: The HOPEline is a toll free call-in program which is available in English and Spanish and offers patient to patient encouragement and support from patient operators who have lived successfully with chronic kidney disease. OTHER PROGRAM SERVICES 6: RSN has a health library that is an online resource with articles written by people with kidney disease and professionals on medical, social, nutritional, and lifestyle issues. OTHER PROGRAM SERVICES 7: KidneySpace is an online discussion forum with 2,265 members which airs your questions, thoughts, and opnions on lifestyle issues related to transplantation and kidney disease. Go to KidneySpace to join the conversation. OTHER PROGRAM SERVICES 8: Kidney talk is an online radio talk show hosted by Lori Hartwell and Stephen Furst covering a wide variety of kidney-related topics. Listen at RSNhope.org or download podcasts from iTunes. OTHER PROGRAM SERVICES 9: RSN's Live & Give newsletter contains 16 pages of patient and professionally written articles that bring health, happiness and hope to readers all across the country. The purpose is to provide patients with education, encouragement and tools necessary to help navigate kidney disease. The Live & Give is published twice yearly with 35,000 copies per edition mailed out to people with kidney disease and dialysis facilities throughtout the United States. OTHER PROGRAM SERVICES 10: COMMEMORATIVE BOOK-HOPE, INSPIRATION AND WISDOM: A TREASURY OF THOUGHTS ON COPING WITH KIDNEY DISEASE IS A COLLECTION OF WINNING ESSAYS, WRITTEN BY PEOPLE WITH CHRONIC KIDNEY DISEASE, FROM RSN'S ANNUAL ESSAY CONTEST.
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et
Lori Hartwell, director and officer, is the daughter of Marlene De Cenzo, director.
Form 990, Part VI, Line 11b: Form 990 Review Process
A COPY OF PROPOSED FORM 990 AND ASSOCIATED SCHEDULES WAS E MAILED TO PRESIDENT FOR REVIEW PRIOR TO FILING OF TAX RETURN AND WAS DISCUSSED AT A BOARD MEETING.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
available upon request
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.