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
TRANSPLANT HOUSE
Employer identification number
26-0585694
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.") ....
505,891
2,408,070
1,436,309
3,606,477
1,731,823
9,688,570
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
505,891
2,408,070
1,436,309
3,606,477
1,731,823
9,688,570
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.
9,688,570
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..
505,891
2,408,070
1,436,309
3,606,477
1,731,823
9,688,570
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
524
3,066
22,021
25,611
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.)..
43,735
47,562
56,614
76,021
223,932
11
Total support (Add lines 7 through 10).
9,938,113
12
Gross receipts from related activities, etc. (see instructions)
..................
12
452,826
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
97.490 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
97.290 %
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:
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
TRANSPLANT HOUSE
Employer identification number
26-0585694
Return Reference
Explanation
FORM 990, PART III, LINE 1
GIFT OF LIFE FAMILY HOUSE SERVES AS A "HOME AWAY FROM HOME" FOR TRANSPLANT PATIENTS AND THEIR FAMILIES BY PROVIDING TEMPORARY, AFFORDABLE LODGING AND SUPPORTIVE SERVICES TO THOSE WHO TRAVEL TO PHILADELPHIA, PENNSYLVANIA FOR TRANSPLANT-RELATED CARE. GIFT OF LIFE FAMILY HOUSE IS A 501(C)(3) NON-PROFIT CHARITABLE ORGANIZATION. GIFT OF LIFE FAMILY HOUSE ENHANCES THE LIVES OF TRANSPLANT PATIENTS AND THEIR FAMILIES BY ADDRESSING THESE ESSENTIAL NEEDS: 1) PROVIDING COMFORTABLE AND AFFORDABLE LODGING IN A WARM, FRIENDLY ATMOSPHERE WHICH INCLUDES A PRIVATE BEDROOM AND FACILITIES FOR COOKING, LAUNDRY AND RECREATION. 2) OFFERING AN EMOTIONAL SUPPORT SYSTEM THROUGH A NETWORK INCLUDING OTHER FAMILIES AT THE FAMILY HOUSE UNDERGOING THE TRANSPLANT JOURNEY, STAFF AND VOLUNTEERS. QUIET AREAS ARE AVAILABLE FOR THOSE TIMES WHEN A FAMILY OR INDIVIDUAL NEEDS TO BE ALONE AND THE KITCHEN AND DINING AREAS ARE ALWAYS OPEN TO SUPPORT FAMILY INTERACTION AND DISCUSSION. 3) HELPING FAMILIES TO RE-ESTABLISH A SENSE OF CONTROL AND ACCOUNTABILITY BY CREATING A COOPERATIVE AND SUPPORTIVE ATMOSPHERE. FAMILY MEMBERS NOT ONLY EXPERIENCE THE BENEFITS OF THE FAMILY HOUSE, THEY ALSO SUPPORT FAMILY HOUSE OPERATIONS BY MAINTAINING THEIR OWN ROOMS AND ASSISTING WITH THE GENERAL TIDINESS IN THE COMMON AREAS OF THE FAMILY HOUSE. 4) MAINTAINING A NETWORK FOR FAMILY MEMBERS AND CAREGIVERS OUTSIDE THE WALLS OF THE FAMILY HOUSE THROUGH THE FAMILY HOUSE CAREGIVER LIFELINE PROGRAM, AN INTEGRATED NETWORK OF ONLINE EDUCATIONAL RESOURCES, COMMUNITY BASED OUTREACH PROGRAMS AND SUPPORT SERVICES IN THE GIFT OF LIFE SERVICE AREA TAILORED SPECIFICALLY TO CAREGIVERS OF TRANSPLANT PATIENTS.
FORM 990, PART V, LINE 2
THE SALARY EXPENSE AND BENEFITS REPORTED IN PART IX OF FORM 990 ARE AN ALLOCATION FROM A RELATED ENTITY, GREATER DELAWARE VALLEY SOCIETY OF TRANSPLANT SURGEONS (EIN: 23-7388767). THE EMPLOYEES OF THE TRANSPLANT HOUSE ARE REPORTED ON THE FORM W-3 OF THIS RELATED ENTITY.
FORM 990, PART VI, SECTION A, LINE 7A
THE BOARD OF TRANSPLANT FOUNDATION, AN AFFILIATED ENTITY, HAS THE RIGHT TO APPOINT MEMBERS OF THE TRANSPLANT HOUSE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7B
THE FOLLOWING ACTIONS BY THE BOARD OF DIRECTORS REQUIRE THE WRITTEN APPROVAL OF THE TRANSPLANT FOUNDATION, AN AFFILIATED ENTITY: A) ALTERING, AMENDING OR REPEALING THE ARTICLES OF INCORPORATION AND/OR BYLAWS; B) BORROWING MONEY UNDER TERMS THAT PROVIDE FOR A REPAYMENT PERIOD OF ONE YEAR OR MORE; C) ADOPTING AN OPERATING BUDGET AND/OR A CAPITAL BUDGET; D) INCURRING CAPITAL EXPENDITURES WHICH, IN THE AGGREGATE, ARE IN EXCESS OF $200,000 IN ANY ONE FISCAL YEAR; E) ORGANIZING OR ACQUIRING ANY SUBSIDIARY OR AFFILIATE; F) ACQUIRING, BY WHATEVER MEANS, AN INTEREST IN ANY OTHER ENTITY OR BECOMING A MEMBER OF ANY OTHER NONPROFIT CORPORATION; G) AUTHORIZING OR DESIGNATING OFFICERS OF THE CORPORATION TO EXECUTE A DEED OF ASSIGNMENT FOR THE BENEFIT OF CREDITORS, FILE A VOLUNTARY PETITION IN BANKRUPTCY, FILE AN ANSWER CONSENTING TO THE APPOINTMENT OF A RECEIVER, OR FILE AN ANSWER TO AN INVOLUNTARY PETITION IN BANKRUPTCY; AND H) AUTHORIZING ANY AND ALL TRANSACTIONS THAT CHANGE, OR HAVE THE EFFECT OF CHANGING, THE OWNERSHIP AND/OR CONTROL OF THE CORPORATION, WITH SUCH A TRANSACTION INCLUDING, BUT NOT BEING LIMITED TO ANY PROPOSED ATTEMPT TO MERGE, ACQUIRE OR COMBINE THE CORPORATION WITH ANY OTHER ENTITY, WHETHER SUCH TRANSACTION IS BY CONTRACT, SALE OF ALL OR SUBSTANTIALLY ALL OF ITS ASSETS, OR BY OPERATION OF LAW.
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 WAS REVIEWED WITH THE GOVERNING BODY AT A BOARD MEETING PRIOR TO FILING, AND ALL BOARD MEMBERS RECEIVED A COPY OF THE FINAL FORM 990 PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES ARE ANNUALLY REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY; DISCLOSE ANY POSSIBLE PERSONAL, FAMILIAL, OR BUSINESS RELATIONSHIP THAT WOULD GIVE RISE TO A CONFLICT OR APPEARANCE OF A CONFLICT; AND ACKNOWLEDGE BY SIGNING THE POLICY THAT HE/SHE IS ACTING IN ACCORDANCE WITH THE LETTER AND SPIRIT OF THE POLICY. THESE SIGNED STATEMENTS AND DISCLOSURES ARE REVIEWED BY THE ORGANIZATION'S VICE PRESIDENT OF ADMINISTRATION AND GENERAL COUNSEL. BOARD MEMBERS MUST REFRAIN FROM VOTING ON ANY TRANSACTION OR OTHER MATTER IN WHICH THE MEMBER HAS A CONFLICT OF INTEREST. MEMBERS MUST ALSO REPORT PROMPTLY TO THE BOARD CHAIRPERSON AND PRESIDENT/CEO ANY FUTURE SITUATION IN WHICH A POSSIBLE CONFLICT OF INTEREST MIGHT ARISE.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION IS PAID BY A RELATED ORGANIZATION. AT THE RELATED ORGANIZATION, COMPENSATION IS DETERMINED ANNUALLY BY A COMMITTEE OF THE BOARD WHICH IS COMPRISED OF INDEPENDENT PERSONS. AN INFORMAL PAIRED COMPARISON RANKING AMONG EXISTING GIFT OF LIFE DONOR PROGRAM JOBS COMBINED WITH MARKET-BASED WAGE DATA (WHEN AVAILABLE) IS USED. A PERIODIC REVIEW PERFORMED EVERY TWO YEARS WITH AN INDEPENDENT COMPENSATION CONSULTANT IS ALSO CONDUCTED.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION WILL MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.