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
MISSOURI LIONS EYE FOUNDATION
Employer identification number
43-1036995
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.") ....
951,618
117,031
314,602
332,327
329,360
2,044,938
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
951,618
117,031
314,602
332,327
329,360
2,044,938
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)..
638,634
6
Public support. Subtract line 5 from line 4.
1,406,304
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..
951,618
117,031
314,602
332,327
329,360
2,044,938
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
128,130
108,668
177,257
216,060
172,969
803,084
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
3,972
20,482
7,538
31,992
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).
2,880,014
12
Gross receipts from related activities, etc. (see instructions)
..................
12
8,420,949
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
48.830 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
65.380 %
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
MISSOURI LIONS EYE FOUNDATION
Employer identification number
43-1036995
Identifier
Return Reference
Explanation
FIRST ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
SERVICES. HLEB IS ALSO ONE OF THE LARGEST EYE BANKS IN NORTH AMERICA IN TERMS OF PROVIDING CORNEAS FOR TRANSPLANT. DURING THE 2008 CALENDAR YEAR, HLEB RANKED THE 5TH HIGHEST IN TRANSPLANTS OF ALL EBAA ACCREDITED EYE BANKS. HLEB FOCUS ON HELPING THE PEOPLE OF MISSOURI, ILLINOIS AND KANSAS. CORNEAS ARE 1ST MADE AVAILABLE TO PATIENTS IN NEED OF A TRANSPLANT IN THESE 3 STATES. WHEN ALL REQUESTS FOR CORNEAL TISSUE IN THIS PRIMARY SERVICE AREA HAVE BEEN FILLED, REMAINING EYE TISSUE IS OFFERED TO SURGEONS IN OTHER PARTS OF THE UNITED STATES. IF THERE IS NO IMMEDIATE NEED IN THIS COUNTRY, CORNEAS CAN BE OFFERED TO SURGEONS AND PATIENTS IN OTHER NATIONS. THIS SYSTEM ALLOWS US TO FULFILL 100% OF THE REQUESTS WE RECEIVE FOR PATIENTS IN MISSOURI, ILLINOIS AND KANSAS. IT ALSO ALLOWS THE EYE BANK TO HELP PEOPLE THROUGHOUT THE REST OF THE UNITED STATES AND ALL OVER THE WORLD. HLEB SUPPLY EYE TISSUE FOR RESEARCH OR TEACHING TO SCIENTISTS AT UNIVERSITIES AS WELL AS TO THE NATIONAL EYE INSTITUTES IN BETHESDA, MARYLAND. THE EYE BANK ALSO PROVIDES TISSUE TO THE NATIONAL DISEASE RESEARCH INTERCHANGE, A NON- PROFIT ORGANIZATION THAT PROVIDES BIOMEDICAL RESEARCHERS REGULAR ACCESS TO HUMAN TISSUES AND ORGANS. IT IS ILLEGAL AND UNETHICAL TO CHARGE A FEE FOR ANY HUMAN ORGAN AND TISSUES. THE EYE BANKS' PROCESSING FEE HELPS TO COVER EXPENSES INCURRED IN PREPARING AND PROVIDING THE HIGHEST QUALITY OF EYE TISSUE POSSIBLE TO THE PATIENT. SAFETY MUST BE ENSURED DURING A THOROUGH REVIEW OF THE DONOR'S MEDICAL HISTORY, MICROSCOPIC EVALUATIONS OF THE DONATED EYE TISSUE, DONOR FAMILY INTERVIEWS AND LABORATORY TESTING. THERE IS NEVER ANY FEE CHARGED TO THE DONOR FAMILY. THE PROCESSING FEE IS ONLY CHARGED WHEN A PATIENT HAS THIRD-PARTY COVERAGE. IF A PATIENT DOES NOT HAVE INSURANCE, THE PROCESSING FEE CAN BE WAIVED. THE FOUNDATION'S EYE CARE ASSISTANCE PROGRAM PROVIDES GRATIS CORNEAL TISSUE TO INDIGENT RECIPIENTS WHO DO NOT HAVE THIRD-PARTY COVERAGE.
SECOND ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4B
MISSOURIANS THROUGH OUR MOBILE GLAUCOMA DETECTION PROGRAM. THE PROGRAM SCREENS INDIVIDUALS BY USING A NON-CONTACT TONOMETER THAT DETERMINES PRESSURE WITHIN THE EYE. THOSE WHO EXHIBIT SYMPTOMS ARE ENCOURAGED TO VISIT AN EYE CARE PROFESSIONAL FOR FURTHER TESTING. GALUCOMA SCREENING IS FREE TO THE PUBLIC, BUT SPONSORING CLUBS OR BUSINESSES ARE ASKED TO DONATE A MINIMUM OF 100 PER DAY OF SCREENING TO COVER SOME OF THE EXPENSES INCURRED BY THE FOUNDATION. AN AVERAGE GLAUCOMA SCREENING COSTS THE FOUNDATION 900 FOR EQUIPMENT MAINTENANCE, STAFF TIME AND TRAVEL EXPENSES. THE 100 DONATION HELPS KEEP THE GLAUCOMA DETECTION PROGRAM ON THE ROAD IN MISSOURI.
THIRD ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4C
ADDITION, THE ECA PROGRAM HAS PROVIDED GRATIS CORNEAL TISSUE FOR NUMEROUS MISSOURIANS. IF THE FOUNDATION IS UNABLE TO ASSIST THE PATIENT WITH ALL OF THEIR ASSISTANCE NEEDS WE WILL WORK WITH OTHER ORGANIZATIONS TO GET THE PATIENT WELL-ROUNDED COVERAGE. ALL APPLICANTS MUST MEET CERTAIN CRITERIA TO ENROLL IN THE PROGRAM. EYEGLASS RECYCLING: THE FOUNDATION SERVES AS THE MISSOURI LIONS' OFFICIAL COLLECTION SITE FOR USED EYEGLASSES. LION VOLUNTEERS AND FOUNDATION PERSONNEL SORT EYEGLASSES THAT COME FROM ALL OVER THE STATE. EACH PAIR OF GLASSES IS CLEANED AND ANALYZED FOR ITS LEVEL OF CORRECTION BY PHILANTHROPIC GROUPS. APPROXIMATELY 60,000 PAIRS OF EYEGLASSES ARE DONATED ANNUALLY TO THE FOUNDATION. ALL OF THE USABLE EYEGLASSES GO TO HELP THE NEEDY IN DEVELOPING COUNTRIES. SINCE JULY 1989, OVER ONE MILLION PAIRS OF RECYCLED GLASSES HAVE BEEN SENT OVERSEAS. DONOR SERVICE CENTER (DSC): THE DSC HELPS FACILITATE THE DONATION PROCESS BY SPEAKING WTIH MEDICAL FACILITIES AND COUNSELING DONOR FAMILIES ABOUT EYE DONATION.
POLICIES AND PROCEDURES GOVERNING CHAPTERS
FORM 990, PAGE 6, PART VI, LINE 10B
BRANCHES MUST FOLLOW POLICIES AND PROCEDURES DEVELOPED BY THE FOUNDATION.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
THE 990 DRAFT .PDF FILE IS RECEIVED FROM THE TAX PREPARER. THE FILE IS SENT TO THE PRESIDENT OF THE BOARD OF DIRECTORS, WHO THEN EMAILS THE FILE TO THE OTHER DIRECTORS FOR REVIEW. DURING THE NEXT BOARD OF DIRECTORS MEETING, THE 990 FORM IS ADDED TO THE AGENDA TO DISCUSS ANY QUESTIONS AND THIS DISCUSSION IS DOCUMENTED IN THE BOARD MINUTES.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. BOARD MINUTES MUST OUTLINE ANY POTENTIAL CONFLICTS OF INTEREST AND WILL BE PART OF THE OFFICIAL RECORD. THIS WILL BE REVIEWED ANNUALLY AT THE JUNE MEETING.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
SALARY AND/OR INCENTIVE AWARD INCREASES FOR PERFORMANCE WILL BE ROUTINELY REVIEWED FOR ADJUSTMENT PRIOR TO JULY 1ST OF EACH YEAR. THE CURRENT EVALUATION AND RATING SYSTEMS IN PRACTICE WILL APPLY. THE EXECUTIVE DIRECTOR HAS THE AUTHORITY TO MAKE ADJUSTMENTS DURING OTHER PERIODS OF THE YEAR AS NEEDED.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
ANNUAL REVIEW PER CHIEF COMPLIANCE OFFICER. RECOMMENDATION FOR ANNUAL INCREASE IS APPROVED BY THE EXECUTIVE DIRECTOR.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
RECONCILIATION OF CHANGES - OTHER
FORM 990, PART XI, LINE 9
LOSSES REPORTED ON RETURN -2,260
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.