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
MIDWEST EYE-BANKS
Employer identification number
38-2117115
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.") .
403,380
62,828
9,406
17,759
6,073
499,446
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......
10,778,644
16,332,111
22,060,834
24,329,665
22,268,486
95,769,740
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
56,300
56,300
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.
11,182,024
16,394,939
22,070,240
24,347,424
22,330,859
96,325,486
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.
384,910
1,399,086
1,783,996
c
Add lines 7a and 7b..
384,910
1,399,086
1,783,996
8
Public support (Subtract line 7c from line 6.)
94,541,490
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...
11,182,024
16,394,939
22,070,240
24,347,424
22,330,859
96,325,486
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
157,377
176,876
198,497
150,312
154,047
837,109
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
157,377
176,876
198,497
150,312
154,047
837,109
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
6,435
6,435
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
138,253
531
5,359
68,569
269,012
481,724
13
Total support. (Add lines 9, 10c, 11, and 12.)..
11,477,654
16,572,346
22,274,096
24,566,305
22,760,353
97,650,754
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
96.820 %
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
1.000 %
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
MIDWEST EYE-BANKS
Employer identification number
38-2117115
Return Reference
Explanation
FORM 990, PAGE 2, PART III, LINE 4A
DISEASES THAT CAN LEAD TO BLINDNESS UNLESS THEY ARE TREATED THROUGH CORNEAL TRANSPLANTATION, AND THE MILLIONS OF OTHERS WHO CAN BE HELPED THROUGH SCIENTIFIC RESEARCH.
FORM 990, PAGE 2, PART III, LINE 4B
WEB CONTENT SHARING OUR MESSAGE OF SIGHT RESTORATION. THE PROFESSIONAL EDUCATION PROGRAM BUILDS AND MAINTAINS RELATIONSHIPS WITH HEALTHCARE PROFESSIONALS AND OTHERS DIRECTLY INVOLVED IN EYE TISSUE DONATION AND TRANSPLANTATION EFFORTS. EFFECTIVE COLLABORATION WITH THESE PROFESSIONALS ENABLES SUITABLE RECOVERY OF TISSUE FOR TRANSPLANTATION AND RESEARCH, TIMELY RETRIEVAL OF DONOR MEDICAL INFORMATION, SUCCESSFUL DISTRIBUTION OF TISSUE FOR TRANSPLANTATION, AND ADVOCACY OF RESEARCH AND DONATION.
FORM 990, PAGE 2, PART III, LINE 4C
COLLECT DATA OR CARRY OUT PRELIMINARY LABORATORY WORK THAT FACILITATES APPLICATION FOR MORE EXTENSIVE SUPPORT BY LARGER PRIVATE OR GOVERNMENTAL AGENCIES. AWARDS ARE GENERALLY 15,000 EACH, AND TOTAL AWARD FUNDING IS APPROXIMATELY 150,000 AND 200,000 PER YEAR. WHEN RESEARCH AWARDS ARE GRANTED, AWARD RECIPIENTS ARE REQUIRED TO SUBMIT A WRITTEN PROGRESS REPORT TO MIDWEST EYE-BANKS WITHIN 14 MONTHS. THE EYE-BANK, IN TURN, APPRISES ITS STAKEHOLDERS OF RESEARCH PROJECTS AND ACCOMPLISHMENTS. RESEARCHERS ARE EXPECTED TO NOTIFY THE EYE-BANK OF ANY ADDITIONAL FUNDING THEY OBTAIN IN THE FUTURE, RESULTING FROM THE WORK MADE POSSIBLE THROUGH THE EYE-BANK GRANT. THEY ARE ALSO ASKED TO ACKNOWLEDGE MIDWEST EYE-BANKS SUPPORT IN ANY PUBLICATIONS OR PRESENTATIONS COVERING THE FUNDED PROJECT(S), AND TO PROVIDE COPIES OF PAPERS PUBLISHED AS A RESULT OF EYE-BANK FUNDING.
FORM 990, PAGE 6, PART VI, LINE 11B
THE 990 IS REVIEWED BY THE CEO AND CFO PRIOR TO FILING. COMPLETED 990 IS PROVIDED VIA E-MAIL TO ALL BOARD MEMBERS FOR COMMENTS AND QUESTIONS PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 12C
THE POLICY IS REVIEWED DURING NEW EMPLOYEE ORIENTATION AND ANNUALLY WITH THE ENTIRE STAFF AND BOARD OF DIRECTORS. ANY POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY SENIOR STAFF UPON DISCOVERY.
FORM 990, PAGE 6, PART VI, LINE 15A
A PERFORMANCE REVIEW IS CONDUCTED BY THE BOARD HR COMMITTEE WITH CEO; MERIT INCREASE IS RECOMMENDED BY THE HR COMMITTEE AND APPROVED BY THE BOARD. THE CEO IS NOT PART OF COMPENSATION DISCUSSION AND CEO DOES NOT PARTICIPATE IN THE SELECTION OF BOARD MEMBERS. THE CEO SALARY IS COMPARED TO SALARIES OF OTHER CEO'S AT PEER ORGANIZATIONS; OTHER EYE BANKS, OPOS, OTHER NONPROFIT ORGANIZATIONS OF SIMILAR SIZE. THE SOURCE OF SALARY INFORMATION IS PRIMARILY THE 990'S ISSUED BY PEER ORGANIZATIONS.
FORM 990, PAGE 6, PART VI, LINE 15B
PERFORMANCE REVIEW FOR OFFICERS AND KEY EMPLOYEES IS CONDUCTED BY THE EMPLOYEES' IMMEDIATE MANAGER; MERIT INCREASES ARE RECOMMENDED BY THE MANAGER AND APPROVED BY THE CEO. SALARIES OF OFFICERS AND KEY EMPLOYEES ARE COMPARED TO SALARIES OF OTHER SIMILAR POSITIONS AT PEER ORGANIZATIONS; OTHER EYE BANKS, OPOS, OTHER NONPROFIT ORGANIZATIONS OF SIMILAR SIZE. A REPORT IS PROVIDED TO THE HR COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR REVIEW. THE SOURCE OF SALARY INFORMATION IS PRIMARILY THE 990'S ISSUED BY PEER ORGANIZATIONS.
FORM 990, PAGE 6, PART VI, LINE 19
GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.