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
Oklahoma Blood Institute
Employer identification number
73-1008735
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.") .
646,135
270,573
400,448
832,711
1,037,397
3,187,264
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......
71,082,104
75,903,196
83,066,670
84,029,579
82,642,403
396,723,952
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
71,728,239
76,173,769
83,467,118
84,862,290
83,679,800
399,911,216
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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.
38,712,021
36,795,950
37,528,138
39,779,080
39,027,252
191,842,441
c
Add lines 7a and 7b..
38,712,021
36,795,950
37,528,138
39,779,080
39,027,252
191,842,441
8
Public support (Subtract line 7c from line 6.)
208,068,775
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...
71,728,239
76,173,769
83,467,118
84,862,290
83,679,800
399,911,216
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
29,795
41,422
23,162
24,715
55,734
174,828
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
29,795
41,422
23,162
24,715
55,734
174,828
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
71,758,034
76,215,191
83,490,280
84,887,005
83,735,534
400,086,044
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
52.006 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
49.962 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.044 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.042 %
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
Oklahoma Blood Institute
Employer identification number
73-1008735
Return Reference
Explanation
FORM 990, PART VI, QUESTION 11A
The Oklahoma Blood Institute (OBI) has the annual IRS form 990 reviewed by two standing committees of the Board of Directors in a joint meeting with the companies external auditors prior to filing. The committees responsible for the review are the Nominating/Corporate Governance Committee and Audit/Risk Management Committee. Members of the committees receive a copy of the 990 prior to the meeting and key sections on governance, policies, compensation and program expenses are reviewed. The review is completed and the meeting documented with minutes that become part of both committees' permanent files. At the conclusion of this review, the entire board is provided a copy of the 990 prior to filing.
OTHER PROGRAM SERVICES
These other program services are blood product derivatives. Derivatives are a product manufactured from a raw material byproduct OBI supplies to plasma manufacturers made into a biological drug. Once returned to OBI, derivatives are used for therapeutic treatments for critically ill patients. Associated revenue is $280,499. Other miscellaneous revenue in the amount of $1,350,832 comes from other sources directly related to the tax-exempt purpose of the organization.
FORM 990, PART VI, QUESTION 12C
OBI's conflict of interest policy is provided to all Board members and Officers on an annual basis and they are required to sign an annual conflict of interest and confidentiality statement each year. Executed copies of the conflict of interest and confidentiality statements are maintained in the corporate records and the Chair of the Audit/Risk Management Committee and Executive Committee are informed of any conflicts disclosed. If a conflict did exist the member would recuse themselves from any votes or discussions related to the area of conflict. OBI maintains a confidential disclosure hot line and web site that allows employees to anonymously report any concerns or potential conflict of interests. All reports are sent thru the senior HR employee and significant issues are forwarded to the Chair of the Audit/Risk Management Committee.
FORM 990, PART VI, QUESTION 15A & B
The compensation of the CEO is determined by the Executive Committee of the Board of Directors comprising community leaders, business executives and physicians with exemplary ethical and fiduciary standards. CEO compensation is based on comparative salary data from similar health care organizations using IRS Form 990s and industry salary surveys. Similarly, compensation for executives reporting to the CEO is proposed by the CEO based on comparable national and local salaries for positions and approved by the Executive Committee. Changes to compensation are reviewed and formally approved by the Executive Committee of the Board of Directors. The role of CEO and other physicians and executives requires a rare blend of astute organizational leadership, capable of providing vision and fiduciary management of the state's largest biopharmaceutical, a 700-plus staff entity, and advanced medical specialization and expertise in the unique scientific field of transfusion medicine. Executives have responsibility for 14 operational facilities across nine major markets in the region and the day-to-day provision of safe and sufficient blood to meet the needs of patients in more than 160 hospitals served.
FORM 990, PART VI, QUESTION 19
Copies of the organizations form 990 are available to the public upon request and at the Guidestar.org web site. Conflict of interest policies and financial statements are available up on request.
FORM 990, PART VI, QUESTIONS 6 - 7B
The Oklahoma Blood Institute's by laws provides for a single member, OBI Holding Company and the single member has the authority to appoint Board Members. The Single Member's board is elected by the Board of The Oklahoma Blood Institute and is subject to OBI's approval their of actions.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.