Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 315,404 | 332,847 | 401,704 | 323,079 | 314,512 | 1,687,546 |
| 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...... | 120,083 | 114,316 | 118,425 | 121,935 | 119,533 | 594,292 |
| 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. | 435,487 | 447,163 | 520,129 | 445,014 | 434,045 | 2,281,838 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 84,050 | 76,900 | 101,428 | 105,460 | 98,985 | 466,823 |
| 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. | 20,750 | 13,050 | 18,838 | 25,127 | 47,221 | 124,986 |
| c | Add lines 7a and 7b.. | 104,800 | 89,950 | 120,266 | 130,587 | 146,206 | 591,809 |
| 8 | Public support. (Subtract line 7c from line 6.) | 1,690,029 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 435,487 | 447,163 | 520,129 | 445,014 | 434,045 | 2,281,838 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 456 | 383 | 290 | 306 | 307 | 1,742 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 456 | 383 | 290 | 306 | 307 | 1,742 |
| 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 435,943 | 447,546 | 520,419 | 445,320 | 434,352 | 2,283,580 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4B | UNDER THE CONSTANT CARE AND SUPERVISION OF A FULL COMPLEMENT OF MEDICAL PROFESSIONALS; FOR MOST OF THESE CHILDREN, IT IS THE ONLY TIME THAT THEY CAN JUST BE KIDS. |
| FORM 990, PAGE 2, PART III, LINE 4D | TEEN RETREAT AND ACTIVITIES - AT THESE EVENTS, ADOLESCENTS WITH BLEEDING DISORDERS ARE PROVIDED WITH THE KNOWLEDGE AND SKILLS THAT THEY REQUIRE TO ASSUME INCREASED RESPONSIBILITY FOR AND GREATER INDEPENDENCE IN ENSURING THEIR ACCESS TO THE CONTINUUM AND QUALITY OF CARE NECESSARY FOR THE LIFE- LONG MANAGEMENT OF A BLEEDING DISORDER. THESE EVENTS ALSO PROVIDE OPPORTUNITIES FOR TEENS TO GAIN SELF- CONFIDENCE AND IMPROVE THEIR SELF- ESTEEM AS THEY NEGOTIATE WITH A SEVERE CHRONIC CONDITION, THE SOMETIMES CHALLENGING PEER RELATIONSHIPS AND DYNAMICS PECULIAR TO ADOLESCENCE. INDIVIDUALS WITH BLEEDING DISORDERS NEED TO HAVE A GOOD JOB WITH GOOD INSURANCE. THE SCHOLARSHIP FUND WAS ESTABLISHED TO PROVIDE FINANCIAL AID FOR COLLEGE TUITION SO RECIPIENTS COULD FURTHER THEIR EDUCATION AND RECEIVE A GOOD JOB TO SUPPORT THEM AND PROVIDE FOR THEIR BLEEDING DISORDER. THE LINKING FACTOR IS A QUARTERLY NEWSLETTER, WHICH HIGHLIGHTS FOUNDATION ACTIVITIES AS WELL AS PROVIDES A RESOURCE FOR FURTHER INFORMATION ON HOW TO CARE FOR BLEEDING DISORDERS. NEWSLETTERS ARE E-MAILED TO FAMILIES AND INDIVIDUALS WITH BLEEDING DISORDERS THROUGHOUT THE STATE. FIRST STEP ACTIVITY - THE FIRST STEP ACTIVITY IS FOCUSED ON ADDRESSING THE NEEDS OF FAMILIES WITH CHILDREN WHO HAVE RECENTLY BEEN DIAGNOSED WITH HEMOPHILIA OR VON WILLEBRAND DISEASE. THIS EVENT AFFORDS THE PARENTS OF YOUNG CHILDREN WITH BLEEDING DISORDERS THE OPPORTUNITY TO CONNECT, NETWORK, SUPPORT ONE ANOTHER, AND GAIN AN INCREASED UNDERSTANDING NOT ONLY OF THE PHYSIOPATHOLOGY OF BLEEDING DISORDERS BUT ALSO THE RANGE OF MODALITIES AND PRACTICES EMPLOYED IN THE PEDIATRIC TREATMENT AND MANAGEMENT OF HEMOPHILIA AND VON WILLEBRAND DISEASE. THE MENS HEALTH GROUP IS A MONTHLY SUPPORT GROUP FOR MEN WITH HEMOPHILIA. MEN, AGES 18 AND OLDER, GATHER THROUGH COMMON INTEREST ACTIVITIES TO LEARN MORE ABOUT CARING FOR THEMSELVES AS THEY AGE, AS WELL AS HOW TO DEAL WITH EMOTIONAL ISSUES THAT COME WITH HAVING FURTHER COMPLICATIONS RELATED TO THEIR BLEEDING DISORDER. FAMILIES WITHIN THE BLEEDING DISORDERS COMMUNITY MAY NEED SOME EXTRA FINANCIAL ASSISTANCE TO SUPPORT THEIR FAMILY THROUGH THE HOLIDAY SEASON. FUNDS ARE USED TO BUY FOOD, CLOTHING AND TOYS FOR FAMILIES DETERMINED TO BE MOST IN NEED. THE PEP (PARENTS EMPOWERING PARENTS) PROGRAM IS A WEEKEND CONFERENCE FOR PARENTS WITH YOUNG CHILDREN, NEWLY DIAGNOSED WITH A BLEEDING DISORDER. WORKSHOPS ARE DESIGNED TO ADDRESS MEDICAL, DEVELOPMENTAL, SOCIAL AND EMOTIONAL ISSUES THAT MAY BE UNIQUE TO THE FAMILY NOT FAMILIAR WITH HOW TO TREAT THEIR CHILDS CONDITION. THE EMERGENCY ASSISTANCE FUND IS A SMALL FUND FOR INDIVIDUALS WITH BLEEDING DISORDERS TO HELP WITH PAY FOR UTILITIES, RENT OR OTHER NEEDED ITEMS. VON WILLEBRAND DISEASE (VWD) IS THE MOST COMMON BLEEDING DISORDER, AFFECTING AS MANY AS ONE IN EVERY 50 PEOPLE. ALTHOUGH VWD CAN BE TREATED IT OFTEN GOES UNDIAGNOSED WHICH CAN CAUSE SEVERE COMPLICATIONS. VWD DOES SHARE SOME COMMONALITIES WITH HEMOPHILIA BUT ALSO POSES MANY UNIQUE CHALLENGES TO THOSE THAT ARE AFFECTED BY IT. EDUCATION ACTIVITIES AND SUPPORT GROUPS ARE HELD, SPECIFICALLY FOR INDIVIDUALS WITH VWD, TO ADDRESS THESE ISSUES AND PROVIDE ANSWERS. THE FORE -A-CURE GOLF TOURNAMENT REPRESENTS THE UTAH HEMOPHILIA FOUNDATION'S LARGEST FUNDRAISER IN SUPPORT OF ITS WIDELY RANGING PROGRAMS OF EDUCATION AND SUPPORT FOR PEOPLE WITH BLEEDING DISORDERS. THE TOURNAMENT CONSISTS OF AN 18-HOLE SCRAMBLE FORMAT WITH CONTESTS AND PRIZES FOR INDIVIDUAL GOLFERS AND TEAMS. CORPORATE SPONSORSHIP PACKAGES ARE ALSO AVAILABLE. GIRLS NIGHT OUT IS AN OUTREACH PROGRAM TO BRING AWARENESS TO WOMEN ABOUT THE SIGNS & SYMPTOMS OF THE MOST COMMON BLEEDING DISORDER, VON WILLEBRAND DISEASE (VWD). STATISTICS SHOW THAT ONE IN 50 WOMEN HAVE VWD BUT, MAY NOT EVEN KNOW IT. GIRLS NIGHT OUT INVITES WOMEN TO SHOP AT OUR BOUTIQUE VENDORS, LEARN FROM INTERACTIVE PRESENTATIONS, AND RECEIVE HEALTH AND WELLNESS TIPS ABOUT VWD. THE UHF ADULT RETREAT BRINGS TOGETHER THE ADULT MEMBERS OF UTAH'S BLEEDING DISORDERS COMMUNITY FOR A WEEKEND OF PEER SUPPORT, NETWORKING, AND EDUCATION IN VARIOUS FACETS OF THE TREATMENT AND LIFE-LONG MANAGEMENT OF BLEEDING DISORDERS. THE EVENT AFFORDS BOTH ADULTS WITH BLEEDING DISORDERS AND THE PARENTS OF CHILDREN WITH BLEEDING DISORDERS AN OPPORTUNITY TO BENEFIT FROM THE PRACTICAL KNOWLEDGE AND INSIGHTS STEMMING FROM SHARED EXPERIENCE. |
| FORM 990, PAGE 6, PART VI, LINE 11B | UPON SUBMITTAL TO THE FOUNDATION'S OFFICE MANAGER, THE OFFICE MANAGER REVIEWS AND THEN SUBMITS THE RETURN TO THE PRESIDENT, EXECUTIVE COMMITTEE, AND DIRECTOR OF THE FOUNDATION FOR THEIR REVIEW AND APPROVAL. |
| FORM 990, PAGE 6, PART VI, LINE 19 | INFORMATION IS AVAILABLE TO PUBLIC UPON REQUEST. |
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