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.) .... | 3,928,482 | 4,494,693 | 4,651,818 | 6,613,765 | 9,712,340 | 29,401,098 |
| 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 | 3,928,482 | 4,494,693 | 4,651,818 | 6,613,765 | 9,712,340 | 29,401,098 |
| 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. | 29,401,098 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 3,928,482 | 4,494,693 | 4,651,818 | 6,613,765 | 9,712,340 | 29,401,098 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 66,975 | 80,828 | 79,736 | 59,933 | 97,568 | 385,040 |
| 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. | 29,786,138 | |||||
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 | 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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| 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, Part VI, Section B, line 11 | The governing body receives a copy of the 990 prior to the filing of the return. |
| Form 990, Part VI, Section B, line 12c | The employees and the board members sign a conflict of interest statement annually. |
| Form 990, Part VI, Section C, line 19 | Lifeshare Transplant Donor Services of Oklahoma, Inc only provides its governing documents, conflict of interest policy, and financial statements when requested. They do not publish this information on their website. |
| Form 990, Part VII | ANTHONY SEBASTIAN, M.D. - OKLAHOMA TRANSPLANT CENTER 940 NE 13TH STREET STE OKLAHOMA CITY, OK 73104. BENJAMIN COWLEY, M.D. - OUHSC/920 STANTON L. YOUNG BLVD WP 2250, OKLAHOMA CITY, OK 73104. ED HEINEN - 3366 NW EXPRESSWAY, SUITE 800, OKLAHOMA CITY, OK 73112. GINA FLESHER, M.S., R.N. - 1407 N. WHISENANT DR., DUNCAN, OK 73533. HARLAN WRIGHT, M.D. - 940 NE 13TH ST., STE. 3000, OKLAHOMA CITY, OK 73104. IRFAN KUNDI, M.D. - 2000 SOUTH WHEELING AVENUE, SUITE 510, TULSA, OK 74104. MICHAEL MORRIS, M.D. - 3300 NW EXPRESSWAY, OKLAHOMA CITY, OK 73112. PAMELA SPANBAUER, R.N., B.S.N., M.Ed. - 5308 NW 118TH CIRCLE, OKLAHOMA CITY, OK 73162. PHIL VAN STAVERN - 2241 NW 56TH, OKLAHOMA CITY, OK 73112. PUNEET SINDHWANI, M.D. - 920 STANTON L. YOUNG BLVD, WP3150, OKLAHOMA CITY, OK 73104. RAJAT KAUL, M.D. - 1124 SOUTH ST. LOUIS AVENUE, SUITE 200, TULSA, OK 74120. SAMANTHA WEYRAUCH DAVIS - 320 SOUTH BOSTON AVENUE, SUITE 200, TULSA, OK 74103-3706. STEVE MILLER, M.D. - 10901 EAST 48TH STREET, TULSA, OK 74146. SUZANNE WHEELER - 4200 E SKELLY DR, SUITE 950, TULSA, OK 74135. THOMAS KENKEL, M.D. - 1124 SOUTH ST. LOUIS AVENUE, SUITE 200, TULSA, OK 74120. |
| Form 990, Part IX, line 24e | Cost of Procurement-Other Acquisition Costs: Program service expenses 409,116. Management and general expenses 0. Fundraising expenses 0. Total expenses 409,116. Call Center: Program service expenses 408,719. Management and general expenses 0. Fundraising expenses 0. Total expenses 408,719. Cost of Procurement-Tissue Procurement Expense: Program service expenses 384,908. Management and general expenses 0. Fundraising expenses 0. Total expenses 384,908. Cost of Procurement-Transportation of Organs and Tissue: Program service expenses 378,650. Management and general expenses 0. Fundraising expenses 0. Total expenses 378,650. Cost of Procurement-Hospital Lab: Program service expenses 365,941. Management and general expenses 0. Fundraising expenses 0. Total expenses 365,941. Cost of Procurement-Anesthesiology: Program service expenses 274,795. Management and general expenses 0. Fundraising expenses 0. Total expenses 274,795. Cost of Procurement-Tissue Typing: Program service expenses 265,181. Management and general expenses 0. Fundraising expenses 0. Total expenses 265,181. Sponsorships: Program service expenses 116,816. Management and general expenses 145,525. Fundraising expenses 0. Total expenses 262,341. Cost of Procurement-Organ Acquisition Non-Recovery: Program service expenses 237,409. Management and general expenses 0. Fundraising expenses 0. Total expenses 237,409. Cost of Procurement-Donor Evaluation: Program service expenses 233,622. Management and general expenses 0. Fundraising expenses 0. Total expenses 233,622. Cost of Procurement-Medical Supplies: Program service expenses 190,600. Management and general expenses 0. Fundraising expenses 0. Total expenses 190,600. Human Resources: Program service expenses 0. Management and general expenses 166,799. Fundraising expenses 0. Total expenses 166,799. Admin & General: Program service expenses 40,349. Management and general expenses 109,737. Fundraising expenses 0. Total expenses 150,086. Cost of Procurement-Transportation of Teams: Program service expenses 144,061. Management and general expenses 0. Fundraising expenses 0. Total expenses 144,061. Donor Data System: Program service expenses 136,835. Management and general expenses 0. Fundraising expenses 0. Total expenses 136,835. Transplant Coordinator Expense: Program service expenses 114,883. Management and general expenses 0. Fundraising expenses 0. Total expenses 114,883. Cost of Procurement-Respiratory Therapy: Program service expenses 113,350. Management and general expenses 0. Fundraising expenses 0. Total expenses 113,350. Professional Education: Program service expenses 53,462. Management and general expenses 55,852. Fundraising expenses 0. Total expenses 109,314. Cost of Procurement-Pharmacy: Program service expenses 100,734. Management and general expenses 0. Fundraising expenses 0. Total expenses 100,734. Cost of Procurement-Intensive Care Unit: Program service expenses 89,025. Management and general expenses 0. Fundraising expenses 0. Total expenses 89,025. Cost of Procurement-Medical Waste: Program service expenses 86,372. Management and general expenses 0. Fundraising expenses 0. Total expenses 86,372. Cost of Procurement-Organ Hospital Bill Review: Program service expenses 79,569. Management and general expenses 0. Fundraising expenses 0. Total expenses 79,569. Memberships and Dues: Program service expenses 8,940. Management and general expenses 56,030. Fundraising expenses 0. Total expenses 64,970. Doubtful Accounts Provision: Program service expenses 51,437. Management and general expenses 0. Fundraising expenses 0. Total expenses 51,437. Donations: Program service expenses 0. Management and general expenses 39,301. Fundraising expenses 0. Total expenses 39,301. Cost of Procurement-Other Excision Costs: Program service expenses 34,872. Management and general expenses 0. Fundraising expenses 0. Total expenses 34,872. Cost of Procurement-Transplant Coordinator: Program service expenses 33,461. Management and general expenses 0. Fundraising expenses 0. Total expenses 33,461. Uniforms & Linens: Program service expenses 14,786. Management and general expenses 0. Fundraising expenses 0. Total expenses 14,786. Taxes-Other: Program service expenses 0. Management and general expenses 5,432. Fundraising expenses 0. Total expenses 5,432. Team Oklahoma: Program service expenses 4,102. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,102. Tools & Med Supplies: Program service expenses 567. Management and general expenses 3,354. Fundraising expenses 0. Total expenses 3,921. Bank Service Charges: Program service expenses 0. Management and general expenses 183. Fundraising expenses 0. Total expenses 183. |
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