Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 6,613,765 | 9,712,340 | 9,679,968 | 11,106,836 | 10,448,747 | 47,561,656 |
| 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 | 6,613,765 | 9,712,340 | 9,679,968 | 11,106,836 | 10,448,747 | 47,561,656 |
| 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. | 47,561,656 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 6,613,765 | 9,712,340 | 9,679,968 | 11,106,836 | 10,448,747 | 47,561,656 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 59,933 | 97,568 | 102,615 | 97,560 | 146,620 | 504,296 |
| 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 | 48,065,952 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) |
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| 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): |
|||||
| 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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section B, line 11b | The President/CEO reviews the 990 prior to the filing of the return. The 990 as filed is shared with the Board of Directors. |
| 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 Contact Addresses for Officers, Directors, Etc | ANTHONY SEBASTIAN, M.D. - OKLAHOMA TRANSPLANT CENTER 940 NE 13TH STREET STE OKLAHOMA CITY, OK 73104. BENJAMIN COWLEY, M.D. - 800 STANTON L. YOUNG BLVD., STE 5300, OKLAHOMA CITY, OK 73104. GINA FLESHER, M.S., R.N. - 1604 TIMBERCREEK 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. SAMANTHA WEYRAUCH DAVIS - 320 SOUTH BOSTON AVENUE, SUITE 200, TULSA, OK 74103-3706. STEVE MILLER, M.D. - 10901 EAST 48TH STREET, TULSA, OK 74146. TOM ANDERSON - 5705 N. MACARTHUR, WARR ACRES, OK 73122. MARY JOHNSON - 6161 SOUTH YALE AVE, TULSA, OK 74136. ED HEINEN - 3366 NW EXPRESSWAY, SUITE 800, OKLAHOMA CITY, OK 73112. RAJAT KAUL, M.D. - 1124 SOUTH ST. LOUIS AVENUE, SUITE 200, TULSA, OK 74120. SUZANNE WHEELER - 4200 E SKELLY DR, SUITE 950, TULSA, OK 74135. PAMELA SPANBAUER, R.N., B.S.N., M.Ed. - 5308 NW 118TH CIRCLE, OKLAHOMA CITY, OK 73162. JAMES SHARROCK - 2604 NW 68TH STREET, OKLAHOMA CITY, OK 73116. |
| Form 990, Part IX, line 24e | Cost of Procurement-Surgeon Fees: Program service expenses 642,125. Management and general expenses 0. Fundraising expenses 0. Total expenses 642,125. Cost of Procurement-Transportation of Organs and Tissue: Program service expenses 578,812. Management and general expenses 0. Fundraising expenses 0. Total expenses 578,812. Cost of Procurement-Tissue Procurement Expense: Program service expenses 526,492. Management and general expenses 0. Fundraising expenses 0. Total expenses 526,492. Sponsorships: Program service expenses 16,360. Management and general expenses 403,047. Fundraising expenses 0. Total expenses 419,407. Cost of Procurement-Donor Evaluation: Program service expenses 362,184. Management and general expenses 0. Fundraising expenses 0. Total expenses 362,184. Cost of Procurement-Organ Acquisition Non-Recovery: Program service expenses 350,643. Management and general expenses 0. Fundraising expenses 0. Total expenses 350,643. Doubtful Accounts Provision: Program service expenses 320,089. Management and general expenses 0. Fundraising expenses 0. Total expenses 320,089. Cost of Procurement-Anesthesiology: Program service expenses 312,874. Management and general expenses 0. Fundraising expenses 0. Total expenses 312,874. Call Center: Program service expenses 308,444. Management and general expenses 0. Fundraising expenses 0. Total expenses 308,444. Cost of Procurement-Other Acquisition Costs: Program service expenses 296,043. Management and general expenses 0. Fundraising expenses 0. Total expenses 296,043. Human Resources: Program service expenses 0. Management and general expenses 287,446. Fundraising expenses 0. Total expenses 287,446. Cost of Procurement-Pharmacy: Program service expenses 282,375. Management and general expenses 0. Fundraising expenses 0. Total expenses 282,375. Cost of Procurement-Intensive Care Unit: Program service expenses 277,484. Management and general expenses 0. Fundraising expenses 0. Total expenses 277,484. Cost of Procurement-Transportation of Teams: Program service expenses 245,975. Management and general expenses 0. Fundraising expenses 0. Total expenses 245,975. Cost of Procurement-Medical Supplies: Program service expenses 201,988. Management and general expenses 0. Fundraising expenses 0. Total expenses 201,988. Professional Education: Program service expenses 70,812. Management and general expenses 124,782. Fundraising expenses 0. Total expenses 195,594. Cost of Procurement-Tissue Typing: Program service expenses 189,226. Management and general expenses 0. Fundraising expenses 0. Total expenses 189,226. Cost of Procurement-Respiratory Therapy: Program service expenses 186,904. Management and general expenses 0. Fundraising expenses 0. Total expenses 186,904. Donor Data System: Program service expenses 156,563. Management and general expenses 0. Fundraising expenses 0. Total expenses 156,563. Transplant Coordinator Expense: Program service expenses 147,286. Management and general expenses 0. Fundraising expenses 0. Total expenses 147,286. Cost of Procurement-Organ Hospital Bill Review: Program service expenses 141,411. Management and general expenses 0. Fundraising expenses 0. Total expenses 141,411. Cost of Procurement-Medical Waste: Program service expenses 137,949. Management and general expenses 0. Fundraising expenses 0. Total expenses 137,949. Admin & General: Program service expenses 31,633. Management and general expenses 80,333. Fundraising expenses 0. Total expenses 111,966. Memberships and Dues: Program service expenses 14,156. Management and general expenses 74,901. Fundraising expenses 0. Total expenses 89,057. Cost of Procurement-Transplant Coordinator: Program service expenses 78,253. Management and general expenses 0. Fundraising expenses 0. Total expenses 78,253. Uniforms & Linens: Program service expenses 17,089. Management and general expenses 0. Fundraising expenses 0. Total expenses 17,089. Retirement of Assets: Program service expenses 0. Management and general expenses 11,738. Fundraising expenses 0. Total expenses 11,738. Tools & Med Supplies: Program service expenses 3,980. Management and general expenses 5,326. Fundraising expenses 0. Total expenses 9,306. Cost of Procurement-Other Excision Costs: Program service expenses 9,260. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,260. Taxes-Other: Program service expenses 0. Management and general expenses 7,408. Fundraising expenses 0. Total expenses 7,408. Bank Service Charges: Program service expenses 0. Management and general expenses 134. Fundraising expenses 0. Total expenses 134. |
| Schedule R, Part II | To assume all of the fundraising activities of its supported organization, ie., the LifeShare Transplant Donor Services of Oklahoma, Inc. which is the Federally-certified organ procurement organization for the State of Oklahoma. |
| Software ID: | |
| Software Version: |