Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 22,122,317 | 22,711,570 | 24,177,316 | 24,337,374 | 26,647,932 | 119,996,509 |
| 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 | 22,122,317 | 22,711,570 | 24,177,316 | 24,337,374 | 26,647,932 | 119,996,509 |
| 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).. | 37,142,636 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 82,853,873 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 22,122,317 | 22,711,570 | 24,177,316 | 24,337,374 | 26,647,932 | 119,996,509 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,163,577 | 1,815,274 | 1,592,014 | 904,927 | 1,862,957 | 7,338,749 |
| 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.).. | 995 | 2,136 | 104,382 | 100,852 | 208,365 | |
| 11 | Total support. Add lines 7 through 10 | 127,552,752 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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): |
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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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | PATRONAGE DIVIDENDS - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 0. 2019 AMOUNT: $ 55,250. 2020 AMOUNT: $ 31,405. COPY FEES - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 1,329. 2019 AMOUNT: $ 455. 2020 AMOUNT: $ 0. MISCELLANEOUS - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 995. 2018 AMOUNT: $ 807. 2019 AMOUNT: $ 17,233. 2020 AMOUNT: $ 197. ACQUIRED CASH RECEIPTS - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 0. 2019 AMOUNT: $ 22,974. 2020 AMOUNT: $ 69,250. ENTERPRISE FLEET SERVICES - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 0. 2019 AMOUNT: $ 8,470. 2020 AMOUNT: $ 0. |
| 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 A, LINE 6 | MEMBERS OR STOCKHOLDERS VERSITI, INC. IS THE SOLE CORPORATE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBER OR STOCKHOLDER POWERS VERSITI, INC. HAS RESERVE POWERS; INCLUDING THE ABILITY TO ELECT A MAJORITY OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | REFER TO NARRATIVE LISTED IN LINE 7A. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 REVIEW VERSITI WISCONSIN UTILIZES GRANT THORNTON LLP TO COMPLETE THE IRS FORM 990 AND RELATED SCHEDULES. FOLLOWING COMPLETION, THEY ARE REVIEWED BY THE CONTROLLER AND CEO. THE DRAFT FORMS ARE THEN REVIEWED BY THE COMPLIANCE AND AUDIT COMMITTEE PRIOR TO SUBMISSION TO THE IRS. THE FULL BOARD IS PROVIDED A COPY OF THE FORM 990 PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST POLICY VERSITI WISCONSIN MAINTAINS A WRITTEN CONFLICT OF INTEREST POLICY. ON AN ANNUAL BASIS, CURRENT DIRECTORS AND OFFICERS ARE ASKED TO COMPLETE A DISCLOSURE FORM BASED ON IRS REQUIREMENTS THAT INCLUDES THE FOLLOWING: WHETHER THEY HAVE ANY DIRECT OR INDIRECT RELATIONSHIP EITHER THROUGH BUSINESS OR FAMILY MEMBER WITH THE ORGANIZATION. WHETHER THEY RECEIVED COMPENSATION FROM ANY ORGANIZATION THAT SHARES COMMON OWNERSHIP OR CONTROL WITH THE ORGANIZATION. WHETHER THEY HAVE SERVED AS AN OFFICER, DIRECTOR, KEY EMPLOYEE, PARTNER OR MEMBER OF AN ENTITY (OR SHAREHOLDER OF A PROFESSIONAL CORPORATION) DOING BUSINESS WITH THE ORGANIZATION. THESE ANSWERS ARE ACCUMULATED, SUMMARIZED AND EVALUATED BY MANAGEMENT TO DETERMINE IF ANY CONFLICTS EXIST. IDENTIFIED CONFLICTS ARE ADDRESSED IN ACCORDANCE WITH THE WRITTEN POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION PROCESS VERSITI AND ITS AFFILIATED BLOOD CENTERS GREATLY VALUE THE GENEROUS CONTRIBUTIONS OF THE INDIVIDUALS AND ORGANIZATIONS THAT SUPPORT OUR MISSION WITHIN THE COMMUNITY WE SERVE. IN ORDER TO ENSURE PROPER STEWARDSHIP OF OUR CHARITABLE RESOURCES, VERSITI AND ITS AFFILIATES FOLLOW A FORMALIZED PROCESS TO CONFIRM THAT COMPENSATION PROVIDED TO OUR EXECUTIVE LEADERSHIP TEAM IS FAIR, REASONABLE, AND NOT EXCESSIVE WHEN COMPARED TO OTHER EXECUTIVES. THIS PROCESS ALSO HELPS US ENSURE THAT OUR COMPENSATION PROGRAM SUPPORTS THE RETENTION OF EXPERIENCED, HIGHLY-QUALIFIED EXECUTIVES WHO ARE COMMITTED TO OUR MISSION. THE COMPENSATION COMMITTEE OF THE VERSITI BOARD OF DIRECTORS, ACTING IN ITS CAPACITY AS THE COMPENSATION COMMITTEE, SETS AND MONITORS THE COMPENSATION PHILOSOPHY FOR VERSITI AND THE RELATED ENTITIES THAT IT SUPPORTS, INCLUDING VERSITI WISCONSIN. |
| FORM 990, PART VI, SECTION C, LINE 19 | ORGANIZATION'S DOCUMENTS OPEN TO THE PUBLIC THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST TO THE PUBLIC DURING NORMAL BUSINESS HOURS AND AT THE ORGANIZATION'S LOCATION. |
| PART VII: | AVERAGE HOURS THE HOURS LISTED ON FORM 990, PART VII ARE REPRESENTATIVE OF AN AVERAGE FOR THE OFFICERS AND EXECUTIVE TEAM. EACH INDIVIDUAL PERSON'S WEEKLY TALLY MAY BE GREATER OR LESSER PER WEEK BASED ON THEIR INDIVIDUAL ROLES AND RESPONSIBILITIES WITHIN THE FILING ORGANIZATION AND RELATED PARTIES. THE SALARY PRESENTED FOR THE PRESIDENT AND CEO IS REFLECTIVE OF TOTAL SALARY COMPENSATION FOR SERVICES TO THE FILING ORGANIZATION AND RELATED AFFILIATES. |
| FORM 990, PART IX, LINE 11G | DONOR TESTING: PROGRAM SERVICE EXPENSES 7,444,905. TOTAL EXPENSES 7,444,905. SUBAWARDS: PROGRAM SERVICE EXPENSES 2,124,326. TOTAL EXPENSES 2,124,326. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,535,635. MANAGEMENT AND GENERAL EXPENSES 146,187. TOTAL EXPENSES 1,681,822. ANIMAL CARE COSTS: PROGRAM SERVICE EXPENSES 1,252,547. TOTAL EXPENSES 1,252,547. OPERATING ROOM: PROGRAM SERVICE EXPENSES 1,048,403. TOTAL EXPENSES 1,048,403. SHIPPING & TRANSPORTATION: PROGRAM SERVICE EXPENSES 769,645. MANAGEMENT AND GENERAL EXPENSES 97,428. TOTAL EXPENSES 867,073. GRADUATE STUDENT STIPENDS: PROGRAM SERVICE EXPENSES 651,140. TOTAL EXPENSES 651,140. OUTSIDE LAB SERVICE: PROGRAM SERVICE EXPENSES 502,264. TOTAL EXPENSES 502,264. ICU: PROGRAM SERVICE EXPENSES 472,468. TOTAL EXPENSES 472,468. PHARMACY: PROGRAM SERVICE EXPENSES 404,006. TOTAL EXPENSES 404,006. LAB: PROGRAM SERVICE EXPENSES 376,659. TOTAL EXPENSES 376,659. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 98,763. MANAGEMENT AND GENERAL EXPENSES 207,870. TOTAL EXPENSES 306,633. OTHER HOSPITAL CHARGES: PROGRAM SERVICE EXPENSES 302,575. TOTAL EXPENSES 302,575. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 302,057. TOTAL EXPENSES 302,057. MEDICAL TRANSPORT: PROGRAM SERVICE EXPENSES 302,011. TOTAL EXPENSES 302,011. ANESTHESIA: PROGRAM SERVICE EXPENSES 297,410. TOTAL EXPENSES 297,410. CLAIM/BILLING REVIEW: PROGRAM SERVICE EXPENSES 271,103. TOTAL EXPENSES 271,103. TEMPORARY HELP: PROGRAM SERVICE EXPENSES 250,003. MANAGEMENT AND GENERAL EXPENSES 9,746. TOTAL EXPENSES 259,749. CARDIOLOGY: PROGRAM SERVICE EXPENSES 246,117. TOTAL EXPENSES 246,117. FACILITY CHARGES: PROGRAM SERVICE EXPENSES 234,607. TOTAL EXPENSES 234,607. RADIOLOGY: PROGRAM SERVICE EXPENSES 213,275. TOTAL EXPENSES 213,275. BOARD MEMBER FEES: PROGRAM SERVICE EXPENSES 205,679. TOTAL EXPENSES 205,679. RESPIRATORY THERAPY: PROGRAM SERVICE EXPENSES 178,093. TOTAL EXPENSES 178,093. PS SUPPLIES: PROGRAM SERVICE EXPENSES 137,421. TOTAL EXPENSES 137,421. OTHER PURCHASE SERV AFFILIATES: PROGRAM SERVICE EXPENSES 122,331. TOTAL EXPENSES 122,331. TISSUE DONOR TRANSPORT: PROGRAM SERVICE EXPENSES 108,713. TOTAL EXPENSES 108,713. OUTSIDE CORE LAB CHARGES: PROGRAM SERVICE EXPENSES 102,237. TOTAL EXPENSES 102,237. RECORD STORAGE: PROGRAM SERVICE EXPENSES 6,825. MANAGEMENT AND GENERAL EXPENSES 87,959. TOTAL EXPENSES 94,784. FUNERAL HOME CHARGES: PROGRAM SERVICE EXPENSES 90,388. TOTAL EXPENSES 90,388. CUSTOMER TESTING: PROGRAM SERVICE EXPENSES 82,745. TOTAL EXPENSES 82,745. US POSTAL SERVICE: PROGRAM SERVICE EXPENSES 2,134. MANAGEMENT AND GENERAL EXPENSES 70,474. TOTAL EXPENSES 72,608. OUTSIDE SALARY & FRINGES: PROGRAM SERVICE EXPENSES 59,435. TOTAL EXPENSES 59,435. NON-MARKETING PRINTING COSTS: PROGRAM SERVICE EXPENSES 52,924. MANAGEMENT AND GENERAL EXPENSES 5,384. TOTAL EXPENSES 58,308. PUBLICATION SERVICES: PROGRAM SERVICE EXPENSES 56,339. TOTAL EXPENSES 56,339. LICENSES, PERMITS, & HOSP FEES: PROGRAM SERVICE EXPENSES 46,020. MANAGEMENT AND GENERAL EXPENSES 8,163. TOTAL EXPENSES 54,183. DNA SEQUENCING: PROGRAM SERVICE EXPENSES 48,711. TOTAL EXPENSES 48,711. PHARMACY DISPENSING FEE: PROGRAM SERVICE EXPENSES 33,200. TOTAL EXPENSES 33,200. TRANSLATION SERVICE: PROGRAM SERVICE EXPENSES 24,505. TOTAL EXPENSES 24,505. CREDIT CARD FEES: PROGRAM SERVICE EXPENSES 23,309. TOTAL EXPENSES 23,309. EDUCATION: PROGRAM SERVICE EXPENSES 11,444. MANAGEMENT AND GENERAL EXPENSES 1,011. TOTAL EXPENSES 12,455. BANK ACCOUNT FEES: PROGRAM SERVICE EXPENSES 11,221. MANAGEMENT AND GENERAL EXPENSES 3,938. TOTAL EXPENSES 15,159. LAUNDRY COSTS: PROGRAM SERVICE EXPENSES 6,221. TOTAL EXPENSES 6,221. SHIPPING SUPPLIES: PROGRAM SERVICE EXPENSES 3,279. MANAGEMENT AND GENERAL EXPENSES 777. TOTAL EXPENSES 4,056. INTER-DEPT CROSS CHARGE (OM): PROGRAM SERVICE EXPENSES 4,053. TOTAL EXPENSES 4,053. NON-HOSPITAL BUSINESS DEVELOPMENT: PROGRAM SERVICE EXPENSES 4,484. TOTAL EXPENSES 4,484. EMPLOYMENT RECRUITMENT FEES: PROGRAM SERVICE EXPENSES 1,890. TOTAL EXPENSES 1,890. MISCELLANEOUS: PROGRAM SERVICE EXPENSES -1,302. TOTAL EXPENSES -1,302. OUTSIDE MEDICAL DIRECTOR (OPO): PROGRAM SERVICE EXPENSES -41,542. TOTAL EXPENSES -41,542. INTER-DEPT CORE LAB CHARGES: PROGRAM SERVICE EXPENSES -136,601. TOTAL EXPENSES -136,601. |
| FORM 990, PART XI, LINE 9: | CHANGE IN EQUITY IN CENETRON 3,615,266. INVESTMENT IN AFFILIATE BALANCE SHEET AMOUNT -900,000. BAD DEBT RESERVE ADJUSTMENT -1,303. |
| Software ID: | |
| Software Version: |