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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 2,386,544 | 3,044,915 | 2,280,020 | 1,941,772 | 2,483,784 | 12,137,035 |
| 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 | 2,386,544 | 3,044,915 | 2,280,020 | 1,941,772 | 2,483,784 | 12,137,035 |
| 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) .. | 70,450 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 12,066,585 | |||||
Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,386,544 | 3,044,915 | 2,280,020 | 1,941,772 | 2,483,784 | 12,137,035 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 64,687 | 152,603 | 140,346 | 189,677 | 221,452 | 768,765 |
| 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.).. | 10 | 10 | ||||
| 11 | Total support. Add lines 7 through 10 | 12,905,810 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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 2021 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-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 1: | GIFT OF LIFE FAMILY HOUSE SERVES AS A "HOME AWAY FROM HOME" FOR TRANSPLANT PATIENTS AND THEIR FAMILIES. FAMILY HOUSE PROVIDES TEMPORARY, AFFORDABLE LODGING AND SUPPORTIVE SERVICES TO THOSE WHO TRAVEL TO PHILADELPHIA, PENNSYLVANIA FOR TRANSPLANT-RELATED CARE. GIFT OF LIFE FAMILY HOUSE IS A 501(C) (3) NON-PROFIT CHARITABLE ORGANIZATION. GIFT OF LIFE FAMILY HOUSE ENHANCES THE LIVES OF TRANSPLANT PATIENTS AND THEIR FAMILIES BY: -PROVIDING COMFORTABLE AND AFFORDABLE LODGING IN A WARM, FRIENDLY ATMOSPHERE WHICH INCLUDES A PRIVATE BEDROOM AND FACILITIES FOR COOKING, LAUNDRY, AND RECREATION -OFFERING AN EMOTIONAL SUPPORT SYSTEM THROUGH A NETWORK INCLUDING OTHER FAMILIES AT FAMILY HOUSE UNDERGOING THE TRANSPLANT JOURNEY, STAFF, AND VOLUNTEERS -HELPING FAMILIES TO RE-ESTABLISH A SENSE OF CONTROL AND ACCOUNTABILITY BY CREATING A COOPERATIVE AND SUPPORTIVE ATMOSPHERE WHERE THEY NOT ONLY EXPERIENCE THE BENEFITS OF FAMILY HOUSE, BUT ALSO SUPPORT ITS OPERATIONS BY MAINTAINING THEIR OWN ROOMS AND ASSISTING WITH THE GENERAL TIDINESS IN COMMON AREAS -MAINTAINING A NETWORK FOR FAMILY MEMBERS AND CAREGIVERS OUTSIDE THE WALLS OF FAMILY HOUSE THROUGH THE CAREGIVER LIFELINE PROGRAM, AN INTEGRATED NETWORK OF ONLINE EDUCATIONAL RESOURCES, COMMUNITY-BASED OUTREACH PROGRAMS AND SUPPORT SERVICES IN GIFT OF LIFE'S SERVICE AREA TAILORED SPECIFICALLY TO CAREGIVERS OF TRANSPLANT PATIENTS |
| FORM 990, PART III, LINE 4A (CONTINUED): | ADOPT-A-FAMILY PROGRAM FAMILY HOUSE OFFERS ITS ACCOMMODATIONS, PROGRAMS, AND SERVICES TO GUESTS ALL FOR A HIGHLY SUBSIDIZED FEE OF $40 PER ROOM PER NIGHT, DESPITE THE ACTUAL OPERATING COST TOTALING $175. FAMILY HOUSE WILL FURTHER SUBSIDIZE THIS $40 FEE IF A FAMILY CANNOT AFFORD IT ENSURING THAT AN ELIGIBLE FAMILY IS NEVER TURNED AWAY DUE TO AN INABILITY TO PAY. THE ADOPT-A-FAMILY PROGRAM FUND HELPS BRIDGE THE GAP BETWEEN THE MODEST, SUBSIDIZED FEE FAMILIES ARE ASKED TO PAY EACH NIGHT AND THE ACTUAL OPERATING COST TO PROVIDE THEM. IN 2021, FAMILY HOUSE PROVIDED 6,172 NIGHTS OF CARE AND SUPPLEMENTED $878,710 WORTH OF SERVICES BECAUSE OF THE SUPPORT OF OUR COMMUNITY. VOLUNTEERS: VOLUNTEERS ARE ESSENTIAL TO FAMILY HOUSE MISSION OF PROVIDING A "HOME AWAY FROM HOME" TO TRANSPLANT FAMILIES. EACH YEAR, THOUSANDS OF VOLUNTEERS DEDICATE THEIR TIME, TALENTS, AND RESOURCES TO SUPPORTING FAMILIES BOTH AT FAMILY HOUSE AND IN THEIR OWN COMMUNITIES. WITHIN FAMILY HOUSE, VOLUNTEER OPPORTUNITIES INCLUDE MEAL PREPARATION THROUGH THE HOME COOK HEROES PROGRAM, GUEST SERVICES, SHUTTLE OPERATIONS, EVENING ACTIVITIES, KITCHEN SPECIALISTS AND MORE. IN 2021, IN-HOUSE VOLUNTEERS HAVE DONATED MORE THAN 2,542 HOURS OF SERVICE. ADDITIONALLY, FAMILY HOUSE VOLUNTEERS ALSO WORK TIRELESSLY WITHIN THEIR OWN COMMUNITIES TO HELP RAISE CRITICAL FUNDS THROUGH THE COORDINATION AND EXECUTION OF FUNDRAISING EVENTS. EACH YEAR HUNDREDS OF VOLUNTEERS HELP KEEP FAMILY HOUSE STOCKED WITH BASIC HOME NECESSITIES, FOOD, AND KITCHEN SUPPLIES THROUGH THE ORGANIZATION OF 'WISH LIST' DRIVES. ADVISORY BOARD: GIFT OF LIFE FAMILY HOUSE'S ADVISORY BOARD IS COMPRISED OF FOURTEEN INDIVIDUALS INCLUDING ORGAN RECIPIENTS AND FAMILY MEMBERS OF TRANSPLANT RECIPIENTS, LIVING DONORS, HEALTHCARE EXECUTIVES, AND COMMUNITY REPRESENTATIVES COMMITTED TO OUR MISSION. LEADERSHIP FOR GIFT OF LIFE FAMILY HOUSE HAS BEEN THOUGHTFULLY SELECTED TO INCLUDE THOSE INDIVIDUALS WHO HAVE BEEN DIRECTLY TOUCHED BY ORGAN DONATION AND THOSE INDIVIDUALS WHO UNDERSTAND THE CRITICAL NEED FOR HOW FAMILY HOUSE IMPACTS AND IMPROVES PATIENT AND FAMILY SATISFACTION AND SURVIVAL DURING THIS CHALLENGING PERIOD. |
| FORM 990, PART V, LINE 2: | TRANSPLANT HOUSE IS AN AFFILIATE IN A GROUP, INCLUDING TRANSPLANT FOUNDATION (EIN: 31-1481798) AND GIFT OF LIFE DONOR PROGRAM ("GLDP" EIN: 23-7388767), OF WHICH GLDP IS CONSIDERED A COMMON PAY AGENT FOR W-2 REPORTING. GLDP REPORTS ALL EMPLOYEES ON ITS FORM W-3; HOWEVER, EACH AFFILIATE HAS EMPLOYEES ALLOCATED TO THAT ENTITY. PER IRS INSTRUCTIONS, EMPLOYEES LISTED ON PART V, LINE 2A ARE THOSE WHO HAVE BEEN DEEMED TO BE EMPLOYEES OF THIS ORGANIZATION. THE SALARY EXPENSE AND BENEFITS REPORTED IN PART IX OF FORM 990 ARE AN ALLOCATION FROM GLDP. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF TRANSPLANT FOUNDATION, AN AFFILIATED ENTITY, HAS THE RIGHT TO APPOINT MEMBERS OF TRANSPLANT HOUSE'S GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING ACTIONS BY THE BOARD OF DIRECTORS REQUIRE THE WRITTEN APPROVAL OF TRANSPLANT FOUNDATION, AN AFFILIATED ENTITY: A) ALTERING, AMENDING, OR REPEALING THE ARTICLES OF INCORPORATION AND/OR BYLAWS; B) BORROWING MONEY UNDER TERMS THAT PROVIDE FOR A REPAYMENT PERIOD OF ONE YEAR OR MORE; C) ADOPTING AN OPERATING BUDGET AND/OR A CAPITAL BUDGET; D) INCURRING CAPITAL EXPENDITURES WHICH, IN THE AGGREGATE, ARE IN EXCESS OF $200,000 IN ANY ONE FISCAL YEAR; E) ORGANIZING OR ACQUIRING ANY SUBSIDIARY OR AFFILIATE; F) ACQUIRING, BY WHATEVER MEANS, AN INTEREST IN ANY OTHER ENTITY OR BECOMING A MEMBER OF ANY OTHER NONPROFIT CORPORATION; G) AUTHORIZING OR DESIGNATING OFFICERS OF THE CORPORATION TO EXECUTE A DEED OF ASSIGNMENT FOR THE BENEFIT OF CREDITORS, FILE A VOLUNTARY PETITION IN BANKRUPTCY, FILE AN ANSWER CONSENTING TO THE APPOINTMENT OF A RECEIVER, OR FILE AN ANSWER TO AN INVOLUNTARY PETITION IN BANKRUPTCY; AND H) AUTHORIZING ANY AND ALL TRANSACTIONS THAT CHANGE, OR HAVE THE EFFECT OF CHANGING, THE OWNERSHIP AND/OR CONTROL OF THE CORPORATION, WITH SUCH A TRANSACTION INCLUDING, BUT NOT BEING LIMITED TO ANY PROPOSED ATTEMPT TO MERGE, ACQUIRE OR COMBINE THE CORPORATION WITH ANY OTHER ENTITY, WHETHER SUCH TRANSACTION IS BY CONTRACT, SALE OF ALL OR SUBSTANTIALLY ALL OF ITS ASSETS, OR BY OPERATION OF LAW. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 WAS REVIEWED WITH THE GOVERNING BODY AT A BOARD MEETING PRIOR TO FILING, AND ALL BOARD MEMBERS RECEIVED A COPY OF THE FINAL FORM 990 PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES ARE ANNUALLY REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY; DISCLOSE ANY POSSIBLE PERSONAL, FAMILIAL, OR BUSINESS RELATIONSHIP THAT WOULD GIVE RISE TO A CONFLICT OR APPEARANCE OF A CONFLICT; AND ACKNOWLEDGE BY SIGNING THE POLICY THAT HE/SHE IS ACTING IN ACCORDANCE WITH THE LETTER AND SPIRIT OF THE POLICY. THESE SIGNED STATEMENTS AND DISCLOSURES ARE REVIEWED BY THE ORGANIZATION'S VICE PRESIDENT OF ADMINISTRATION AND GENERAL COUNSEL. BOARD MEMBERS MUST REFRAIN FROM VOTING ON ANY TRANSACTION OR OTHER MATTER IN WHICH THE MEMBER HAS A CONFLICT OF INTEREST. MEMBERS MUST ALSO REPORT PROMPTLY TO THE BOARD CHAIRPERSON AND PRESIDENT/CEO ANY FUTURE SITUATION IN WHICH A POSSIBLE CONFLICT OF INTEREST MIGHT ARISE. |
| FORM 990, PART VI, SECTION B, LINE 15 | EXECUTIVE COMPENSATION IS PAID BY A RELATED ORGANIZATION. EXECUTIVE COMPENSATION IS DETERMINED ANNUALLY BY A COMMITTEE OF THAT BOARD COMPRISED OF INDEPENDENT BOARD MEMBERS WITH THE INPUT OF AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT INCLUDING A COMPETITIVE MARKET-BASED ANALYSIS. THE PROCESS FOR DETERMINING COMPENSATION OF THESE POSITIONS IS DOCUMENTED IN THE MINUTES. ADDITIONALLY, EVERY TWO YEARS A MARKET BASED WAGE DATA AND POSITION COMPARISON RANKING OF ALL ORGANIZATIONAL POSITIONS IS PERFORMED BY AN INDEPENDENT COMPENSATION CONSULTANT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION WILL MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Software ID: | |
| Software Version: |