2023-08-15T16:39:58-05:00 2022-09-30 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 46204 990 2021-10-01 581990866 DCI DONOR SERVICES INC DCID 6152345251 566 MAINSTREAM DRIVE STE 300 NASHVILLE TN 37228 JILL GRANDAS CORPORATE EXECUTIVE DIRECTOR 6153273061 2023-08-15 1 JILL GRANDAS 999009999 SAMANTHA BOKORI P01057347 3174648600 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z DONOVAN SCHULTZ 1633 CHURCH ST STE 500 NASHVILLE TN 37203 142432223 0 X WWW.DCIDS.ORG X 1991 TN DCI DONOR SERVICES, INC. SUPPORTS A LOCAL FOCUS ON DONORS, DONOR FAMILIES, AND THE LIVES OF THOSE WE IMPACT; WE ARE A STABLE COMMUNITY MEMBER SERVING PATIENTS FIRST IN ALL THAT WE DO. OUR CORE PURPOSE IS TO SAVE AND IMPROVE LIVES. 5 2 611 150 0 0 0 0 95486322 96221706 0 129668 9491502 14863263 104977824 111214637 0 0 0 0 37694429 43432990 0 0 0 57250290 58825659 94944719 102258649 10033105 8955988 105092079 113442153 26957470 26351556 78134609 87090597 X DCI DONOR SERVICES, INC. SUPPORTS A LOCAL FOCUS ON DONORS, DONOR FAMILIES, AND THE LIVES OF THOSE WE IMPACT; WE ARE A STABLE COMMUNITY MEMBER SERVING PATIENTS FIRST IN ALL THAT WE DO. OUR CORE PURPOSE IS TO SAVE AND IMPROVE LIVES. 0 0 72543490 111084969 DCI DONOR SERVICES, INC. ("DCIDS") IS A NOT-FOR-PROFIT 501(C)(3) ORGANIZATION THAT OPERATES THREE FEDERALLY CERTIFIED ORGAN PROCUREMENT ORGANIZATIONS (OPOS), AN EYE BANK (EB), AND A FULL SERVICE TISSUE BANK (TB). DCIDS PROMOTES THE DONATION OF HUMAN ORGANS AND TISSUES, PRIMARILY FOR TRANSPLANT, THROUGH EDUCATION PROGRAMS FOR THE GENERAL PUBLIC AND HEALTH PROFESSIONALS, AND THROUGH AGREEMENTS WITH VARIOUS HOSPITALS AND MEDICAL PROFESSIONALS PROVIDES THE ORGANS AND TISSUES RECOVERED BY ITS MEMBER ORGANIZATIONS. EACH OF THE OPOS IS CERTIFIED BY THE CENTER FOR MEDICARE AND MEDICAID SERVICES AND DESIGNATED BY THE US SECRETARY OF HEALTH AND HUMAN SERVICES TO PARTICIPATE IN THE FEDERAL MEDICARE PROGRAM. EACH OPO IS AN INSTITUTIONAL MEMBER OF BOTH THE ASSOCIATION OF ORGAN PROCUREMENT ORGANIZATIONS AS WELL AS THE UNITED NETWORK FOR ORGAN SHARING, WHICH HOLDS THE CONTRACT TO FUNCTION AS THE NATIONAL ORGAN PROCUREMENT AND TRANSPLANT NETWORK MANDATED BY FEDERAL LAW. THE TB FOLLOWS REQUIREMENTS SET BY THE CENTERS FOR DISEASE CONTROL, US FOOD AND DRUG ADMINISTRATION, AS WELL AS THE STANDARDS ESTABLISHED BY THE AMERICAN ASSOCIATION OF TISSUE BANKS AND IS A FULLY ACCREDITED MEMBER OF THAT ORGANIZATION AS WELL. THE EB FOLLOWS STANDARDS ESTABLISHED BY THE EYE BANK ASSOCIATION OF AMERICA, AND IS AN ACCREDITED MEMBER OF THAT ORGANIZATION. ACCORDINGLY, THE OPOS SEEK REIMBURSEMENT FOR EXPENSES INCURRED IN COORDINATING THE RECOVERY OF ORGANS THAT ARE SENT TO TRANSPLANTING HOSPITALS AND ANNUALLY FILE A FEDERAL COST REPORT DETAILING AND RECONCILING ITS REVENUE AND EXPENSES. THE TB DERIVES ITS COST-COVERING REVENUES FROM HOSPITALS OR DENTISTS WHO ARE TRANSPLANTING TISSUES PROCESSED AND/OR DISTRIBUTED BY THE TB. THE EB EARNS REVENUE TO RECOVER EXPENSES BY PROCESSING CORNEA TISSUE AND PROVIDING CORNEAS FOR TRANSPLANT TO SURGERY CENTERS. ALL PROGRAM SERVICE EXPENSES OF DCIDS ARE INCURRED IN SUPPORT OF THE ABOVE STATED TAX EXEMPT PROCUREMENT AND EDUCATIONAL ACTIVITIES. FOR THE YEAR ENDED SEPTEMBER 30, 2022, DCIDS PROCURED 2,120 ORGANS AND RECOVERED 3,919 TISSUE DONORS FOR TRANSPLANTATION. IN ADDITION, DCIDS PROVIDED EDUCATIONAL OPPORTUNITIES FOR NURSES AND PHYSICIANS CONCERNING ISSUES IN TRANSPLANTATION, AS WELL AS SEVERAL PROGRAMS TO EDUCATE AND HEIGHTEN AWARENESS OF THE GENERAL PUBLIC CONCERNING ORGAN AND TISSUE DONATION AND TRANSPLANTATION. 72543490 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 327 0 1 611 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 0 CA NM TN X EMILY BRYAN 6155643631 566 MAINSTREAM DRIVE STE 300 NASHVILLE TN 37228 H KEITH JOHNSON MD PRESIDENT 8.00 32.00 X X 25199 3911 6427 JAMES PERRY TREASURER 1.00 9.00 X X 0 0 12128 WILLIAM STERLING BOARD MEMBER 3.00 0.00 X 12000 0 0 THOMAS BOYLE SECRETARY 10.00 0.00 X X 0 0 0 CYNDA RENNIE BOARD MEMBER 10.00 0.00 X 0 0 0 JILL GRANDAS CORPORATE EXECUTIVE DIRECTOR 40.00 0.00 X 325006 0 24715 JAMES E ATTRILL ASSISTANT TREASURER 5.00 35.00 X 0 255426 13826 TERESA THOMPSON CHIEF FINANCIAL OFFICER 40.00 0.00 X 202809 0 20870 SEAN VAN SLYCK EXECUTIVE DIRECTOR 40.00 0.00 X 298548 0 63768 WAYNE DUNLAP EXECUTIVE DIRECTOR 40.00 0.00 X 248849 0 48204 KELLY SCOTT EXECUTIVE DIRECTOR 40.00 0.00 X 252161 0 13013 DEANA CLAPPER ASSOCIATE EXECUTIVE DIRECTOR 40.00 0.00 X 197110 0 64497 BURNETT KELLY SURGICAL DIRECTOR 40.00 0.00 X 399618 0 31750 EARL JONES SR. DIR. OPS. - PROCESSING SVCS. 40.00 0.00 X 191860 0 23101 DONNA SMITH SR. DIRECTOR OF CLINICAL SERVICES 40.00 0.00 X 203282 0 10728 STEPHANIE COZBY SR. DIRECTOR OF QUALITY 40.00 0.00 X 185192 0 8228 JOEL SMITH SR. DIRECTOR OF TISSUE SERVICES 40.00 0.00 X 177067 0 12159 2718701 259337 353414 54 0 1 0 VANDERBILT UNIVERSITY MEDICAL CENTER 1161 21ST AVE S D-3300 MEDICAL C NASHVILLE TN 37232 HOSPITAL & PHYSICIAN SERVICES 5191450 CHATTANOOGA-HAMILTON COUNTY HOSPITAL PO BOX 670 CHATTANOOGA TN 37401 HOSPITAL & PHYSICIAN SERVICES 2327421 UNIVERSITY HEALTH SYSTEMS PO BOX 415000 NASHVILLE TN 37241 HOSPITAL & PHYSICIAN SERVICES 2007493 UNM HEALTH SCIENCES CENTER PO BOX 912884 DENVER CO 80291 HOSPITAL & PHYSICIAN SERVICES 1474183 STERIS CORPORATION PO BOX 676548 DALLAS TX 75267 LABORATORY SERVICES 881316 42 ORGAN PROCUREMENT FEES 621990 87825954 87825954 EST. PROVIDER. PYMT. 900099 8395752 8395752 96221706 129668 129668 75600 0 75600 75600 75600 45923313 31217586 14705727 14705727 OTHER TISSUE REVENUE 900099 32500 32500 49436 49436 81936 111214637 111084969 0 129668 1561682 37199 1524483 33350006 22332214 11017792 878926 601448 277478 4782536 3272687 1509849 2859840 1956987 902853 249922 249922 780886 780886 82947 82947 6818879 3054816 3764063 263551 263551 906266 906266 597613 597613 1965938 1810144 155794 1978611 1323442 655169 170056 136045 34011 184221 184221 2094507 74977 2019530 624571 624571 ORGAN PROCUREMENT 31019035 31019035 0 0 MEDICAL SUPPLIES 5633744 5633744 0 0 EQUIP. RENT. & MAINT. 1367362 147740 1219622 0 BAD DEBT EXPENSE 940821 0 940821 0 3146729 879461 2267268 102258649 72543490 29715159 0 32586786 336886 28490000 0 31551571 41377248 11226669 13590068 1625502 2143269 46143519 18638837 28101551 27504682 105092079 113442153 20340114 19653067 5152390 4875501 1464966 1822988 26957470 26351556 X 0 0 0 0 78134609 87090597 78134609 87090597 105092079 113442153 8955988 0 X 0 1 X 0 0 X 83229941 102481652 117464215 128284816 142145019 573605643 83229941 102481652 117464215 128284816 142145019 573605643 0 0 0 573605643 1906 4725 83196 75600 205268 370695 1906 4725 83196 75600 205268 370695 18897 15960 9713 25801 81936 152307 83250744 102502337 117557124 128386217 142432223 574128645 0.99910 0.99950 0.00060 0.00040 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2017 AMOUNT: $ 18,897. 2018 AMOUNT: $ 15,960. 2020 AMOUNT: $ 1,000. 2021 AMOUNT: $ 49,436. COVID REIMBURSEMENT - 2019 AMOUNT: $ 7,703. 2020 AMOUNT: $ 3,769. OTHER TISSUE REVENUE - 2019 AMOUNT: $ 2,010. 2020 AMOUNT: $ 21,032. 2021 AMOUNT: $ 32,500. 0 0 0 0 0 0 1 82947 0 0 82947 0 PART II-B, LINE 1: PAYMENTS TO LEGAL FIRMS FOR RESEARCH AND COMMUNICATION WITH GOVERNMENT OFFICIALS REGARDING PROPOSED BILLS AND CHANGES TO EXISTING REGULATIONS RELATING TO ORGAN AND TISSUE DONATION. 830783 830783 9456424 2870710 6585714 20250494 3602882 16647612 15605818 12165245 3440573 27504682 PAYABLE TO RELATED ORGANIZATION 256987 RESEARCH 75450 SHORT-TERM LIABILITIES 1490551 1822988 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES CORNEAL TISSUE EAST ASIA AND THE PACIFIC 0 0 PROGRAM SERVICES CORNEAL TISSUE & TISSUE GRAFTS MIDDLE EAST AND NORTH AFRICA 0 0 PROGRAM SERVICES CORNEAL TISSUE & TISSUE GRAFTS NORTH AMERICA 0 0 PROGRAM SERVICES CORNEAL TISSUE & TISSUE GRAFTS SOUTH ASIA 0 0 PROGRAM SERVICES CORNEAL TISSUE SUB-SAHARAN AFRICA 0 0 PROGRAM SERVICES CORNEAL TISSUE EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 PROGRAM SERVICES CORNEAL TISSUE & TISSUE GRAFTS SOUTH AMERICA 0 0 PROGRAM SERVICES CORNEAL TISSUE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART III ACCOUNTING METHOD: X X X 0 1 0 0 0 0 0 0 0 BURNETT KELLY SURGICAL DIRECTOR 397292 0 0 0 2326 0 12470 0 19280 0 431368 0 0 0 SEAN VAN SLYCK EXECUTIVE DIRECTOR 297738 0 0 0 810 0 56450 0 7318 0 362316 0 0 0 JILL GRANDAS CORPORATE EXECUTIVE DIRECTOR 322680 0 0 0 2326 0 12813 0 11902 0 349721 0 0 0 WAYNE DUNLAP EXECUTIVE DIRECTOR 247633 0 0 0 1216 0 34096 0 14108 0 297053 0 0 0 JAMES E ATTRILL ASSISTANT TREASURER 0 213947 0 38068 0 3411 0 6966 0 6860 0 269252 0 0 KELLY SCOTT EXECUTIVE DIRECTOR 251681 0 0 0 480 0 9750 0 3263 0 265174 0 0 0 DEANA CLAPPER ASSOCIATE EXECUTIVE DIRECTOR 196499 0 0 0 611 0 52375 0 12122 0 261607 0 0 0 TERESA THOMPSON CHIEF FINANCIAL OFFICER 196867 0 0 0 5942 0 7991 0 12879 0 223679 0 0 0 EARL JONES SR. DIR. OPS. - PROCESSING SVCS. 190102 0 0 0 1758 0 7803 0 15298 0 214961 0 0 0 DONNA SMITH SR. DIRECTOR OF CLINICAL SERVICES 201473 0 0 0 1809 0 2462 0 8266 0 214010 0 0 0 STEPHANIE COZBY SR. DIRECTOR OF QUALITY 184627 0 0 0 565 0 0 0 8228 0 193420 0 0 0 JOEL SMITH SR. DIRECTOR OF TISSUE SERVICES 176708 0 0 0 359 0 4945 0 7214 0 189226 0 0 0 PART I, LINE 4B DCI DONOR SERVICES, INC. PARTICIPATES IN AN UNFUNDED EXECUTIVE DEFERRED COMPENSATION PLAN AVAILABLE ONLY TO A SELECT GROUP OF MANAGEMENT AND KEY EMPLOYEES. THE 457 (F) PLAN IS A NON-QUALIFIED PLAN WHOSE PURPOSE IS TO RETAIN HIGHLY QUALIFIED EXECUTIVE OR MANAGERIAL PERSONNEL PER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974. NO PAYMENTS WERE MADE UNDER THE PLAN DURING CALENDAR YEAR 2021. DR OSCAR GRANDAS SEE PART V 160750 SEE PART V 0 BRONWYN ROBERTS SEE PART V 91618 SEE PART V 0 SCHEDULE L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: DR. OSCAR GRANDAS (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: SPOUSE OF JILL GRANDAS (D) DESCRIPTION OF TRANSACTION: RECOVERY SURGEON AND MEDICAL DIRECTOR FOR THE ORGANIZATION (A) NAME OF PERSON: BRONWYN ROBERTS (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: SIBLING OF WAYNE DUNLAP (D) DESCRIPTION OF TRANSACTION: EMPLOYED AS THE MANAGER OF QUALITY AND COMPLIANCE FOR TENNESSEE DONOR SERVICES SCHEDULE L, PART IV: DR. OSCAR GRANDAS IS A FAMILY MEMBER TO JILL GRANDAS, WHO IS AN OFFICER OF DCI DONOR SERVICES, INC. DCI DONOR SERVICES, INC. COMPENSATES DR. GRANDAS FOR SERVICES HE PROVIDES TO THE ORGANIZATION IN HIS OCCUPATION AS AN ORGAN RECOVERY SURGEON. HE ALSO PROVIDES SERVICES AS A MEDICAL DIRECTOR FOR TENNESSEE DONOR SERVICES. BRONWYN ROBERTS IS THE SIBLING OF WAYNE DUNLAP, WHO IS A KEY EMPLOYEE OF DCI DONOR SERVICES, INC. IN HIS ROLE AS EXECUTIVE DIRECTOR FOR NEW MEXICO DONOR SERVICES. BRONWYN ROBERTS WAS HIRED BY TENNESSEE DONOR SERVICES FOR THE ROLE OF MANAGER OF QUALITY AND COMPLIANCE. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS DIALYSIS CLINIC INC. FORM 990, PART VI, SECTION A, LINE 7A DIALYSIS CLINIC INC., AS THE SOLE MEMBER OF DCI DONOR SERVICES, INC., HAS THE POWER TO NOMINATE, ELECT, APPOINT, FILL VACANCIES OF, AND REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B DIALYSIS CLINIC INC. SHALL HAVE THE SOLE VOTE ON ALL MATTERS COMING BEFORE THE MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE CURRENTLY NO COMMITTEES THAT ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF FORM 990 IS SUPPLIED TO EACH MEMBER OF THE GOVERNING BODY AND ADJUSTMENTS ARE SUGGESTED AND COMPLETED AS NECESSARY. EACH BOARD MEMBER IS SENT A COPY OF THE FORM 990 DRAFT AND IS GIVEN AN APPROPRIATE AMOUNT OF TIME TO REVIEW AND COMMENT. A CERTIFICATION LETTER IS SIGNED ONCE THE BOARD MEMBERS HAVE COMPLETED THEIR REVIEW OF THE 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS SIGN A CONFLICT OF INTEREST THAT STATES THE DIRECTORS HAVE NOT VIOLATED THE CONFLICT OF INTEREST POLICY. ALL EMPLOYEES ARE ALSO REQUIRED TO SIGN THE CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS AS WELL. FORM 990, PART VI, SECTION B, LINE 15 DCI DONOR SERVICES, INC. BELONGS TO THE ASSOCIATION OF ORGAN PROCUREMENT ORGANIZATIONS (AOPO). AOPO COMPLETES A YEARLY SURVEY OF ALL SALARIED POSITIONS WITHIN AN ORGAN PROCUREMENT ORGANIZATION, WHICH INCLUDES THE CEO SALARIES, AS WELL AS THE SALARIES FOR OTHER KEY POSITIONS. THIS YEARLY SURVEY IS USED TO DETERMINE THE SALARIES FOR THE EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ANY DOCUMENT OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC WILLIAM STERLING - 10500 ACADEMY RD. N.E., APT. 219, ALBUQUERQUE, NM 87111. THOMAS BOYLE - 501 GRANT STREET, STE. 200, PITTSBURGH, PA 15219. CYNDA RENNIE - P.O. BOX 7437, CITRUS HEIGHTS, CA 95621-1114. DIALYSIS CLINIC INC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 620850498 KIDNEY DIALYSIS TN 501(C)(3) 3 N/A 0 APPLIED MEDICAL RESEARCH INC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 621450328 MEDICAL RESEARCH TN 501(C)(3) 4 DIALYSIS CLINIC INC 1 BIG HORN BASIN REGIONAL DIALYSIS LLC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 462756449 KIDNEY DIALYSIS WY N/A 0 1 BILLINGS CLINIC DIALYSIS LLC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 464233625 KIDNEY DIALYSIS MT N/A 0 1 WATT DIALYSIS CENTER LLC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 474310307 KIDNEY DIALYSIS WY N/A 0 1 DIALYSIS SERVICES OF DECATUR LLC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 821234100 KIDNEY DIALYSIS DE N/A 0 1 MUSIC CITY KIDNEY CARE ALLIANCE LLC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 475282575 ACCOUNTABLE CARE ORGANIZATION DE N/A 0 1 METROPOLITAN KIDNEY CARE ALLIANCE LLC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 475265602 ACCOUNTABLE CARE ORGANIZATION DE N/A 0 1 INDEPENDENCE KIDNEY CARE ALLIANCE LLC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 814457256 ACCOUNTABLE CARE ORGANIZATION DE N/A 0 1 JEFFERSON CITY RENAL SERVICES LLC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 823188781 ESRD CLINIC DE N/A 0 1 AVAIL SOUTHEAST KIDNEY CARE LLC 1633 CHURCH ST STE 500 NASHVILLE TN 37203 832903658 ESRD CLINIC TN N/A 0 1 COMMUNITY MEDICAL CENTER DIALYSIS 1633 CHURCH ST STE 500 NASHVILLE TN 37203 831522514 KIDNEY DIALYSIS DE N/A 0 1 NORTH ALABAMA HOME DIALYSIS 1633 CHURCH ST STE 500 NASHVILLE TN 37203 844306386 KIDNEY DIALYSIS DE N/A 0 1 RENAL CONSULTANTS 1633 CHURCH ST STE 500 NASHVILLE TN 37203 800066197 MANAGED CARE TN N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 DIALYSIS CLINIC INC M 4227139 FMV DIALYSIS CLINIC INC P 2428070 FMV DIALYSIS CLINIC INC R 780997 FMV