COMMUNITY BLOOD HOLDINGS INC: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY BLOOD HOLDINGS INC (EIN 82-1728681)
Tax period
2018-01-01 to 2018-12-31
Filed
2019-11-15
IRS object ID
201933199349302788
Schema version
2018v3.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2019-11-15T10:57:16-06:00ReturnTs
Tax Period End2018-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN590548468PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PURVIS GRAY & COMPANY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1222 NORTH EAST FIRST STREETAddressLine1Txt
CityGAINESVILLECityNm
State AbbreviationFLStateAbbreviationCd
ZIP32601ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2018-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN821728681EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY BLOOD HOLDINGS INCBusinessNameLine1Txt
Business Name Line2C/O JOHN HASWELLBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlCOMMBusinessNameControlTxt
Phone3523765226PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1726 NE 1ST STAddressLine1Txt
CityGAINESVILLECityNm
State AbbreviationFLStateAbbreviationCd
ZIP32601ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJOHN HASWELLPersonNm
Person TitleVICE PRESIDENTPersonTitleTxt
Phone8887952707PhoneNum
Signature2019-11-14SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRACHEL A CLEMENTS CPAPreparerPersonNm
PTINP01315098PTIN
Phone3523782461PhoneNum
Preparation2019-11-14PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address68.110.130.24IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-11-15IPDt
IP Tm10:57:16IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id74D06EF235C2413C5BE7E9CDE89F70F165947F5DAtSubmissionCreationDeviceId
At Submission Filing Device Id321E2311F2BEE7E40A521C1F2A8C1020FBC84215AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-04-17 16:48:07ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJOHN HASWELLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1726 NE 1ST STREETAddressLine1Txt
CityGAINESVILLECityNm
State AbbreviationFLStateAbbreviationCd
ZIP32601ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$4,403,706GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2017FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionSUPPORT OTHER CHARITABLE INSTITUTIONS OR ENTITES ENGAGED IN THE ESTABLISHMENT, MAINTENANCE AND OPERATION OF HUMAN BLOOD COMPONENT COLLECTION AND DISTRIBUTION FACILITIES AND ALL OTHER RELATED ACTVITIES OR SERVICES; PROVIDE MATERIAL SUPPORT BY LEASING FACILITIES AND EQUIPMENT OWNED BY IT TO OTHER CHARITABLE INSTITUTIONS OR ENTITIES ENGAGED IN THE ESTABLISHMENT, MAINTENANCE AND OPERATION OF HUMAN BLOOD COMPONENT COLLECTION AND DISTRIBUTION.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers6TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$10,000PYContributionsGrantsAmt
CY Contributions Grants$3,568,775CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
CY Investment Income$51,242CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$10,000PYTotalRevenueAmt
CY Total Revenue$3,620,017CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$850PYOtherExpensesAmt
CY Other Expenses$972CYOtherExpensesAmt
PY Total Expenses$850PYTotalExpensesAmt
CY Total Expenses$972CYTotalExpensesAmt
PY Revenues Less Expenses$9,150PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$3,619,045CYRevenuesLessExpensesAmt
Total Assets BOY$9,150TotalAssetsBOYAmt
Total Assets EOY$3,535,885TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$9,150NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$3,535,885NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSUPPORT OTHER CHARITABLE INSTITUTIONS OR ENTITES ENGAGED IN THE ESTABLISHMENT, MAINTENANCE AND OPERATION OF HUMAN BLOOD COMPONENT COLLECTION AND DISTRIBUTION FACILITIES AND ALL OTHER RELATED ACTVITIES OR SERVICES; PROVIDE MATERIAL SUPPORT BY LEASING FACILITIES AND EQUIPMENT OWNED BY IT TO OTHER CHARITABLE INSTITUTIONS OR ENTITIES ENGAGED IN THE ESTABLISHMENT, MAINTENANCE AND OPERATION OF HUMAN BLOOD COMPONENT COLLECTION AND DISTRIBUTION.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
DescSUPPORTING THE ONGOING OPERATIONS OF A COMMUNITY BLOOD CENTER AND RELATED SERVICES BY MAINTAINING AND PRESERVING BOTH CASH AND NONCASH CONTRIBUTIONS AND/OR OBTAINING FINANCING AND ACQUIRING REAL OR OTHER PROPERTY TO MAINTAIN FOR THE ONGOING USE IN COMMUNITY BLOOD BANKING AND RELATED ACTIVITIES.Desc
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (true)DeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld CompliancefalseBackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJOHN HASWELLPersonNm
Phone8887952707PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1726 NE 1ST STAddressLine1Txt
CityGAINESVILLECityNm
State AbbreviationFLStateAbbreviationCd
ZIP32601ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (6 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
NANCY ECKERT
SECRETARY/TR2.00Yes (X)Yes (X)$0$370,260$32,878
GEORGIANN ELLIS
PRESIDENT2.00Yes (X)Yes (X)$0$0$0
JOHN HASWELL
VICE PRESIDE2.00Yes (X)Yes (X)$0$0$0
RONNIE BROWN
DIRECTOR2.00Yes (X)$0$0$0
JAMES KELLY
DIRECTOR2.00Yes (X)$0$0$0
DOUG MARKEN
DIRECTOR2.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Tot Reportable Comp Rltd Org$370,260TotReportableCompRltdOrgAmt
Total Other Compensation$32,878TotalOtherCompensationAmt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Related Organizations$3,568,775RelatedOrganizationsAmt
Noncash Contributions$3,568,775NoncashContributionsAmt
Total Contributions$3,568,775TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$43,160TotalRevenueColumnAmt
Related Or Exempt Func Income$43,160RelatedOrExemptFuncIncomeAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$791,771SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$783,689SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$8,082SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,082TotalRevenueColumnAmt
Related Or Exempt Func Income$8,082RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,620,017TotalRevenueColumnAmt
Related Or Exempt Func Income$51,242RelatedOrExemptFuncIncomeAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$850TotalAmt
Management And General$850ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescLICENSES & FEESDesc
Total$122TotalAmt
Management And General$122ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$972TotalAmt
Program Services$0ProgramServicesAmt
Management And General$972ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$9,150BOYAmt
EOY$8,238EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
EOY$161,837EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
EOY$3,365,810EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$9,150BOYAmt
EOY$3,535,885EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$9,150BOYAmt
EOY$3,535,885EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$9,150BOYAmt
EOY$3,535,885EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$9,150BOYAmt
EOY$3,535,885EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$3,619,045ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$92,310NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type3 Func IntYes (X)SupportingOrgType3FuncIntInd
IRS Written DeterminationYes (X)IRSWrittenDeterminationInd
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1LIFESOUTH COMMUNITY BLOOD CENTERS INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN591545914EIN
Organization Type10OrganizationTypeCd
Governing Document ListedfalseGoverningDocumentListedInd
Support$0SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (true)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationfalseSuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgfalseOrganizationChangeSuprtOrgInd
Support Non Supported OrgfalseSupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp

FieldValueIRS element (for citing)
Timely Provided DocumentsYes (true)TimelyProvidedDocumentsInd
Officers Close RelationshipYes (true)OfficersCloseRelationshipInd
Supported Org Voice InvestmentYes (true)SupportedOrgVoiceInvestmentInd

Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp

FieldValueIRS element (for citing)
Activities TestYes (X)ActivitiesTestInd
Activities Further Exempt PrpsYes (true)ActivitiesFurtherExemptPrpsInd
Activities Engaged Org InvlmntYes (true)ActivitiesEngagedOrgInvlmntInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, SECTION D, LINE 3THE BOARD OF DIRECTORS SUPERVISES THE ORGANIZATION'S INVESTMENT POLICY.
PART IV, SECTION E, LINE 2ASUBSTANTIALLY ALL OF THE ORGANIZATION'S ACTIVITIES DURING THE TAX YEAR DIRECTLY FURTHERED THE EXEMPT PURPOSES OF LIFESOUTH COMMUNITY BLOOD CENTERS, INC. BY WAY OF ITS CONTINUED DEVELOPMENT OF FORMAL POLICIES AND PROCEDURES AND CONSIDERATION OF A BUSINESS OPPORTUNITY IN WHICH IT HAD A DIRECT IMPACT ON A CRITICAL ASPECT OF PROVIDING BLOOD SERVICES TO THE COMMUNITIES IN WHICH IT SERVES. LIFESOUTH IDENTIFIED THE CRITICAL BUSINESS OPPORTUNITY AND PRESENTED THE ORGANIZATION WITH A FORMAL REQUEST TO CONSIDER SUCH SUPPORT AND THE BOARD OF DIRECTORS CONSIDERED, DELIBERATED, AND THEN MADE A DECISION TO MOVE FORWARD WITH THE BUSINESS OPPORTUNITY.
PART IV, SECTION E, LINE 2BTHE ORGANIZATION IS AWARE THAT THE BUSINESS OPPORTUNITY PRESENTED BY LIFESOUTH FURTHERS A CRITICAL FUNCTION THAT IMPACTS THE ABILITY TO ACHIEVE ITS EXEMPT PURPOSE ON A DAILY BASIS. AS A RESULT, THE ORGANIZATION MADE A DECISION TO ACTIVELY SUPPORT THE DAILY ABILITY OF LIFESOUTH TO SERVE ITS COMMUNITY HOSPITALS THROUGH PARTICIPATION IN THE BUSINESS OPPORTUNITY AS PRESENTED TO THE BOARD OF DIRECTORS.

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonNANCY ECKERTPersonNm
TitleSECRETARY/TREASURERTitleTxt
Compensation Based On Rltd Orgs$313,665CompensationBasedOnRltdOrgsAmt
Bonus Related Organizations$32,095BonusRelatedOrganizationsAmt
Other Compensation Rltd Orgs$24,500OtherCompensationRltdOrgsAmt
Deferred Comp Rltd Orgs$27,000DeferredCompRltdOrgsAmt
Nontaxable Benefits Rltd Orgs$5,878NontaxableBenefitsRltdOrgsAmt
Total Compensation Rltd Orgs$403,138TotalCompensationRltdOrgsAmt

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTradedGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution2ContributionCnt
Noncash Contributions Rpt F990$3,568,775NoncashContributionsRptF990Amt
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGiftsInd
Third Parties UsedfalseThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990 - ORGANIZATION'S MISSIONSUPPORT OTHER CHARITABLE INSTITUTIONS OR ENTITES ENGAGED IN THE ESTABLISHMENT, MAINTENANCE AND OPERATION OF HUMAN BLOOD COMPONENT COLLECTION AND DISTRIBUTION FACILITIES AND ALL OTHER RELATED ACTVITIES OR SERVICES; PROVIDE MATERIAL SUPPORT BY LEASING FACILITIES AND EQUIPMENT OWNED BY IT TO OTHER CHARITABLE INSTITUTIONS OR ENTITIES ENGAGED IN THE ESTABLISHMENT, MAINTENANCE AND OPERATION OF HUMAN BLOOD COMPONENT COLLECTION AND DISTRIBUTION.
FORM 990, PAGE 6, PART VI, LINE 11BTHE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING THE ANNUAL RETURN.
FORM 990, PAGE 6, PART VI, LINE 12CANNUALLY, EACH BOARD MEMBER IS REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND TO COMPLETE AND RETURN THE CONFLICT OF INTEREST DISCLOSURE FORM EACH BOARD MEMBER HAS A CONTINUING OBLIGATION TO DISCLOSE ANY REAL OR APPARENT CONFLICTS THROUGHOUT THE YEAR. THESE DISCLOSURES ARE ANNUALLY RECEIVED BY THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL AS DICTATED BY THE POLICY AND PROCEDURES MANUAL.
FORM 990, PAGE 6, PART VI, LINE 19GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1LIFESOUTH COMMUNITY BLOOD CENTERSBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line14039 NEWBERRY ROADAddressLine1Txt
CityGAINESVILLECityNm
State AbbreviationFLStateAbbreviationCd
ZIP32607ZIPCd
FieldValueIRS element (for citing)
EIN591545914EIN
Primary ActivitiesBLOOD SVCSPrimaryActivitiesTxt
Legal Domicile StateFLLegalDomicileStateCd
Exempt Code Section501C3ExemptCodeSectionTxt
Public Charity Status10PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1LIFESOUTH COMMUNITY BLOOD CENTERSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeCTransactionTypeTxt
Involved$3,568,775InvolvedAmt
Method Of Amount DeterminationFAIR MARKET VALUEMethodOfAmountDeterminationTxt

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