2017-08-14T12:46:47-05:00 2016-12-31 731335926 BARBARA A LEY A PROFESSIONAL CORP 6305 WATERFORD BLVD STE 450 OKLAHOMA CITY OK 73118 990 2016-01-01 731281589 LifeShare Transplant Donor Services of Oklahoma Inc LIFE 4058405551 4705 NW Expressway Oklahoma City OK 73132 Jeff Orlowski Chief Executive Officer 4058405551 2017-08-14 1 Janet Gifford P00303744 4058480255 68.15.98.80 2017-08-14 12:44:45 CD P A534573D47F9BC60F9DECC6E83CD2BEF7B1A7ADF A8270428046EB288D2BA6542FE07DD4E2CCD22A8 2016 2021-01-29 14:40:06Z 4705 NW Expressway Oklahoma City OK 73132 26893212 0 X www.lifeshareoklahoma.org X 1984 OK Provides organ procurement services within the state of Oklahoma. 14 14 133 150 0 0 48908 53275 24262570 26737324 97568 102613 0 0 24409046 26893212 0 0 0 0 8957127 10139232 0 0 0 12787134 14275739 21744261 24414971 2664785 2478241 17209124 19809995 4464764 4587536 12744360 15222459 LifeShare Transplant Donor Services of Oklahoma, Inc. provides organ procurement services within the state of Oklahoma; identification of organ donors;surgical excision and distributions of organs and public education regarding organ donors. 0 0 19370640 26737324 Organ procurement and placement was provided for 276 kidneys, 125 livers, 11 pancreas, 54 hearts,and 53 lungs. LifeShare also provided tissue procurement of 637 tissue donors. 19370640 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 75 0 1 133 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 OK X LifeShare Transplant Donor Services 4058405551 4705 NW Expressway Oklahoma City OK 73132 ANTHONY SEBASTIAN MD DIRECTOR 0.50 X 0 0 0 BENJAMIN COWLEY MD DIRECTOR 0.80 X 0 0 0 GINA FLESHER MS RN DIRECTOR 0.50 X 0 0 0 HARLAN WRIGHT MD DIRECTOR 0.50 X 0 0 0 IRFAN KUNDI MD DIRECTOR 0.50 X 0 0 0 MICHAEL MORRIS MD DIRECTOR 0.50 X 0 0 0 SAMANTHA WEYRAUCH DAVIS DIRECTOR 0.50 X 0 0 0 STEVE MILLER MD DIRECTOR 0.50 X 0 0 0 TOM ANDERSON DIRECTOR 0.50 X 0 0 0 MARY JOHNSON EXECUTIVE DIRECTOR 0.50 X X 0 0 0 ED HEINEN IMMEDIATE PAST PRESIDENT 0.80 X 0 0 0 RAJAT KAUL MD PRESIDENT 0.50 X X 0 0 0 SUZANNE WHEELER SECRETARY/TREASURER 1.20 X X 0 0 0 PAMELA SPANBAUER RN BSN MEd VICE PRES/PRESIDENT ELECT 1.20 X X 0 0 0 JANICE WHALEY EXECUTIVE VP/COO 40.00 X 202406 0 31942 JEFF ORLOWSKI PRESIDENT/CEO 40.00 X 270601 0 49354 MICHELLE GIBSON VP HUMAN RESOURCES 40.00 X 124269 0 36182 LARRY SICKLES VP OF CLINICAL SERVICES 40.00 X 118714 0 35056 JAN FOUTCH VP OF QUALITY SERVICES 40.00 X 139261 0 25526 RICARDO BLANCHARD VP,FINANCE 40.00 X 126095 0 25083 ELIZABETH HANNAN DIRECTOR OF HOSPITAL DEVEL 40.00 X 108054 0 18221 JOANNA ZAMAN DIRECTOR OF ORGAN RECOVERY 40.00 X 102642 0 33636 JEFFREY LEGG HIGHLY COMPENSATED EMPLOYEE 40.00 X 123482 0 35839 LOGAN WILKE HIGHLY COMPENSATED EMPLOYEE 40.00 X 108562 0 37386 1424086 0 328225 12 0 1 0 GENESIS CONSULTING LLC 4453 SWILCAN BRIDGE LANE NORTH JACKSONVILLE FL 32224 SURGEON FEES 286750 OKLAHOMA TRANSPLANT PHYSICIANS LLC 3 MARYLAND FARMS BRENTWOOD TN 37027 SURGEON FEES 168750 MONARCH MARKETING GROUP LLC 200 NW 63RD OKLAHOMA CITY OK 73116 ADVERTISING 163830 ECL2 CONSULTING SERVICES LLC PO BOX 1731 GRAPEVINE TX 76099 CONSULTING 102290 4 53275 53275 EXTRA-RENAL PROCUREMENT 621991 10424793 10424793 MEDICARE/MEDICAID PAYMENTS 621991 9496834 9496834 TISSUE PROCUREMENT 621991 6456196 6456196 ODEAP DEC WEEK 621991 129859 129859 RESEARCH ORGANS 621991 117670 117670 111972 111972 26737324 93536 93536 9077 0 9077 9077 9077 26893212 26737324 0 102613 X 1746134 890869 855265 6202972 5377445 825527 602331 494555 107776 1011905 830843 181062 575890 472845 103045 42912 42912 54322 54322 4911 4911 1050577 922619 127958 609390 105508 503882 259706 80064 179642 248757 34557 214200 375654 375654 349931 239178 110753 73707 47237 26470 15224 15224 384113 384113 285665 285665 Cost of Procurement-Imp 2182998 2182998 Cost of Procurement-Org 1319812 1319812 Cost of Procurement-Ope 1317302 1317302 Cost of Procurement-Sur 660314 660314 5040444 4394494 645950 24414971 19370640 5044331 0 288 286 5782632 9230008 6793616 5133944 115098 106128 241836 215122 5553496 1278768 4267129 4274728 834047 8525 15732 17209124 19809995 2964718 3141746 1500046 1445790 4464764 4587536 X 12744360 15222459 12744360 15222459 17209124 19809995 2478241 -142 0 X 1 X 1 X 1 0 X 4494693 4651818 6613765 9712340 9679968 35152584 4494693 4651818 6613765 9712340 9679968 35152584 35152584 80828 79736 59933 97568 102615 420680 35573264 66559768 0.98820 0.98710 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 771990 771990 1365547 120431 1245116 1837668 506375 1331293 1578291 651962 926329 4274728 26888162 -140 -4910 -5050 26893212 0 26893212 24410062 0 24410062 4909 4909 24414971 Part XI, Line 2d - Other Adjustments: Brokerage Fees -4,910. Part XII, Line 4b - Other Adjustments: Brokerage Fees 4,909. X X X 0 0 0 0 0 0 0 0 0 JANICE WHALEY EXECUTIVE VP/COO 202406 0 0 0 0 0 21392 0 10550 0 234348 0 0 0 JEFF ORLOWSKI PRESIDENT/CEO 270601 0 0 0 0 0 27553 0 21801 0 319955 0 0 0 MICHELLE GIBSON VP HUMAN RESOURCES 124269 0 0 0 0 0 13566 0 22616 0 160451 0 0 0 LARRY SICKLES VP OF CLINICAL SERVICES 118714 0 0 0 0 0 14883 0 20173 0 153770 0 0 0 JAN FOUTCH VP OF QUALITY SERVICES 139261 0 0 0 0 0 14796 0 10730 0 164787 0 0 0 RICARDO BLANCHARD VP,FINANCE 126095 0 0 0 0 0 13480 0 11603 0 151178 0 0 0 JEFFREY LEGG HIGHLY COMPENSATED EMPLOYEE 123482 0 0 0 0 0 13167 0 22672 0 159321 0 0 0 Form 990, Part VI, Section A, line 4 There shall now be no more than 18 on the Board of Directors. This was originally 16. The addition of Directors being classified as Independent or Dependent determined by criteria listed in Bylaws. Quorum requirements increased from 60% of total Board member attendance to 75%. Granting of a proxy no longer constitutes attendance at such meetings for purposes of attendance requirements. Each Director is now required to attend 75% of regular meetings during calendar year. Failure constitutes resignation. Secretary/Treasurer shall now be appointed Chair of the Finance Committee. All Board members are required to participate on at least one standing committee of the Board. There must be one Independent Director on the Finance Committee. Added Executive Committee and Governance Committee. Removed Nominating Committee, Medical Advisory Subcommittee, and Tissue Advisory Committee. Disclosures of any interest or affiliation shall be made by all officers and Directors on an annual basis on a Conflicts of Interest Statement. Failure to complete the Conflicts of Interest Statement by the deadline imposed by the CEO will result in discipline of the officer and suspension of Director from all Board activities. 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. - COLLEGE OF MED BLDG, NEPHROLOGY SECTION, SUITE 530, OKLAHOMA CITY, OK 73104. GINA FLESHER, M.S., R.N. - 1407 N. WHISENANT 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 - 9705 N BROADWAY, SUITE 150, OKLAHOMA CITY, OK 73114. 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. Form 990, Part IX, line 24e Cost of Procurement-Tissue Procurement Expense: Program service expenses 427,954. Management and general expenses 0. Fundraising expenses 0. Total expenses 427,954. Cost of Procurement-Transportation of Organs and Tissue: Program service expenses 426,861. Management and general expenses 0. Fundraising expenses 0. Total expenses 426,861. Cost of Procurement-Hospital Lab: Program service expenses 413,828. Management and general expenses 0. Fundraising expenses 0. Total expenses 413,828. Call Center: Program service expenses 401,049. Management and general expenses 0. Fundraising expenses 0. Total expenses 401,049. Cost of Procurement-Other Acquisition Costs: Program service expenses 374,007. Management and general expenses 0. Fundraising expenses 0. Total expenses 374,007. Cost of Procurement-Organ Acquisition Non-Recovery: Program service expenses 291,677. Management and general expenses 0. Fundraising expenses 0. Total expenses 291,677. Sponsorships: Program service expenses 13,331. Management and general expenses 277,071. Fundraising expenses 0. Total expenses 290,402. Cost of Procurement-Anesthesiology: Program service expenses 266,166. Management and general expenses 0. Fundraising expenses 0. Total expenses 266,166. Cost of Procurement-Donor Evaluation: Program service expenses 240,025. Management and general expenses 0. Fundraising expenses 0. Total expenses 240,025. Transplant Coordinator Expense: Program service expenses 210,687. Management and general expenses 0. Fundraising expenses 0. Total expenses 210,687. Cost of Procurement-Tissue Typing: Program service expenses 206,494. Management and general expenses 0. Fundraising expenses 0. Total expenses 206,494. Cost of Procurement-Transportation of Teams: Program service expenses 202,817. Management and general expenses 0. Fundraising expenses 0. Total expenses 202,817. Cost of Procurement-Respiratory Therapy: Program service expenses 178,030. Management and general expenses 0. Fundraising expenses 0. Total expenses 178,030. Cost of Procurement-Medical Supplies: Program service expenses 175,224. Management and general expenses 0. Fundraising expenses 0. Total expenses 175,224. Cost of Procurement-Medical Waste: Program service expenses 159,741. Management and general expenses 0. Fundraising expenses 0. Total expenses 159,741. Cost of Procurement-Intensive Care Unit: Program service expenses 148,198. Management and general expenses 0. Fundraising expenses 0. Total expenses 148,198. Human Resources: Program service expenses 0. Management and general expenses 146,357. Fundraising expenses 0. Total expenses 146,357. Donor Data System: Program service expenses 132,489. Management and general expenses 0. Fundraising expenses 0. Total expenses 132,489. Cost of Procurement-Pharmacy: Program service expenses 115,679. Management and general expenses 0. Fundraising expenses 0. Total expenses 115,679. Professional Education: Program service expenses 59,609. Management and general expenses 51,490. Fundraising expenses 0. Total expenses 111,099. Admin & General: Program service expenses 15,544. Management and general expenses 85,483. Fundraising expenses 0. Total expenses 101,027. Cost of Procurement-Other Excision Costs: Program service expenses 73,432. Management and general expenses 0. Fundraising expenses 0. Total expenses 73,432. Memberships and Dues: Program service expenses 11,113. Management and general expenses 61,274. Fundraising expenses 0. Total expenses 72,387. Cost of Procurement-Organ Hospital Bill Review: Program service expenses 72,365. Management and general expenses 0. Fundraising expenses 0. Total expenses 72,365. Team Oklahoma: Program service expenses 43,630. Management and general expenses 0. Fundraising expenses 0. Total expenses 43,630. Cost of Procurement-Transplant Coordinator: Program service expenses 35,150. Management and general expenses 0. Fundraising expenses 0. Total expenses 35,150. Uniforms & Linens: Program service expenses 15,137. Management and general expenses 0. Fundraising expenses 0. Total expenses 15,137. Tools & Med Supplies: Program service expenses 2,366. Management and general expenses 10,556. Fundraising expenses 0. Total expenses 12,922. Taxes-Other: Program service expenses 0. Management and general expenses 11,104. Fundraising expenses 0. Total expenses 11,104. Bank Service Charges: Program service expenses 0. Management and general expenses 1,504. Fundraising expenses 0. Total expenses 1,504. Retirement of Assets: Program service expenses 0. Management and general expenses 1,111. Fundraising expenses 0. Total expenses 1,111. Doubtful Accounts Provision: Program service expenses -318,109. Management and general expenses 0. Fundraising expenses 0. Total expenses -318,109.